Sailimai Man1,2,3, Jun Lv1,3,4, Canqing Yu1,3,4, Yuhan Deng2,5, Jianchun Yin6, Bo Wang7,8, Liming Li9,10,11, Hui Liu12. 1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. 2. Meinian Institute of Health, Beijing, China. 3. Peking University Health Science Center Meinian Public Health Institute, Beijing, China. 4. Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China. 5. Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China. 6. MJ Health Care Group, Shanghai, China. 7. Meinian Institute of Health, Beijing, China. paul@meinianresearch.com. 8. Peking University Health Science Center Meinian Public Health Institute, Beijing, China. paul@meinianresearch.com. 9. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. lmlee@bjmu.edu.cn. 10. Peking University Health Science Center Meinian Public Health Institute, Beijing, China. lmlee@bjmu.edu.cn. 11. Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China. lmlee@bjmu.edu.cn. 12. Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. liuhui@pumc.edu.cn.
Abstract
BACKGROUND: The risks of NAFLD and NAFLD with fibrosis progression among metabolically healthy obesity (MHO) individuals are largely unexplored. This cohort study investigated the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and NAFLD and its fibrosis progression. METHODS: Participants included 31,010 adults from a health check-up cohort free from NAFLD and intermediate or high probability of advanced fibrosis at baseline. Metabolically healthy was defined as not having any component of metabolic syndrome. Obesity was identified by body mass index (BMI) and waist circumference (WC). Participants were cross-classified by metabolic health and obesity at baseline. The outcomes were NAFLD, and NAFLD with fibrosis progression, as assessed by abdominal B-type ultrasound and noninvasive fibrosis score. RESULTS: During a median follow-up of 2.2 (interquartile range, 1.2-4.9) years, 7,393 participants developed NAFLD. MHO individuals (HR 5.51, 95% CI 4.98, 6.09 for BMI criteria; HR 6.76, 95% CI 6.04, 7.57 for WC criteria) had a significantly higher risk of NAFLD than those with metabolically healthy normal weight or low WC. The corresponding HRs (95% CIs) for metabolically healthy overweight (defined by BMI) and medium WC were 2.74 (2.49-3.02) and 2.93 (2.65-3.24), respectively. Furthermore, 557 participants developed NAFLD with fibrosis progression. The association between different obesity phenotypes and NAFLD with fibrosis progression also showed a similar pattern. CONCLUSION: MHO was associated with significantly higher risks of NAFLD and its fibrosis progression, suggesting that regarding NAFLD prevention, MHO individuals might still benefit from lifestyle interventions aimed at body weight and WC maintenance.
BACKGROUND: The risks of NAFLD and NAFLD with fibrosis progression among metabolically healthy obesity (MHO) individuals are largely unexplored. This cohort study investigated the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and NAFLD and its fibrosis progression. METHODS: Participants included 31,010 adults from a health check-up cohort free from NAFLD and intermediate or high probability of advanced fibrosis at baseline. Metabolically healthy was defined as not having any component of metabolic syndrome. Obesity was identified by body mass index (BMI) and waist circumference (WC). Participants were cross-classified by metabolic health and obesity at baseline. The outcomes were NAFLD, and NAFLD with fibrosis progression, as assessed by abdominal B-type ultrasound and noninvasive fibrosis score. RESULTS: During a median follow-up of 2.2 (interquartile range, 1.2-4.9) years, 7,393 participants developed NAFLD. MHO individuals (HR 5.51, 95% CI 4.98, 6.09 for BMI criteria; HR 6.76, 95% CI 6.04, 7.57 for WC criteria) had a significantly higher risk of NAFLD than those with metabolically healthy normal weight or low WC. The corresponding HRs (95% CIs) for metabolically healthy overweight (defined by BMI) and medium WC were 2.74 (2.49-3.02) and 2.93 (2.65-3.24), respectively. Furthermore, 557 participants developed NAFLD with fibrosis progression. The association between different obesity phenotypes and NAFLD with fibrosis progression also showed a similar pattern. CONCLUSION: MHO was associated with significantly higher risks of NAFLD and its fibrosis progression, suggesting that regarding NAFLD prevention, MHO individuals might still benefit from lifestyle interventions aimed at body weight and WC maintenance.