Highlights
- •MHO individuals had equal chances to have NAFLD compared with MUO subjects.
- •MHO participants with NAFLD had 2 times higher chance to become MUO in long-term.
- •This transition subsequently increased their cardiometabolic risk.
- •NAFLD inclusion in metabolic status definition of obese could be of added value.
Abstract
Background/objectives
We evaluated the role of the presence of non-alcoholic fatty liver disease (NAFLD)
at baseline in the transition from metabolically healthy to metabolically unhealthy
obesity (MHO to MUO) ten years later.
Methods
A prospective cohort study (ATTICA study, Greece) was performed between 2002 and 2012
studying a sample from the greater metropolitan Athens area. In total, 1514 (49·8%)
men and 1528 (50.2%) women (aged >18 years old) free-of-CVD were included. Healthy
metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome
components. NAFLD was defined according to validated liver steatosis indices. Follow-up
CVD assessment (2011–2012) was achieved in n = 2020 participants (n = 317 cases).
Results
NAFLD prevalence among MHO participants ranged from 29% to 39% according to the specific
NAFLD score used. MHO participants who developed metabolically unhealthy status had
about two times higher odds to have NAFLD at baseline compared with their metabolically
healthy normal weight counterparts whereas stable MHO was not associated significantly
with NAFLD. Moreover, MHO status accompanied by NAFLD was associated with increased
CVD risk (Hazard Ratio = 2.90 95% Confidence Interval (1.35, 5.40)) in comparison
to their non-NAFLD MHO counterparts. Further analysis revealed that in the obese,
NAFLD indices and not simply visceral adiposity increased significantly the ability
of metabolic status (using standard definition) to predict long-term CVD incidence.
Conclusions
Considering NAFLD, even when assessed using validated indices only, in the clinical
assessment of apparently healthy obese individuals predicts who is to develop MUO
and contributes independently and more accurately to defining future cardiometabolic
risk.
Abbreviations:
ALT (Alanine transaminase), AST (Aspartate transaminase), BMI (Body mass index), CVD (Cardiovascular disease), GGT (Gamma-Glutamyl transferase), FLI (Fatty liver index), HR (Hazard ratio), HSI (Hepatic steatosis index), HOMA-IR (Homeostasis model assessment of insulin resistance), MHN (Metabolically healthy non-obese), MHO (Metabolically healthy obese), MetS (Metabolic syndrome), MUN (Metabolically unhealthy non-obese), MUO (Metabolically unhealthy obese), NAFLD (Non-alcoholic fatty liver disease), NAFLD-FLS (Non-alcoholic fatty liver disease fatty liver score), OR (Odds Ratio), 95% CI (95% Confidence Interval)Keywords
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Article info
Publication history
Published online: September 30, 2021
Accepted:
September 26,
2021
Received in revised form:
September 24,
2021
Received:
July 6,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
