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Comparative Study
. 2015 Apr;239(2):629-33.
doi: 10.1016/j.atherosclerosis.2015.02.011. Epub 2015 Feb 7.

The association of nonalcoholic fatty liver disease, obesity, and metabolic syndrome, with systemic inflammation and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA)

Mahmoud Al Rifai  1 , Michael G Silverman  2 , Khurram Nasir  3 , Matthew J Budoff  4 , Ron Blankstein  5 , Moyses Szklo  6 , Ronit Katz  7 , Roger S Blumenthal  1 , Michael J Blaha  8
Affiliations
Comparative Study

The association of nonalcoholic fatty liver disease, obesity, and metabolic syndrome, with systemic inflammation and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA)

Mahmoud Al Rifai et al. Atherosclerosis. 2015 Apr.

Abstract

Introduction: We characterized the association of 3 metabolic conditions - obesity, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) - with increased inflammation and subclinical atherosclerosis.

Methods: We conducted cross-sectional analysis of 3976 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with adequate CT imaging to diagnose NAFLD. Obesity was defined as BMI ≥ 30 kg/m(2), metabolic syndrome by AHA/NHLBI criteria, and NAFLD using non-contrast cardiac CT and a liver/spleen attenuation ratio (L/S) < 1. Increased inflammation was defined as high sensitivity C-reactive protein (hsCRP) ≥2 mg/L and subclinical atherosclerosis as coronary artery calcium (CAC) > 0. We studied the association of a stepwise increase in number of these metabolic conditions (0-3) with increased inflammation and CAC, stratifying results by gender and ethnicity.

Results: Mean age of participants was 63 (±10) years, 45% were male, 37% white, 10% Chinese, 30% African American, and 23% were Hispanic. Adjusting for obesity, metabolic syndrome and traditional risk factors, NAFLD was associated with a prevalence odds ratio for hsCRP ≥2 mg/L and CAC >0 of 1.47 (1.20-1.79) and 1.37 (1.11-1.68) respectively. There was a positive interaction between female gender and NAFLD in the association with hsCRP ≥2 mg/L (p = 0.006), with no interaction by race. With increasing number of metabolic conditions, there was a graded increase in prevalence odds ratios of hsCRP ≥2 mg/L and CAC >0.

Conclusion: NAFLD is associated with increased inflammation and CAC independent of traditional risk factors, obesity and metabolic syndrome. There is a graded association between obesity, metabolic syndrome, and NAFLD with inflammation and CAC.

Keywords: Inflammation; Metabolic syndrome; Nonalcoholic fatty liver disease; Obesity; Subclinical atherosclerosis.

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Conflict of interest statement

There is no conflict of interest to be declared

Figures

Figure 1
Figure 1. Prevalence of hsCRP ≥2 mg/L and CAC >0 by Number of Metabolic Conditions
*Adjusted for age, gender, ethnicity, smoking status, LDL cholesterol, use of lipid-lowering medica on, highest level of educa on completed
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