Relationship between Nonalcoholic Fatty Liver Disease and Carotid Artery Atherosclerosis Beyond Metabolic Disorders in Non-Diabetic Patients

다국어 초록 (Multilingual Abstract)

Background: The objective of this study was to investigate the association between nonalcoholic fatty liver disease (NAFLD)and carotid artery atherosclerosis beyond metabolic disorders.
Methods: We studied 320 non-diabetic patients with ultrasonographically diagnosed NAFLD and 313 non-diabetic patients without NAFLD who have less than 40 g alcohol/week drinking history. Carotid atherosclerotic burden was assessed by carotid intima-media thickness (IMT) and plaque. All subjects were divided to the metabolic syndrome (MetS) according to International Diabetes Federation criteria.
Results: NAFLD patients had a significantly increased mean carotid IMT (0.79 ± 0.18 vs. 0.73 ± 0.13 mm; p < 0.001) than those without the condition. The prevalence of increased IMT, defined as IMT ≥ 1 mm, and carotid plaque were 52.5% and 34.1% in the patients with NAFLD vs. 35.8% and 18.8% in the patients without this condition (p < 0.001). The difference in IMT and prevalence of plaque was also significant even in patients without MetS as well as those with MetS (all p < 0.05).
NAFLD-associated adjusted odds ratio for increased IMT was 1.236 [95% confidence interval (CI), 1.023-1.467, p = 0.016]without MetS and 1.178 (95% CI, 1.059-1.311, p = 0.003) with MetS. NAFLD-associated adjusted odds ratio of carotid plaque was 1.583 (95% CI, 1.309-1.857, p = 0.024) without MetS and 1.536 (95% CI, 0.512-4.604, p = 0.444) with MetS.
Conclusion: NAFLD is significantly associated with carotid atherosclerosis in non-diabetic outpatients even without MetS.
Carotid screening for NAFLD might be beneficial for assessment of future atherosclerotic complications.

참고문헌 (Reference)

• 1 최수연, "심혈관계 위험인자로서의 비알코올지방간질환; 경동맥 동맥경화와의 상관관계" 대한간학회 14 (14): 77-88, 2008
• 2 정진원, "동맥경화의 진단방법으로 경동맥 내막-중막 두께의 의의" 한국심초음파학회 10 (10): 8-12, 2002
• 3 박병현, "관상동맥 질환의 유무와 심한정도를 예측하는데 있어 경동맥 내막-중막 두께와 죽상경화반의 의의" 한국심초음파학회 8 (8): 45-53, 2000
• 4 Vermeersch SJ, "Validation of a new automated IMT measurement algorithm" 21 : 976-978, 2007
• 5 Saadeh S, "The utility of radiological imaging in nonalcoholic fatty liver disease" 123 : 745-750, 2002
• 6 Palmentieri B, "The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis" 38 : 485-489, 2006
• 7 McCullough AJ, "The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease" 8 : 521-533, 2004
• 8 Musso G, "Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects" 31 : 562-568, 2008
• 9 Jousilahti P, "Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke" 31 : 1851-1855, 2003
• 10 Korean Society for the Study of Obesity, "Report on cut-off point of body mass index and waist circumference for criteria of obesity and abdominal obesity among Korean. In Proceedings of the Symposium for Criteria of Obesity and Abdominal Obesity Among Korean" 2-3, 2005
• 11 Targher G, "Relation of nonalcoholic hepatic steatosis to early carotid atherosclerosis in healthy men: role of visceral fat accumulation" 27 : 2498-2500, 2004
• 12 Adams LA, "Recent concepts in non-alcoholic fatty liver disease" 22 : 1129-1133, 2005
• 13 Park SH, "Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults" BLACKWELL PUBLISHING 21 : 138-143, 2006
• 14 Neuschwander-Tetri BA, "Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference" 37 : 1202-1219, 2003
• 15 Petit JM, "Nonalcoholic fatty liver is not associated with carotid intima-media thickness in type 2 diabetic patients" 94 : 4103-4106, 2009
• 16 Marchesini G, "Nonalcoholic fatty liver disease: a feature of the metabolic syndrome" 50 : 1844-1850, 2001
• 17 Targher G, "Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients" 30 : 2119-2121, 2007
• 18 Brea A, "Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case-control study" 25 : 1045-1050, 2005
• 19 Pacifico L, "Nonalcoholic fatty liver disease and carotid atherosclerosis in children" 63 : 423-427, 2008
• 20 Angulo P, "Nonalcoholic fatty liver disease" 346 : 1221-1231, 2002
• 21 Targher G, "Non-alcoholic fatty liver disease is associated with carotid artery wall thickness in diet-controlled type 2 diabetic patients" (29) : 55-60, 2006
• 22 Nannipieri M, "Mexico City diabetes study. Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study" 28 : 1757-1762, 2005
• 23 Hanley AJ, "Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study" 54 : 3140-3147, 2005
• 24 Schindhelm RK, "Liver alanine aminotransferase, insulin resistance and endothelial dysfunction in normotriglyceridaemic subjects with type 2 diabetes mellitus" 35 : 369-374, 2005
• 25 "International Diabetes Federation Press Conference. The IDF consensus worldwide definition of the metabolic syndrome"
• 26 Volzke H, "Hepatic steatosis is associated with an increased risk of carotid atherosclerosis" 11 : 1848-1853, 2005
• 27 Wannamethee G, "Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes" 142 : 699-708, 1995
• 28 Aygun C, "Evaluation of metabolic syndrome frequency and carotid artery intima-media thickness as risk factors for atherosclerosis in patients with nonalcoholic fatty liver disease" 53 : 1352-1357, 2008
• 29 Villanova N, "Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease" 42 : 473-480, 2005
• 30 Hernaez R, "Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis" 54 : 1082-1090, 2011
• 31 Stefan N, "Causes and metabolic consequences of Fatty liver" 29 : 939-960, 2008
• 32 O’Leary DH, "Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group" 340 : 14-22, 1999
• 33 김현창, "Association between nonalcoholic fatty liver disease and carotid intima-media thickness according to the presence of metabolic syndrome" ELSEVIER IRELAND LTD 204 (204): 521-525, 2009
• 34 Barth JD, "An update on carotid ultrasound measurement of intima-media thickness" 89 : 32-39, 2002
• 35 Sanyal AJ, "American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease" 123 : 1705-1725, 2002