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Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population
Hepatology ( IF 13.5 ) Pub Date : 2018-04-16 , DOI: 10.1002/hep.29631
Fredrik Åberg 1 , Jaana Helenius-Hietala 2 , Pauli Puukka 3 , Martti Färkkilä 4 , Antti Jula 3
Affiliation  

The metabolic syndrome and alcohol risk use are both associated with a high prevalence of hepatic steatosis, but only a minority develop liver failure or liver cancer. Few general population studies have analyzed metabolic predictors of such severe liver complications. We studied which metabolic factors best predict severe liver complications, stratified by alcohol consumption, in 6732 individuals without baseline liver disease who participated in the Finnish population‐based Health 2000 Study (2000‐2001), a nationally representative cohort. Follow‐up data from national registers until 2013 were analyzed for liver‐related admissions, mortality, and liver cancer. Baseline alcohol use and metabolic factors were analyzed by backward stepwise Cox regression analysis. Eighty‐four subjects experienced a severe liver event during follow‐up. In the final multivariate model, factors predictive of liver events were age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.004‐1.04), sex (women: HR, 0.55; 95% CI, 0.34‐0.91), alcohol use (HR, 1.002; 95% CI, 1.001‐1.002), diabetes (HR, 2.73; 95% CI, 1.55‐4.81), low‐density lipoprotein (LDL) cholesterol (HR, 0.74; 95% CI, 0.58‐0.93), and homeostasis model assessment of insulin resistance (HOMA‐IR) (HR, 1.01; 95% CI, 1.004‐1.02). Among alcohol risk users (≥210 g/week for men, ≥ 140 g/week for women), diabetes (HR, 6.79; 95% CI, 3.18‐14.5) was the only significant predictor. Among nonrisk drinkers, age, alcohol use, smoking, waist circumference, low LDL cholesterol and HOMA‐IR were significant independent predictors. The total‐to‐LDL cholesterol ratio and waist circumference‐to‐body mass index ratio emerged as additional independent predictors. Conclusion: Multiple components of the metabolic syndrome independently affected the risk for severe liver disease. Alcohol was significant even when average alcohol consumption was within the limits currently defining nonalcoholic fatty liver disease. (Hepatology 2018;67:2141‐2149)

中文翻译:

饮酒与代谢综合征在预测普通人群严重肝病中的相互作用

代谢综合征和酒精风险使用都与肝脂肪变性的高患病率有关,但只有少数会发展为肝功能衰竭或肝癌。很少有一般人群研究分析了此类严重肝脏并发症的代谢预测因素。我们在 6732 名没有基线肝病的个体中研究了哪些代谢因素最能预测严重的肝脏并发症,并按饮酒分层,这些个体参加了芬兰人口健康 2000 研究 (2000-2001),这是一个全国性的代表性队列。对截至 2013 年的国家登记的随访数据进行了肝脏相关入院、死亡率和肝癌的分析。通过向后逐步 Cox 回归分析分析基线酒精使用和代谢因素。84 名受试者在随访期间经历了严重的肝脏事件。在最终的多变量模型中,预测肝脏事件的因素是年龄(风险比 [HR],1.02;95% 置信区间 [CI],1.004-1.04)、性别(女性:HR,0.55;95% CI,0.34-0.91 )、饮酒 (HR, 1.002; 95% CI, 1.001-1.002), 糖尿病 (HR, 2.73; 95% CI, 1.55-4.81), 低密度脂蛋白 (LDL) 胆固醇 (HR, 0.74; 95% CI, 0.58-0.93)和胰岛素抵抗的稳态模型评估(HOMA-IR)(HR,1.01;95% CI,1.004-1.02)。在酒精风险使用者中(男性≥210 克/周,女性≥140 克/周),糖尿病(HR,6.79;95% CI,3.18-14.5)是唯一的显着预测因子。在非危险饮酒者中,年龄、饮酒、吸烟、腰围、低 LDL 胆固醇和 HOMA-IR 是重要的独立预测因素。总胆固醇与低密度脂蛋白胆固醇的比率和腰围与体重指数的比率成为额外的独立预测因素。结论:代谢综合征的多个组成部分独立地影响严重肝病的风险。即使平均饮酒量在当前定义的非酒精性脂肪肝的限度内,酒精也很重要。(肝病学 2018 年;67:2141-2149)
更新日期:2018-04-16
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