In the United States, obesity has increased in prevalence over time and is strongly associated with subsequent outcomes such as diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). It is unclear, however, as to how the magnitude of NAFLD risk from obesity and DM is increased in safety-net health system settings. Among the San Francisco Health Network (SFHN) patients (N = 47,211), we examined the association between Body Mass Index (BMI) and elevated liver enzyme levels, including interaction by DM status. Our findings revealed that 32.2 percent of SFHN patients were obese, and Pacific Islanders in the safety-net had the highest rates of obesity compared to other racial groups, even after using higher race-specific BMI cutoffs. In SFHN, obesity was associated with elevated liver enzymes, with the relationship stronger among those without DM. Our findings highlight how obesity is a stronger factor of NAFLD in the absence of DM, suggesting that practitioners consider screening for NAFLD among safety-net patients with obesity even if DM has not developed. These results highlight the importance of directing efforts to reduce obesity in safety-net health systems and encourage researchers to further examine effect modification between health outcomes in such populations.

中文翻译：

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安全网卫生系统中的肥胖和代谢结果。

在美国，肥胖的患病率随着时间的推移而增加，并且与糖尿病 (DM) 和非酒精性脂肪肝 (NAFLD) 等后续结果密切相关。然而，目前尚不清楚肥胖和糖尿病导致 NAFLD 风险的程度如何在安全网卫生系统环境中增加。在旧金山健康网络 (SFHN) 患者 (N = 47,211) 中，我们研究了体重指数 (BMI) 与肝酶水平升高之间的关联，包括 DM 状态之间的相互作用。我们的研究结果显示，32.2% 的 SFHN 患者肥胖，与其他种族群体相比，安全网中的太平洋岛民的肥胖率最高，即使在使用较高的种族特定 BMI 临界值后也是如此。在 SFHN 中，肥胖与肝酶升高相关，在非糖尿病患者中这种关系更为明显。我们的研究结果强调了在没有糖尿病的情况下，肥胖是 NAFLD 的一个更重要的因素，这表明即使尚未发展为糖尿病，医生也应该考虑在安全网肥胖患者中筛查 NAFLD。这些结果凸显了在安全网卫生系统中指导减少肥胖的重要性，并鼓励研究人员进一步研究此类人群健康结果之间的影响修正。