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Fatty liver deteriorates metabolic health
Adults with nonalcoholic fatty liver disease who are considered metabolically healthy are more likely to become metabolically unhealthy compared with those who have a healthy liver, especially among those with lower body mass, according to findings published in Obesity.
“The relationship between obesity and disease risk is not uniform, and there is a subgroup of people with obesity who are resistant to metabolic abnormalities. We refer to these individuals as metabolically healthy people with obesity,” Cheol-Young Park, PhD, a professor in the division of endocrinology and metabolism of the department of internal medicine at Kangbuk Samsung Hospital at Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “However, accumulating data have suggested that [metabolically healthy] people with obesity do not have a completely benign condition.”
Park and colleagues examined metabolic health status and liver health across a median follow-up of 5.1 years in 22,551 adults from the Kangbuk Samsung Healthy Study cohort (mean age, 41.9 years; 39.7% women). At baseline, the researchers measured glucose and insulin levels, blood pressure, weight, height, cholesterol and waist circumference and established whether fatty liver was present using abdominal ultrasonography. Participants returned for a medical assessment every year after the baseline visit.
According to the researchers, if a participant met at least two thresholds for unhealthy metabolic status during follow-up, including having obesity, triglycerides greater than 150 mg/dL, HDL cholesterol less than 40 mg/dL (men) or 50 mg/dL (women), BP at least 130 mm Hg/85 mm Hg or glucose levels greater than 100 mg/dL, they were considered to have changed to a metabolically unhealthy status.
Nonalcoholic fatty liver disease (NAFLD) was present in 23.8% of the participants, according to the researchers, who noted that it was 1.53 times more likely that those with fatty liver would become metabolically unhealthy compared with those without fatty liver (OR = 1.53; 95% CI, 1.49-1.56). The increased likelihood of going from metabolically healthy to metabolically unhealthy held for those with fatty liver (OR = 1.29; 95% CI, 1.19-1.39) after adjusting for age, sex, BMI, lifestyle factors, BP, triglycerides, HDL cholesterol and glucose levels. According to the researchers, the risk for a change in metabolic health status also remained when they included white blood cell count, C-reactive protein, non-HDL, estimated glomerular filtration rate, HbA1c and gamma-glutamyl transferase among the adjustments (HR = 1.26; 95% CI, 1.12-1.36).
There was a “more prominent” effect on the change from metabolically healthy to metabolically unhealthy status in those with the lowest BMI and fat mass levels, the researchers wrote, noting that the effect followed a consistently declining trajectory along with rising measures of BMI and fat mass (P < .0001 for both).
“The reason for this difference is unclear; however, one possible explanation is that people with obesity often have diverse cardiovascular risk factors, including high triglycerides and low HDL cholesterol levels, high blood pressure, hyperglycemia and insulin resistance, compared with individuals without obesity or with normal weight,” the researchers wrote. “These strong associations with multiple cardiometabolic risk factors and insulin resistance in people with obesity may partially dilute the role of NAFLD as a predictor for metabolic conversion to an unhealthy phenotype.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.