The pathologic relevance of metabolic criteria in patients with biopsy-proven nonalcoholic fatty liver disease and metabolic dysfunction associated fatty liver disease: A multicenter cross-sectional study in China

Rui-Xu Yang; Zheng-Sheng Zou; Bi-Hui Zhong; Hong Deng; Fang-Ping He; Jun-Ping Shi; Cai-Yan Zhao; Yu-Qiang Mi; Yong-Jian Zhou; Fu-Sheng Di; Rui-Dan Zheng; Qin Du; Jia Shang; Branko Popovic; JinJun Chen; Jian-Gao Fan

doi:10.1016/j.hbpd.2021.06.002

The pathologic relevance of metabolic criteria in patients with biopsy-proven nonalcoholic fatty liver disease and metabolic dysfunction associated fatty liver disease: A multicenter cross-sectional study in China

Hepatobiliary Pancreat Dis Int. 2021 Oct;20(5):426-432. doi: 10.1016/j.hbpd.2021.06.002. Epub 2021 Jun 25.

Authors

Rui-Xu Yang¹, Zheng-Sheng Zou², Bi-Hui Zhong³, Hong Deng⁴, Fang-Ping He⁵, Jun-Ping Shi⁶, Cai-Yan Zhao⁷, Yu-Qiang Mi⁸, Yong-Jian Zhou⁹, Fu-Sheng Di¹⁰, Rui-Dan Zheng¹¹, Qin Du¹², Jia Shang¹³, Branko Popovic¹⁴, JinJun Chen¹⁵, Jian-Gao Fan¹⁶

Affiliations

¹ Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China.
² Department of Liver Disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
³ Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
⁴ Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
⁵ Department of Gastroenterology II, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Regions, Urumqi 830011, China.
⁶ The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China.
⁷ Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
⁸ Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China.
⁹ Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China.
¹⁰ Department of Endocrinology and Metabolism, The Third Central Hospital of Tianjin, Tianjin 300170, China.
¹¹ Diagnosis and Treatment Center for Liver Diseases, Zhengxing Hospital, Zhangzhou 363000, China.
¹² Department of Gastroenterology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
¹³ Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou 450003, China.
¹⁴ Sanofi-Aventis Deutschland GmbH, Frankfurt 65929, Germany.
¹⁵ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address: chjj@smu.edu.cn.
¹⁶ Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China. Electronic address: fanjiangao@xinhuamed.com.cn.

PMID: 34246549
DOI: 10.1016/j.hbpd.2021.06.002

Abstract

Background: This study aimed to assess the association between metabolic syndrome (MetS) and severity of nonalcoholic fatty liver disease (NAFLD), and to discuss the pathological relevance of the diagnostic criteria in metabolic (dysfunction) associated fatty liver disease (MAFLD).

Methods: This was a multicenter, cross-sectional study. Patients with NAFLD confirmed by liver biopsy were enrolled between July 2016 and December 2018 from 14 centers across the mainland of China. Anthropometric and metabolic parameters were collected to assess the pathological relevance.

Results: Of 246 enrolled patients with NAFLD, 150 (61.0%) had the comorbidity of MetS. With the increase of metabolic components, the proportions of nonalcoholic steatohepatitis (NASH) and significant fibrosis were notably increased. The comorbid three metabolic components significantly increased the proportion of NASH, and further increase of metabolic components did not increase the proportion of NASH. However, the increase of metabolic components was parallel to the increase of the proportion of liver fibrosis. Among the 246 patients, 239 (97.2%) met the diagnostic criteria of MAFLD. Although non-MAFLD patients had less NASH, they present with similar proportion of significant fibrosis and cirrhosis. In the diagnostic criteria of MAFLD, BMI ≥ 23 kg/m² was related to NASH (Mantel-Haenszel Common Estimate OR: 2.975; 95% CI: 1.037-8.538; P = 0.043), and T2DM was related to significant fibrosis (Mantel-Haenszel Common Estimate OR: 2.531; 95% CI: 1.388-4.613; P = 0.002). The homeostasis model assessment of insulin resistance (HOMA-IR) ≥ 2.5 was the most significant factor for NASH (OR: 4.100; 95% CI: 1.772-9.487; P = 0.001) and significant factor for liver fibrosis (OR: 2.947; 95% CI: 1.398-6.210; P = 0.004) after the adjustments of the BMI and diabetes.

Conclusions: Metabolic dysregulations are important risk factors in NAFLD progression. The insulin resistance status may play a predominant role in the progression in MAFLD patients.

Keywords: Insulin resistance; Metabolic syndrome; Nonalcoholic fatty liver disease.

Publication types

Multicenter Study

MeSH terms

Biopsy
China / epidemiology
Cross-Sectional Studies
Humans
Insulin Resistance*
Liver Cirrhosis / diagnosis
Liver Cirrhosis / epidemiology
Metabolic Syndrome* / diagnosis
Metabolic Syndrome* / epidemiology
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / epidemiology