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- W2406680260 abstract "The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased worldwide during recent years, in several regions amounting to more than 30% in the general adult population.1Williams C.D. Stengel J. Asike M.I. et al.Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.Gastroenterology. 2011; 140: 124-131Google Scholar, 2Ahmed A. Wong R.J. Harrison S.A. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes.Clin Gastroenterol Hepatol. 2015; 13: 2062-2070Google Scholar NAFLD is associated strongly with progressive hepatic diseases such as fibrosis and cirrhosis, and thereby also contributes to the development of hepatocellular carcinoma.3Pais R. Lebray P. Rousseau G. et al.Nonalcoholic fatty liver disease increases the risk of hepatocellular carcinoma in patients with alcohol-associated cirrhosis awaiting liver transplants.Clin Gastroenterol Hepatol. 2015; 13: 992-999.e2Google Scholar, 4Mittal S. El-Serag H.B. Sada Y.H. et al.Hepatocellular carcinoma in the absence of cirrhosis in United States Veterans is associated with nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol. 2016; 14: 124-131.e1Abstract Full Text Full Text PDF Scopus (362) Google Scholar However, there is accumulating evidence that hepatocellular carcinoma can arise in NAFLD without cirrhosis.4Mittal S. El-Serag H.B. Sada Y.H. et al.Hepatocellular carcinoma in the absence of cirrhosis in United States Veterans is associated with nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol. 2016; 14: 124-131.e1Abstract Full Text Full Text PDF Scopus (362) Google Scholar, 5Chalasani N. Younossi Z. Lavine J.E. et al.The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology.Gastroenterology. 2012; 142: 1592-1609Google Scholar, 6Cohen J.C. Horton J.D. Hobbs H.H. Human fatty liver disease: old questions and new insights.Science. 2011; 332: 1519-1523Google Scholar Furthermore, it increasingly is recognized that in high-risk groups for cardiometabolic diseases, such as morbid obesity or type 2 diabetes, the prevalence of NAFLD is higher than 70%.1Williams C.D. Stengel J. Asike M.I. et al.Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.Gastroenterology. 2011; 140: 124-131Google Scholar Consequently, because among the noncommunicable diseases cardiometabolic diseases represent the most important causes of morbidity and mortality worldwide, the question arises of whether NAFLD also is involved in the pathogenesis of cardiometabolic diseases. However, it is difficult to address this question. One approach is to perform precise phenotyping of body fat distribution, ectopic lipid accumulation, metabolism, and cardiovascular risk. In this respect, the concept of metabolically healthy obesity is helpful. It shows that it is not the total amount of body fat, but the body fat distribution and the amount of ectopic lipid deposition that predicts metabolic risk.7Stefan N. Häring H.U. Hu F.B. et al.Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications.Lancet Diabetes Endocrinol. 2013; 1: 152-162Google Scholar Our studies indicated that it is not visceral obesity, but NAFLD that most strongly associates with insulin resistance,8Stefan N. Fritsche A. Schick F. Häring H.U. Phenotypes of prediabetes and stratification of cardiometabolic risk.Lancet Diabetes Endocrinol. 2016; ([Epub ahead of print])Google Scholar which is considered to be involved strongly in the pathogenesis of cardiometabolic diseases.9Saltiel A.R. Kahn C.R. Insulin signalling and the regulation of glucose and lipid metabolism.Nature. 2001; 414: 799-806Google Scholar Furthermore, insulin resistant NAFLD also is considered an independent determinant of increased vascular intima-media thickness,8Stefan N. Fritsche A. Schick F. Häring H.U. Phenotypes of prediabetes and stratification of cardiometabolic risk.Lancet Diabetes Endocrinol. 2016; ([Epub ahead of print])Google Scholar an early marker of atherosclerosis. Thus, NAFLD may be associated not only with cardiovascular disease,10Targher G. Day C.P. Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease.N Engl J Med. 2010; 363: 1341-1350Google Scholar but also involved in the pathogenesis of insulin resistance and subclinical inflammation, involving impaired hepatic insulin signaling, dyslipidemia, and dysregulated hepatokine production.11Shulman G.I. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease.N Engl J Med. 2014; 371: 1131-1141Google Scholar, 12Stefan N. Haring H.U. The role of hepatokines in metabolism.Nat Rev Endocrinol. 2013; 9: 144-152Google Scholar, 13Stefan N. Haring H.U. Circulating fetuin-A and free fatty acids interact to predict insulin resistance in humans.Nat Med. 2013; 19: 394-395Google Scholar Besides data from smaller clinical studies involving precise phenotyping procedures, it would be important to have support for this hypothesis from population studies. In this regard, Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar asked the question of whether NAFLD is associated with coronary artery calcium (CAC), determined on noncontrast cardiac computed tomography (CT), in an elderly cohort in the Rancho Bernardo Study, which is a prospective population-based study of mostly white adults in suburban Southern California. In cross-sectional analyses of data from 250 subjects the volume of visceral adipose tissue (VAT), but not the liver-to-spleen attenuation ratio, an estimate of liver fat content, both measured during abdominal CT imaging, correlated positively with CAC. Furthermore, in longitudinal analyses involving 99 subjects who were followed up for 5 years, baseline VAT, but not baseline hepatic steatosis, was higher in participants with CAC progression. In addition, in parallel to the increase in CAC, VAT increased, whereas hepatic steatosis decreased, during the same period of follow-up evaluation. Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar concluded that VAT, but not hepatic steatosis, may be a risk factor for coronary artery disease. In light of the wealth of data indicating that a causative relationship of NAFLD with cardiovascular disease probably exists,1Williams C.D. Stengel J. Asike M.I. et al.Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.Gastroenterology. 2011; 140: 124-131Google Scholar, 5Chalasani N. Younossi Z. Lavine J.E. et al.The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology.Gastroenterology. 2012; 142: 1592-1609Google Scholar, 11Shulman G.I. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease.N Engl J Med. 2014; 371: 1131-1141Google Scholar, 12Stefan N. Haring H.U. The role of hepatokines in metabolism.Nat Rev Endocrinol. 2013; 9: 144-152Google Scholar, 13Stefan N. Haring H.U. Circulating fetuin-A and free fatty acids interact to predict insulin resistance in humans.Nat Med. 2013; 19: 394-395Google Scholar, 15Goossens N. Hoshida Y. Song W.M. et al.Nonalcoholic steatohepatitis is associated with increased mortality in obese patients undergoing bariatric surgery.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Scopus (14) Google Scholar including excellent previously published data16Arulanandan A. Ang B. Bettencourt R. et al.Association between quantity of liver fat and cardiovascular risk in patients with nonalcoholic fatty liver disease independent of nonalcoholic steatohepatitis.Clin Gastroenterol Hepatol. 2015; 13: 1513-1520.e1Google Scholar from Jacobs et al,14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar this conclusion should relate specifically to the relationship between NAFLD and CAC. However, what explains the finding that NAFLD does not associate with CAC in the study by Jacobs et al?14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar First, it is necessary to compare these data with other reports in this field. Middle-aged individuals (mean age, 53 y) with a CT-based presence of NAFLD were almost twice as likely to have increased CAC (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03–2.95) than healthy controls after adjustment for several important determinants of cardiovascular disease.17Assy N. Djibre A. Farah R. et al.Presence of coronary plaques in patients with nonalcoholic fatty liver disease.Radiology. 2010; 254: 393-400Google Scholar In another study it also was shown that NAFLD (OR, 2.46; 95% CI, 1.07–5.69) was an independent risk for CAC.18Chen C.H. Nien C.K. Yang C.C. et al.Association between nonalcoholic fatty liver disease and coronary artery calcification.Dig Dis Sci. 2010; 55: 1752e60Google Scholar A similar association was shown in a large cross-sectional study of 4123 patients and controls in Seoul, Korea. The study reported that the presence of NAFLD predicted an increased CAC score independent of classic risk factors including visceral adiposity, with an adjusted OR of 1.32 (95% CI, 1.12–1.57).19Kim D. Choi S.Y. Park E.H. et al.Nonalcoholic fatty liver disease is associated with coronary artery calcification.Hepatology. 2012; 56: 605e13Google Scholar In the Jackson Heart Study, 2884 older participants (mean age, 60 y) underwent a noncontrast CT examination for the assessment of fatty liver, VAT, and CAC. In cross-sectional analyses fatty liver, but not VAT, was found to be an independent determinant of CAC.20Liu J. Musani S.K. Bidulescu A. et al.Fatty liver, abdominal adipose tissue and atherosclerotic calcification in African Americans: the Jackson Heart Study.Atherosclerosis. 2012; 224: 521-525Google Scholar In addition, in a cross-sectional analysis of data from the Framingham Heart Study including 3014 participants, hepatic steatosis was associated with increased CAC (OR, 1.20; 95% CI, 1.10–1.30), and this relationship also was independent of VAT.21Mellinger J.L. Pencina K.M. Massaro J.M. et al.Hepatic steatosis and cardiovascular disease outcomes: an analysis of the Framingham Heart Study.J Hepatol. 2015; 63: 470-476Google Scholar Furthermore, a recent systematic review and meta-analysis that included 7 studies showed an association between hepatic steatosis and CAC.22Oni E.T. Agatston A.S. Blaha M.J. et al.A systematic review: burden and severity of subclinical cardiovascular disease among those with nonalcoholic fatty liver; should we care?.Atherosclerosis. 2013; 230: 258-267Google Scholar Finally, in a South Korean occupational cohort of 2175 people who were followed up for a median of 2.3 years, hepatic steatosis at baseline was higher in subjects in whom CAC progressed over time.23Sung K.C. Ryu S. Lee J.Y. et al.Fatty liver, insulin resistance, and obesity: relationships with increase in coronary artery calcium over time.Clin Cardiol. 2016; (Epub ahead of print)Google Scholar How does the study by Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar differ from these reports? Although the investigators of the aforementioned studies found NAFLD, more so than increased VAT, to be associated with increased CAC, Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar found increased VAT, but not NAFLD, to be associated with increased CAC. What may explain the different findings? A low power of the study by Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar may explain the finding that NAFLD did not associate with CAC in their study. In respect to both the cross-sectional and the longitudinal analyses, the study by Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar had the smallest sample size. Furthermore, noncontrast CT-based estimation of liver fat content has low sensitivity and specificity when liver fat content is less than 30%.24Schwenzer N.F. Springer F. Schraml C. et al.Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance.J Hepatol. 2009; 51: 433-445Google Scholar Thus, in an elderly population, in whom the metabolic risk appears to be somewhat lower compared with a middle-aged population, this may become an important issue. Furthermore, as also was discussed by Jacobs et al,14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar in an elderly population the increased prevalence of fibrosis may increase unenhanced CT liver attenuation and, thereby, underestimate the prevalence of hepatic steatosis. Nevertheless, the study by Jacobs et al14Jacobs K. Brouha S. Bettencourt R. et al.Association of nonalcoholic fatty liver disease with visceral adiposity but not coronary artery calcification in the elderly.Clin Gastroenterol Hepatol. 2016; 14: 1337-1344Abstract Full Text Full Text PDF Google Scholar helps to address the important point of whether and to what extent fatty liver may be involved in the pathogenesis of cardiovascular disease in the elderly. Association of Nonalcoholic Fatty Liver Disease With Visceral Adiposity but Not Coronary Artery Calcification in the ElderlyClinical Gastroenterology and HepatologyVol. 14Issue 9PreviewNonalcoholic fatty liver disease (NAFLD) is related closely to risk factors for coronary artery disease, but it is unclear whether NAFLD independently contributes to atherosclerosis. We investigated the association between NAFLD and coronary artery calcium (CAC) scores, determined based on noncontrast cardiac computed tomography data, in an elderly cohort. Full-Text PDF" @default.
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- W2406680260 title "Nonalcoholic Fatty Liver Disease and Coronary Artery Calcification" @default.
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