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目的 探讨超重/肥胖人群特定部位脂肪量与非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)发生的关系。方法 于2014年4—5月通过方便抽样选取北京地区19～56岁超重/肥胖人群736名(190名男性和546名女性),年龄为36(31～46)岁，体质指数(body mass index, BMI)为28.0(26.2～30.7)。采用双能X射线吸收法测量全身和局部脂肪量，Logistic回归模型用于分析局部脂肪量与NAFLD发生风险的相关性。结果 超重/肥胖人群NAFLD患病率为70.0%(515/736)。经多因素Logistic回归分析，调整年龄、性别、BMI、是否患有高血压以及全身脂肪量后，腰围、大腿和腰部脂肪量与NAFLD发生风险显著相关(P<0.05),未发现上肢、躯干、臀部脂肪量与NAFLD发生风险的关联；大腿脂肪量与年龄(P交互<0.001)、BMI分组(P交互=0.001)之间存在交互作用影响NAFLD发生风险，亚组分析发现大腿脂肪量与NAFLD发生风险在≤36岁组(OR=0.62,95%CI 0.48～0.81)、男性(OR=0.32,95%CI 0.16～0.64)和超重组(OR=0.48,95%CI 0.36～0.64)中呈负相关，但是在>36岁组、女性和肥胖组中，两者关联无统计学意义。躯干脂肪量与年龄组有交互作用(P交互=0.009),在>36岁组与NAFLD发生风险呈正相关(OR=1.63,95%CI 1.35～1.97),在≤36岁组中则未发现存在关联。此外，臀部脂肪量与BMI分组具有交互作用(P交互<0.001),在超重组中臀部脂肪量与NAFLD发生风险呈负相关(OR=0.12,95%CI 0.06～0.25),而在肥胖组则无统计学意义。腰围、上肢和腰部脂肪量与年龄、性别和BMI分组交互作用均无统计学意义。结论 腰围、腰部和大腿脂肪量与NAFLD发生风险有关。大腿脂肪量与年龄、BMI分组对NAFLD发生风险存在交互作用，大腿脂肪量对于NAFLD的保护作用仅在≤36岁组、男性或超重者中表现，而在>36岁组、女性或肥胖组中未发现；躯干脂肪量与年龄具有交互作用，躯干脂肪量与NAFLD关联在>36岁者中显著；臀部脂肪量与BMI分组也具有交互作用，臀部脂肪量与NAFLD关联在超重者中更加明显。
Abstract：OBJECTIVE To explore the relationship between fat distribution and non-alcoholic fatty liver(NAFLD) in overweight/obese adults.METHODS This cross-sectional study included 736(190 men and 546 women) 19-56 years old overweight/obese people in Beijing were selected by convenient sampling. Their age and body mass index(BMI) distribution were 36(31-46) years old and 28.0(26.2-30.7), respectively. The body fat mass and regional fat mass were measured by dual energy X-ray absorptiometry(DXA), and Logistic regression model was used to analyze the association between regional fat mass and the risk of NAFLD.RESULTS The prevalence of NAFLD was 70.0%(515/736) in overweight/obese population. In the multivariate Logistic model, after adjusting for age, gender, BMI, hypertension and body fat mass, waist circumference(WC), thigh fat mass and android fat mass were significantly association with NAFLD risk(P<0.05), but no association was found between arms, trunk and gynoid fat mass and NAFLD risk. There were interactions between thigh fat mass and age(Pinteraction<0.001) and BMI group(Pinteraction=0.001). Subgroup analysis showed that thigh fat mass and NAFLD risk were significantly associated in ≤36-year-old(OR=0.62, 95%CI 0.48-0.81), male(OR=0.32, 95%CI 0.16-0.64) and overweight(OR=0.48, 95%CI 0.36-0.64) groups, but in the >36-year-old, female and the obesity group this association was not statistically significant. There was an interaction between trunk fat mass and age group(Pinteraction=0.009). There was a positive correlation between trunk fat mass and NAFLD risk in >36-year-old group(OR=1.63, 95%CI 1.35-1.97), but no association was found in ≤36-year-old group. In addition, we also found that a significant interaction between gynoid fat mass and BMI group on NAFLD(Pinteraction<0.001). In overweight, gynoid fat mass was negatively correlated with the risk of NAFLD(OR=0.12, 95% CI 0.06-0.25), but in the obesity group, the association was not statistically significant. There were no statistically significant interactions between WC, arms fat mass and android mass and age, sex and BMI groups.CONCLUSION WC, android fat mass and thigh fat mass are associated with the risk of NAFLD. Thigh fat mass has a significant interaction with age and BMI group on the risk of NAFLD(only in ≤36-year-old group, male and overweight group a significant protective effect of thigh fat on NAFLD was found, but not in >36-year-old group, female and obesity group). Trunk fat mass had an interaction with age(the association between trunk fat mass and NAFLD was significant in >36-year-old group). Gynoid fat mass and BMI group also have a significant interaction on NAFLD(the detrimental effect of gynoid fat on NAFLD is much more profound in the obesity group).
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基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2022.05.013
中图分类号:R575.5;R589.2
引用信息:
[1]曾媛,袁姝倩,谢铭,等.超重/肥胖成人局部脂肪量与非酒精性脂肪肝发生风险的关系[J].卫生研究,2022,51(05):753-760.DOI:10.19813/j.cnki.weishengyanjiu.2022.05.013.
基金信息:
国家自然科学基金(No.81903336); 湖南省自然科学基金(No.2019JJ50376)
2022-09-19
2022-09-19