Abstract
Background: While liver fat is linked to metabolic disease in first-world environments, its prevalence and impact in rural locations are less clear. We aimed to measure the association between liver fat, cardiometabolic profiles and subclinical cardiovascular disease (CVD) in a large rural Indian cohort. Hypothesis: We hypothesized that despite lower BMI, the presence of liver fat would be related to cardiometabolic risk and subclinical CVD. Methods: In 4691 individuals in the Birbhum Population Project (BPP) in West Bengal, India, we performed liver ultrasonography, carotid ultrasound and biochemical and clinical profiling. We assessed the association of liver fat with risk factors (dysglycemia, dyslipidemia, hypertension) and subclinical CVD (by carotid intimal-medial thickness) in models adjusted for age, sex, income, education, BMI, waist circumference, smoking, blood pressure and glucose. Results: Rural Indians exhibited a higher visceral adiposity index and pro-atherogenic dyslipidemia at a lower BMI than Americans. Individuals with any degree of liver fat by ultrasound had a greater probability of dysglycemia (adjusted odds ratio OR=1.67, 95%CI 1.31-2.12, P<0.0001) and pro-atherogenic dyslipidemia (OR=1.33, 95% CI 1.07-1.63, P=0.009), but not hypertension. We observed a positive association between liver fat and carotid intimal-medial thickness (CIMT) in an unadjusted model (β=0.02, P=0.0001), which was extinguished after adjustment for cardiometabolic risk factors. Conclusion: In a large population of rural Indians, presence of liver fat was associated with prevalent cardiometabolic risk and subclinical CVD at lower BMIs relative to multi-ethnic Americans, though the association with subclinical CVD was extinguished after adjustment. These results underscore the emerging relevance of hepatic steatosis in the developing world, and suggest efforts to target this accessible phenotype for cardiometabolic risk prevention.
Published Version
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