Abstract
BackgroundProgressive overloads of intrahepatic triglycerides are related to metabolic dysregulation of multiple lipid and lipoprotein profiles, but whether similar dose effects are found in each subtype of metabolic associated fatty liver disease (MAFLD) remains unclear. We aimed to characterize the lipid profiles associated with liver fat content (LFC) in MAFLD patients who were overweight, lean/normal weight, or had diabetes.MethodsWe conducted a cross-sectional study enrolling 1,182 consecutive participants (144 non-MAFLD and 1,038 MAFLD) who underwent MRI proton density fat fraction measurement (MRI-PDFF) from 2011 to 2020. Lipid and apolipoprotein profiles, free fatty acid (FFA), liver and metabolism parameters, and anthropometric measurements were also assessed.ResultsMAFLD patients with type 2 diabetes or overweight/obesity had a higher proportion of abnormal lipid and lipoprotein profiles than those who were lean/normal weight. The degree of LFC had a positive correlation with total cholesterol, triglyceride, ApoB, and ApoE in patients with overweight/obesity and type 2 diabetes. In those with overweight/obesity, there were dose–response relationships between moderate-to-severe steatosis and total cholesterol, triglyceride, HDL-c, LDL-c, ApoB, ApoE, and Lp(a). A similar trend was observed for triglyceride in those with type 2 diabetes and for HDL-c in patients who were lean/normal weight (all p for trend <0.05). The combined model of relative lipid-related markers performed well in the prediction of moderate-to-severe steatosis (AUC: 0.762 for overweight/obesity; 0.742 for lean/normal weight).ConclusionLFC was associated with lipid profiles, including triglyceride, LDL-c, ApoB, ApoE, and FFA. These relationships were varied by the phenotype of MAFLD according to its diagnostic flow.
Highlights
As the most prevalent chronic liver disease globally, metabolic associated fatty liver disease (MAFLD) is characterized by intrahepatic lipid accumulation, inflammation, and fibrosis [1], and it affects approximately 30% of the general population
We aimed to identify the relationship between liver fat content and various lipid profiles, with the former defined with magnetic resonance imaging proton density fat fraction measurement (MRI-PDFF), a noninvasive, highly accurate, and reproducible method similar to 1H-MRS in terms of quantifying hepatic steatosis
Our findings suggested that total cholesterol, triglyceride, ApoB, and ApoE were significantly correlated with the degree of liver fat content (LFC) in MAFLD patients with obesity or diabetes, while stepwise increase in low-density lipoprotein cholesterol (LDL-c) and free fatty acid (FFA) was only associated with higher LFC in those with obesity/overweight
Summary
As the most prevalent chronic liver disease globally, metabolic associated fatty liver disease (MAFLD) is characterized by intrahepatic lipid accumulation, inflammation, and fibrosis [1], and it affects approximately 30% of the general population. Compared to the previously defined nonalcoholic fatty liver disease (NAFLD) criteria, which excluded excessive alcohol consumption or other concomitant liver disease, the characterization of MAFLD introduced a novel algorithm with stratification of patients into categories of overweight or obese, type 2 diabetes mellitus (T2DM), or normal weight/lean with metabolic dysfunction, including central obesity, abnormal glucolipid metabolism profile, and increased hypersensitive Creactive protein [2]. Progressive overloads of intrahepatic triglycerides are related to metabolic dysregulation of multiple lipid and lipoprotein profiles, but whether similar dose effects are found in each subtype of metabolic associated fatty liver disease (MAFLD) remains unclear. We aimed to characterize the lipid profiles associated with liver fat content (LFC) in MAFLD patients who were overweight, lean/normal weight, or had diabetes
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