Many studies investigated the association between nonalcoholic fatty liver disease (NALFD) and cardiovascular diseases. However, the relationship between NAFLD and cerebral small vessel disease has not been thoroughly investigated yet. A total of 1283 participants from health promotion center cohort were included in analysis. The cerebral SVD burdens were assessed with white matter hyperintensities (WMH), lacunes, and microbleeds (MB). US diagnosis of fatty liver was made based on standard criteria, and NFS was used to assess severity of fibrosis and to classify participants with NAFLD in two groups: high-intermediate (NFS ≥ -1.455) and low probability (NFS < -1.455) of advanced fibrosis. Multivariable logistic regression was used to assess the association between NAFLD and severity of WMH, and presence of lacunes and MB after controlling for age, sex, smoking, alcohol, Body mass index, intracranial volume, systolic blood pressure, LDL cholesterol, use of lipid lowering medications, use of antidiabetic medications, and use of antihypertensive medications. The association of NAFLD with the severity of WMH was also explored in clinically relevant subgroups, and the interaction of NAFLD with clinical characteristics was tested using Wald tests for cross-product terms in regression models. NAFLD had a significant association with WMH severity but not with presence of lacunes nor MB. Multivariable logistic regression showed that compared to participants without NAFLD, participants with NAFLD had more frequent moderate to severe WMH. compared to participants without NAFLD, the OR for WMH in participants with low NFS and with intermediate to high NFS were 0.97 (0.57, 1.65) and 2.12 (1.44, 3.12), respectively. Especially, linear trend tests showed a significant trend for more severe WMH among non-NAFLD, NAFLD with low NFS and NAFLD with high NFS (P for trend <0.001). The positive association between NAFLD and WMH was prominent in the subgroups with middle age, female, low education, and non-obesity. Our findings suggested that NAFLD has a significant association with moderate to severe WMH in cognitively normal individuals and NAFLD severity also predicted more severe WMH. Odds ratios for prevalence of moderate or severe white matter hyperintensity by non-alcoholic fatty liver disease status in predefined subgroups.* Adjusted for age and sex, body mass index (underweight, normal, overweight, and obese), education (< middle school and ≥ middle school), smoking (never, former or current, and missing), and alcohol (none, and moderate), systolic blood pressure, fasting glucose, LDL cholesterol, use of diabetes medication use of antihyperlipidemia medication, and use of antihypertensive medication.
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