维生素摄入量与代谢相关脂肪性肝病进程的相关性分析

The association between vitamin intake and the progression of metabolic dysfunction⁃associated fatty liver disease

目的 探讨膳食多种维生素摄入量与代谢相关脂肪性肝病(metabolic dysfunction-associated fatty liver disease, MAFLD)个体肝纤维化风险及全因死亡率之间的相关性。方法 从美国第三次国家健康和营养检查调查(National Health and Nutrition Examination Surveys,NHANES)中获取相关数据,并采用24 h饮食回顾法评估膳食维生素摄入情况,包括维生素A、维生素B1、维生素B6、维生素B12、维生素C、维生素D、核黄素、叶酸和α-生育酚。非酒精性脂肪性肝病纤维化评分(non-alcoholic fatty liver disease fibrosis score,NFS)<-1.455被定义为非高级别纤维化,NFS≥-1.455被定义为高级别纤维化。结果 共纳入3 844例MAFLD个体,中位随访时间为25年10个月,其中1 739例(45.3%)个体在随访期间死亡。非高级别纤维化个体的维生素B1、核黄素、α-生育酚、VB6和VB12摄入量显著高于对照组(P <0.05)。调整风险因素后,α-生育酚摄入量最高四分位数组(> 11.5 mg/d)的纤维化风险明显低于摄入量最低四分位数组(P=0.031)。与VC摄入量最低四分位数组相比,最高四分位数组(> 130 mg/d)的死亡率降低了0.34倍(HR:0.66, 95%CI:0.51~0.85, P=0.001)。结论 摄入更多α-生育酚可减轻MAFLD个体的纤维化,摄入更多VC可降低MAFLD个体的全因死亡率。

Objective There is a Few studies explored the association between vitamin intake and meta-bolic dysfunction-associated fatty liver disease(MAFLD),while the existing results were still contradictory.This study aimed to investigate the association between dietary vitamins and all-cause mortality as well as fibrosis risk in patients with MAFLD.Methods The data were extracted from the third National Health and Nutrition Examination Surveys 1988-1994.Dietary vitamins was assessed using a 24 h diet recall,including vitamin A,vitamin B6,vitamin B12,vitamin C,vitamin D,thiamin,riboflavin,folic acid andα-tocopherol.The non-alcoholic fatty liver disease fibrosis score(NFS)<-1.455 was considered as non-advanced fibrosis,while NFS≥-1.455 was considered as advanced fibrosis.Results A total of 3844 MAFLD participants were included in this study.The median time of follow-up was 310 months.1739 participants(45.3%)were deceased during the follow-up.The intake of thiamin,riboflavin,α-tocopherol,VB6,and VB12 were significantly higher in patients with NFS-determined non-advanced fibrosis(P<0.05).After adjusting,a significantly lower risk of fibrosis was found in patients with the highest quartile(>11.5 mg/d)ofα-tocopherol intake compared to the lowest intake group(P=0.031).Compared to the lowest quartile group,the risk of mortality was reduced by 0.34 folds in the group consuming the highest quartile amount(>130 mg/d)of VC(HRs:0.66,95%CI:0.51~0.85,P=0.001).Conclusions Moreα-tocopherol intake reduced fibrosis grade in MAFLD patients.VC intake may reduce all-cause mortality in patients with MAFLD.