Obesity is an important determinant of severity in newly defined metabolic dysfunction-associated fatty liver disease

Background: The recently proposed definition of metabolic dysfunction-associated fatty liver disease(MAFLD) is based on the co-existence of hepatic steatosis with other metabolic disorders, including obesity and metabolic risk abnormalities such as hyperglycemia, high blood pressure and dyslipidemia. This study aimed to assess MAFLD severity according to the presence of metabolic abnormalities and obesity. Methods: Using transient elastography, hepatic steatosis and fibrosis severity were assessed by measuring the controlled attenuation parameter and liver stiffness measurement. A total of 1163 patients with MAFLD were categorized into the following four groups according to metabolic risk abnormalities and obesity presence: non-obese without metabolic risk abnormality group(Group 1;reference group);nonobese with metabolic risk abnormality group(Group 2);obese without metabolic risk abnormality group(Group 3);and obese with metabolic risk abnormality group(Group 4). A multiple logistic regression analysis was performed to determine severe hepatic steatosis and fibrosis risk in each group in both unadjusted and adjusted models. Results: In the adjusted model, the odds ratios(ORs) [95% confidence interval(CI)] for severe hepatic steatosis in Groups 2, 3, and 4 were 1.07(0.61-1.88), 2.43(1.44-4.08), and 4.07(2.56-6.48), respectively( P trend < 0.001). For liver fibrosis, compared with Group 1, Group 2 showed no significant increases in OR, whereas Groups 3 and 4(obese groups) showed significant increases(OR = 4.70, 95% CI: 1.24-17.82 and OR = 6.43, 95% CI: 1.88-22.02, respectively). Conclusions: Obesity, rather than metabolic abnormality, is the principal determinant of severe hepatic steatosis and fibrosis in patients with MAFLD.

Cholecystectomy increases the risk of metabolic syndrome in the Korean population:a longitudinal cohort study

Background:Cholecystectomy is a common surgical procedure to treat symptomatic gallstones;however,the long-term outcomes after cholecystectomy are unknown.Therefore,we aimed to investigate whether incident metabolic syndrome(MetS)is associated with cholecystectomy through a large,population-based,longitudinal study.Methods:Subjects aged≥20 years who underwent cholecystectomy from 2010 to 2014(n=76,485)and controls(n=76,485),matched for age and sex,were identified from the Korean National Health Insurance Corporation.Cox proportional hazards analyses were performed to evaluate the association between cases and incident MetS,and hazard ratios and 95% confidence intervals(CIs)were calculated.Results:A total of 152,970 patients were included.Mean age was 52.47±12.76 years,and 50.65% of participants were male.During the follow-up period,there were 38,979(25.48%)newly diagnosed MetS cases in the study participants.The risk of MetS in the cholecystectomy group was approximately 20% higher than that in the control group[adjusted odds ratio(OR),1.20;95%CI:1.17-1.23].In the fully adjusted models,the corresponding ORs for new-onset high waist circumference(WC),low high-density lipoprotein cholesterol(HDL-C)levels,high triglycerides(TG)levels,high blood pressure(BP),and high blood glucose levels were 1.16(1.13-1.19),1.19(1.16-1.22),1.25(1.22-1.28),1.27(1.23-1.31),and 1.21(1.18-1.24),respectively.Cholecystectomy was an independent risk factor of incident MetS,after adjusting for potential confounding factors.In the subgroup analyses,the cholecystectomy group had a higher risk of MetS than the control group in subjects without hypertension or dyslipidemia,respectively.Conclusions:In this large,population-based study,cholecystectomy was associated with an increased risk of developing MetS,independent of other confounding factors.Therefore,careful monitoring of metabolic variables and long-term follow-up are required to evaluate MetS risk after cholecystectomy.