代谢功能障碍相关的脂肪肝(MAFLD)和慢性肾脏疾病(CKD)提出了显着的健康挑战,然而,尽管腹部肥胖在加剧这些疾病中具有潜在的作用,但它却很少受到关注。因此,我们使用1988年至1994年美国的国家健康和营养检查调查III(NHANESIII)进行了一项回顾性队列研究,包括9161名参与者。2019年死亡率随访调查。统计分析包括单变量和多变量Logistic和Cox回归模型,和协变量调整后的中介效应分析应用于研究。我们的发现显示,同时患有腹部肥胖和MAFLD的个体更可能是女性,年龄较大,晚期肝纤维化患病率较高(7.421%vs.2.363%,p<0.001),2型糖尿病(T2DM)(21.484%vs.8.318%,p<0.001)和CKD(30.306%与16.068%,p<0.001)与单独使用MAFLD的那些相比。MAFLD(调整后OR:1.392,95%CI1.013-1.913,p=0.041),腹部肥胖(校正OR1.456,95%CI1.127-1.880,p=0.004),腹部肥胖伴MAFLD(校正OR1.839,95%CI1.377-2.456,p<0.001),晚期纤维化(校正OR1.756,95%CI1.178-2.619,p=0.006)和T2DM(校正OR2.365,95%CI1.758-3.183,p<0.001)是CKD的独立危险因素。在30年的随访期内,腹部肥胖MAFLD组的全因死亡率以及按疾病分类的死亡率最高。测量腹部肥胖的指数,如腰围(WC),腰臀比(WHR),和脂质积累产物(LAP),与BMI对CKD的影响相比,MAFLD对CKD的调解作用更大(比例调解65.23%,70.68%,71.98%,分别与32.63%)。总之,腹型肥胖和MAFLD并存会增加CKD的患病率和死亡率,腹部肥胖在MAFLD和CKD之间的关系中起中介作用。
Metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) present notable health challenges, however, abdominal obesity has received scant attention despite its potential role in exacerbating these conditions. Thus, we conducted a retrospective cohort study using the National Health and Nutrition Examination Surveys III (NHANES III) of the United States from 1988 to 1994 including 9161 participants, and mortality follow-up survey in 2019. Statistical analyze including univariable and multivariable Logistic and Cox regression models, and Mediation effect analyze were applied in study after adjustment for covariates. Our findings revealed that individuals with both abdominal obesity and MAFLD were more likely to be female, older and exhibit higher prevalence of advanced liver fibrosis (7.421% vs. 2.363%, p < 0.001), type 2 diabetes mellitus (T2DM) (21.484% vs. 8.318%, p < 0.001) and CKD(30.306% vs. 16.068%, p < 0.001) compared to those with MAFLD alone. MAFLD (adjusted OR: 1.392, 95% CI 1.013-1.913, p = 0.041), abdominal obesity (adjusted OR 1.456, 95% CI 1.127-1.880, p = 0.004), abdominal obesity with MAFLD (adjusted OR 1.839, 95% CI 1.377-2.456, p < 0.001), advanced fibrosis(adjusted OR 1.756, 95% CI 1.178-2.619, p = 0.006) and T2DM (adjusted OR 2.365, 95% CI 1.758-3.183, p < 0.001) were independent risk factors of CKD. The abdominal obese MAFLD group had the highest all-cause mortality as well as mortality categorized by disease during the 30-year follow-up period. Indices for measuring abdominal obesity, such as waist circumference (WC), waist-hip ratio (WHR), and lipid accumulation product (LAP), elucidated a greater mediation effect of MAFLD on CKD compared to BMI on CKD (proportion mediation 65.23%,70.68%, 71.98%, respectively vs. 32.63%). In conclusion, the coexistence of abdominal obesity and MAFLD increases the prevalence and mortality of CKD, and abdominal obesity serves as a mediator in the association between MAFLD and CKD.