背景:代谢功能障碍相关的脂肪变性肝病(MASLD)在肥胖人群中非常普遍。我们旨在研究MASLD患者体重指数(BMI)与临床预后的关系。
方法:对32,900名MASLD患者进行回顾性队列研究,通过美国大型卫生系统的电子健康记录中的国际疾病分类-9和10个代码识别,平均随访5.5年(范围:1-15年),分为6个BMI类别,<25、25-<30、30-<40、40-<50和≥50kg/m2。
结果:肝脏失代偿和肝外肥胖相关癌症的风险呈J形分布(线性和二次项的ps均<0.05)。与BMI25-<30kg/m2的患者相比,BMI<25和BMI≥50kg/m2的患者的肝脏失代偿调整后的HR(95%CIs)分别为1.44(1.17-1.77)和2.27(1.66-3.00),分别。肥胖相关肝外癌的相应数字为1.15(0.97-1.36)和1.29(1.00-1.76)。BMI与肝移植和非肥胖相关癌症呈负相关(均为线性术语<0.05),但与HCC或所有类型的癌症合并无关。观察到BMI与全因死亡率之间类似的J形关联;BMI<25和≥50kg/m2的调整后的HR(95%CIs)为1.51(1.32-1.72)和3.24(2.67-3.83),分别,与BMI25-<30kg/m2(线性和二次项的ps均<0.001)相比。
结论:患有MASLD和极重度肥胖(BMI≥50kg/m2)的患者风险最高,超过瘦MASLD患者,发展为肝脏失代偿,肥胖相关的肝外癌症,或因任何原因而死亡。
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with obesity. We aimed to study the association of body mass index (BMI) with clinical outcomes in patients with MASLD.
METHODS: A retrospective cohort of 32,900 patients with MASLD, identified through the International Classification of Diseases-9 and 10 codes within the electronic health records of a large US-based health system, with a mean follow-up of 5.5 years (range: 1-15 y), was stratified into 6 BMI categories, <25, 25-<30, 30-<40, 40-<50, and ≥50 kg/m2.
RESULTS: The risk of liver decompensation and extrahepatic obesity-associated cancers had a J-shaped profile (both ps for linear and quadratic terms <0.05). Compared to patients with BMI 25-<30 kg/m2, the adjusted HRs (95% CIs) for liver decompensation of patients with BMI <25 and BMI ≥50 kg/m2 were 1.44 (1.17-1.77) and 2.27 (1.66-3.00), respectively. The corresponding figures for obesity-associated extrahepatic cancer were 1.15 (0.97-1.36) and 1.29 (1.00-1.76). There was an inverse association for BMI with liver transplantation and non-obesity-associated cancer (both ps for linear terms <0.05), but no association with HCC or all types of cancers combined. A similar J-shaped association between BMI and all-cause mortality was observed; adjusted HRs (95% CIs) for BMI <25 and ≥50 kg/m2 were 1.51 (1.32-1.72) and 3.24 (2.67-3.83), respectively, compared with BMI 25-<30 kg/m2 (both ps for linear and quadratic terms <0.001).
CONCLUSIONS: Patients with MASLD and very severe obesity (BMI ≥50 kg/m2) had the highest risk, exceeding that of patients with lean MASLD, for developing liver decompensation, obesity-associated extrahepatic cancers, or dying from any cause.