Abstract 52: Associations of Nonalcoholic Fatty Liver Disease with Subclinical Myocardial Dysfunction: The CARDIA Study

Background: Nonalcoholic fatty liver disease (NAFLD) is an obesity-related condition with high cardiovascular morbidity. NAFLD patients often have echocardiographic features of left ventricular (LV) diastolic dysfunction. In a large population-based cross-sectional sample of black and white adults free from prevalent liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical myocardial dysfunction independent of BMI or visceral adipose tissue (VAT). Methods: Participants from the Coronary Artery Risk Development in Young Adults study (Y25 exam; age 43-55 years) with concurrent CT quantification of liver fat and tissue Doppler echocardiography with myocardial strain measured by speckle tracking were included (n=2,572). NAFLD was defined as liver attenuation ≤ 40 Hounsfield units after exclusion of other causes of liver fat (medication/alcohol use). Linear regression models were used to test associations. Results: NAFLD prevalence was 9.9%. NAFLD participants were more likely to be male (57.1% vs. 41.5%), white (57.5% vs. 50.6%), and had higher BMI (36.3 vs. 29.8 kg/m2) and VAT (222.4 vs. 120.5 cm3) than non-NAFLD. Those with NAFLD also had lower e’ tissue velocity (10.8 vs. 11.9 cm/s), lower E/A ratio (1.2 vs. 1.3), and higher E/e’ ratio (8.4 vs. 7.7). Increased LV mass, left atrial area, LV relative wall thickness, and cardiac output (CO) were present in NAFLD. Global longitudinal strain was also worse in NAFLD (-14.2% vs. -15.2%, all p<0.05). In multivariable analyses adjusted for demographics, health behaviors and BMI, the associations of NAFLD with markers of subclinical myocardial dysfunction were attenuated but remained significant (Table 1). Only e’ velocity, LV mass and CO remained significant after adjustment for VAT. Effect modification by race and sex was not statistically significant. Conclusion: NAFLD is associated with subclinical myocardial dysfunction independent of BMI. Attenuation of the relationship by VAT supports the hypothesis that VAT may be a marker of NAFLD.

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Abstract P224: Association of Nonalcoholic Fatty Liver Disease With Left Ventricular Geometry and Remodeling: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽

10.1161/circ.135.suppl_1.p224 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Lisa B VanWagner ◽

Jane E Wilcox ◽

Hongyan Ning ◽

Cora E Lewis ◽

Sanjiv J Shah ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Left Ventricular ◽

Liver Fat ◽

Nonalcoholic Fatty Liver ◽

Lv Mass ◽

Lv Remodeling ◽

The Relationship

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with high cardiovascular mortality, including heart failure (HF). Left ventricular hypertrophy (LVH) increases the risk of future HF. The relationship between NAFLD and LV geometry is unknown. In a large prospective population-based sample of black and white adults free from liver or heart disease, we examined the relationship between NAFLD and markers of LV remodeling. Methods: Participants from the CARDIA study (Y25 exam; age 43-55 years) with concurrent CT quantification of liver fat and tissue Doppler echocardiography were included (n=2,576). Echocardiography was repeated at Y30 follow up (age 47-62 years). LV geometry was classified into normal and abnormal geometry by integrating relative wall thickness and LV mass index. NAFLD was defined as CT liver attenuation ≤ 40 Hounsfield units after excluding other causes of liver fat. Logistic and polytomous regression models were used to test associations. Results: NAFLD prevalence was 9.6%. NAFLD participants were more likely to be male (57.7% vs. 40.0%), white (57.3% vs. 50.2%), and had higher BMI (36.0 vs. 29.9 kg/m 2 ) than non-NAFLD. At Y30 NAFLD participants had higher LV mass, left atrial diameter, and LV relative wall thickness compared to non-NAFLD (p<0.01). Those with NAFLD had higher prevalence of LVH (31.9% vs. 18.2%), concentric remodeling (15.3% vs. 13.1%), concentric hypertrophy (12.9% vs. 7.9%) and eccentric hypertrophy (18.9% vs. 10.1%, p<0.0001). In multivariable analyses NAFLD was independently associated with prevalent LV remodeling (Table). Associations were attenuated after adjustment for HF risk factors. In contrast, NAFLD was associated with incident LVH independent of HF risk factors. Adjustment for BMI attenuated this association. There was no interaction by race or sex. Conclusion: NAFLD is associated with subclinical changes in LV geometry and remodeling, a precursor to HF. The role of NAFLD in LV remodeling as a potential therapeutic target warrants further investigation.

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Effect of Dulaglutide on Liver Fat in Patients with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial (D-LIFT Trial)

SSRN Electronic Journal ◽

10.2139/ssrn.3582791 ◽

2020 ◽

Author(s):

Mohammad Kuchay ◽

Sonal Krishan ◽

Sunil Kumar Mishra ◽

Narendra Singh Choudhary ◽

Manish Kumar Singh ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Controlled Trial ◽

Liver Fat ◽

Nonalcoholic Fatty Liver ◽

Randomized Controlled

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Abstract 05: Association of 25-Year Body Mass Index Trajectories Throughout Early Adulthood With Nonalcoholic Fatty Liver Disease in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽

10.1161/circ.135.suppl_1.05 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Lisa B VanWagner ◽

Sadiya Khan ◽

Hongyan NIng ◽

Juned Siddique ◽

Cora E Lewis ◽

...

Keyword(s):

Body Mass Index ◽

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Body Mass ◽

Fatty Liver Disease ◽

Early Adulthood ◽

Liver Fat ◽

Nonalcoholic Fatty Liver ◽

Bmi Trajectory

Background: Nonalcoholic Fatty Liver Disease (NAFLD) has increased in parallel with obesity, is a risk factor for cirrhosis and liver cancer, and has few effective treatments. Identifying modifiable risk factors for NAFLD development is essential to effectively design prevention programs. We tested whether trajectories of body mass index (BMI) change throughout early adulthood were associated with risk of prevalent NAFLD in midlife independent of current BMI. Methods: Participants from the CARDIA study, a prospective multicenter population-based biracial cohort of adults (baseline age 18-30 years), underwent BMI measurement at exam years 0, 2, 5, 7, 10, 15, 20, and 25. At Year 25 (Y25, 2010-2011), liver fat was assessed by computed tomography. NAFLD was identified after exclusion of other causes of liver fat (alcohol/hepatitis). Latent mixture modeling was used to identify 25-year trajectories in BMI percent (%) change relative to baseline BMI over time. Multivariable logistic regression models were used to assess associations between BMI trajectory group and prevalent NAFLD with adjustment for baseline or current Y25 BMI. Results: Among 4,423 participants, we identified 4 distinct trajectories of BMI %change: stable BMI (26.2% of the cohort, 25-year mean BMI Δ=0.7 kg/m 2 ), mild increase (46.0%, BMI Δ=5.2 kg/m 2 ), moderate increase (20.9%, BMI Δ=10.0 kg/m 2 ), and extreme increase (6.9%, BMI Δ=15.1 kg/m 2 ) (Figure). NAFLD prevalence at Y25 was higher with increasing BMI trajectory: 4.1%, 9.3%, 13.0%, and 17.6% (p-trend <0.0001). At baseline, 34.6% of participants had overweight or obesity. After adjustment for confounders, trajectories of greater BMI increase were associated with greater NAFLD prevalence independent of baseline or current Y25 BMI (Figure). Conclusion: Weight gain throughout adulthood is associated with greater prevalence of NAFLD in midlife independent of baseline or current BMI. These findings highlight weight maintenance throughout adulthood as a potential target for primary prevention of NAFLD.

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