Prediction of Shoulder Pain in Youth Competitive Swimmers: The Development and Internal Validation of a Prognostic Prediction Model

Background: Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain. Purpose: To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism. Results: A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94). Conclusion: Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.

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Predictors of perioperative atrial fibrillation in non cardiac elective surgery: the Hart score

EP Europace ◽

10.1093/europace/euab116.151 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

G Stronati ◽

C Mondelli ◽

S Principi ◽

M Silenzi ◽

A Urbinati ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

High Risk ◽

Risk Score ◽

Primary Endpoint ◽

Thyroid Dysfunction ◽

Previous History ◽

Internal Validation ◽

Old Patients ◽

Multivariable Logistic Regression

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Postoperative atrial fibrillation (POAF) is defined as de novo onset of atrial fibrillation in the post operative period, in patients with no previous history of atrial fibrillation. It affects almost 3% of all over 45 year old patients undergoing non cardiovascular surgery and is associated with a higher risk of stroke and mortality. PURPOSE To assess independent predictors of POAF in elective non-cardiac surgery. METHODS Retrospective observational database including all patients attending a cardiological preoperative assessment from the 1st of January 2016 to the 31st of December 2019. The primary endpoint was the occurrence of POAF. Individual predictors of the primary endpoint were tested through a series of multivariable logistic regression models, including only those variables with a p<.01 in the univariable models. Independent predictors were entered into a score, and assigned points according to their odd ratios. Performance of the risk score was tested with the receiver operating characteristic curve. A bootstrap procedure was employed for internal validation of both the multivariable logistic regression model and the risk score, using 10000 bootstrap samples and bias-corrected and accelerated confidence intervals. RESULTS A total of 2048 patients were enrolled (1350 men, age 71 ± 12 years). Fourty-four patients experienced POAF (2.1%) – median 3 days (1st-3rd quartile 2-3 days). Age (OR 1.03 for each year; 95% CI 1.01-1.07), hypertension (OR 3.43; 95% CI 1.22-9.63), thyroid dysfunction (OR 2.70; 95% CI 1.35-5.42) and intermediate or high risk surgery (OR 18.28; 95% CI 2.51-33.09) resulted as independent predictors of POAF (all p < 0.05). We therefore created the HART score according to Table 1 (OR 2.59 for each point; 95% CI 1.79-3.75; p > 0.001). A cut-off score ≥ 5 has a 70% sensitivity and a 72% specificity in detecting POAF in our population (AUC 0.74). Bootstrapping for internal validation confirmed the overall results. CONCLUSIONS A four items point-based risk score such as the HART score, could be effective in implementing effective POAF screening and improve management. The HART score Variable Points H Hypertension 1 point A Age (65-74 years) 1 point Age (75+ years) 2 points R Intermediate Risk surgery 3 points High Risk surgery 3 points T Thyroid dysfunction 1 point

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Swim-Training Volume and Shoulder Pain Across the Life Span of the Competitive Swimmer: A Systematic Review

Journal of Athletic Training ◽

10.4085/1062-6050-439-18 ◽

2020 ◽

Vol 55 (1) ◽

pp. 32-41 ◽

Cited By ~ 3

Author(s):

Stef Feijen ◽

Angela Tate ◽

Kevin Kuppens ◽

Anke Claes ◽

Filip Struyf

Keyword(s):

Life Span ◽

Shoulder Pain ◽

Data Extraction ◽

Age Groups ◽

Supraspinatus Tendon ◽

Training Volume ◽

Competitive Swimming ◽

Competitive Swimmer ◽

The Relationship ◽

Competitive Swimmers

Background Competitive swimmers are exposed to enormous volumes of swim training that may overload the soft tissue structures and contribute to shoulder pain. An understanding of training factors associated with the injury is needed before practice guidelines can be developed. Objectives To investigate the relationship between swim-training volume and shoulder pain and to determine swim-training volume and shoulder pain prevalence across the life span of the competitive swimmer. Data Sources Relevant studies within PubMed, Web of Science, and MEDLINE. Study Selection Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. Data Extraction Twelve studies (N = 1460 participants) met the criteria. Swimmers were grouped by age for analysis: young (<15 years), adolescent (15–17 years), adult (18–22 years), and masters (23–77 years). Data Synthesis Adolescent swimmers showed the highest rates of shoulder pain (91.3%) compared with other age groups (range = 19.4%–70.3%). The greatest swim-training volumes were reported in adolescent (17.27 ± 5.25 h/wk) and adult (26.8 ± 4.8 h/wk) swimmers. Differences in exposure were present between swimmers with and those without shoulder pain in both the adolescent (P = .01) and masters (P = .02) groups. In adolescent swimmers, the weekly swim-training volume (P < .005, P = .01) and years active in competitive swimming (P < .01) correlated significantly with supraspinatus tendon thickness, and all swimmers with tendon thickening experienced shoulder pain. Conclusions Evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers (level II conclusion). Year-round monitoring of the athlete's swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume. However, additional high-quality studies are needed to determine cutoff values in order to make data-based decisions regarding the influence of swim training.

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A study protocol for the development and internal validation of a multivariable prognostic model to determine lower extremity muscle injury risk in elite football (soccer) players, with further exploration of prognostic factors

Diagnostic and Prognostic Research ◽

10.1186/s41512-019-0063-8 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 2

Author(s):

Tom Hughes ◽

Richard Riley ◽

Jamie C. Sergeant ◽

Michael J. Callaghan

Keyword(s):

Logistic Regression ◽

Prognostic Factors ◽

Clinical Reasoning ◽

Prognostic Model ◽

Model Development ◽

Health Examination ◽

Prevention Strategies ◽

Internal Validation ◽

Risk Estimates ◽

Multivariable Logistic Regression

Abstract Background Indirect muscle injuries (IMIs) are a considerable burden to elite football (soccer) teams, and prevention of these injuries offers many benefits. Preseason medical, musculoskeletal and performance screening (termed periodic health examination (PHE)) can be used to help determine players at risk of injuries such as IMIs, where identification of PHE-derived prognostic factors (PF) may inform IMI prevention strategies. Furthermore, using several PFs in combination within a multivariable prognostic model may allow individualised IMI risk estimation and specific targeting of prevention strategies, based upon an individual’s PF profile. No such models have been developed in elite football and the current IMI prognostic factor evidence is limited. This study aims to (1) develop and internally validate a prognostic model for individualised IMI risk prediction within a season in elite footballers, using the extent of the prognostic evidence and clinical reasoning; and (2) explore potential PHE-derived PFs associated with IMI outcomes in elite footballers, using available PHE data from a professional team. Methods This is a protocol for a retrospective cohort study. PHE and injury data were routinely collected over 5 seasons (1 July 2013 to 19 May 2018), from a population of elite male players aged 16–40 years old. Of 60 candidate PFs, 15 were excluded. Twelve variables (derived from 10 PFs) will be included in model development that were identified from a systematic review, missing data assessment, measurement reliability evaluation and clinical reasoning. A full multivariable logistic regression model will be fitted, to ensure adjustment before backward elimination. The performance and internal validation of the model will be assessed. The remaining 35 candidate PFs are eligible for further exploration, using univariable logistic regression to obtain unadjusted risk estimates. Exploratory PFs will also be incorporated into multivariable logistic regression models to determine risk estimates whilst adjusting for age, height and body weight. Discussion This study will offer insights into clinical usefulness of a model to predict IMI risk in elite football and highlight the practicalities of model development in this setting. Further exploration may identify other relevant PFs for future confirmatory studies and model updating, or influence future injury prevention research.

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Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy

International Urology and Nephrology ◽

10.1007/s11255-021-02809-7 ◽

2021 ◽

Author(s):

Mike Wenzel ◽

Felix Preisser ◽

Matthias Mueller ◽

Lena H. Theissen ◽

Maria N. Welte ◽

...

Keyword(s):

Logistic Regression ◽

Radical Prostatectomy ◽

Regression Models ◽

Urethral Sphincter ◽

Anatomical Characteristics ◽

Logistic Regression Models ◽

Pad Test ◽

Type D ◽

Multivariable Logistic Regression ◽

Type C

Abstract Purpose To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.

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Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

Therapeutic Advances in Urology ◽

10.1177/1756287220984046 ◽

2021 ◽

Vol 13 ◽

pp. 175628722098404

Author(s):

Xudong Guo ◽

Hanbo Wang ◽

Yuzhu Xiang ◽

Xunbo Jin ◽

Shaobo Jiang

Keyword(s):

Logistic Regression ◽

Renal Disease ◽

Complication Rate ◽

Adverse Outcomes ◽

Laparoscopic Nephrectomy ◽

Multivariable Logistic Regression Analysis ◽

Invasive Approach ◽

Intraoperative Complication ◽

Multivariable Logistic Regression ◽

Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

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The influence of comorbid depression and overweight status on peripheral inflammation and cortisol levels

Psychological Medicine ◽

10.1017/s0033291721000088 ◽

2021 ◽

pp. 1-8

Author(s):

Anna P. McLaughlin ◽

Naghmeh Nikkheslat ◽

Caitlin Hastings ◽

Maria A. Nettis ◽

Melisa Kose ◽

...

Keyword(s):

Logistic Regression ◽

Significant Risk ◽

Normal Weight ◽

Cortisol Awakening Response ◽

Peripheral Inflammation ◽

Comorbid Depression ◽

Diurnal Cortisol ◽

Overweight Status ◽

Multivariable Logistic Regression ◽

Cortisol Levels

Abstract Background Depression and overweight are each associated with abnormal immune system activation. We sought to disentangle the extent to which depressive symptoms and overweight status contributed to increased inflammation and abnormal cortisol levels. Methods Participants were recruited through the Wellcome Trust NIMA Consortium. The sample of 216 participants consisted of 69 overweight patients with depression; 35 overweight controls; 55 normal-weight patients with depression and 57 normal-weight controls. Peripheral inflammation was measured as high-sensitivity C-Reactive Protein (hsCRP) in serum. Salivary cortisol was collected at multiple points throughout the day to measure cortisol awakening response and diurnal cortisol levels. Results Overweight patients with depression had significantly higher hsCRP compared with overweight controls (p = 0.042), normal-weight depressed patients (p < 0.001) and normal-weight controls (p < 0.001), after controlling for age and gender. Multivariable logistic regression showed that comorbid depression and overweight significantly increased the risk of clinically elevated hsCRP levels ⩾3 mg/L (OR 2.44, 1.28–3.94). In a separate multivariable logistic regression model, overweight status contributed most to the risk of having hsCRP levels ⩾3 mg/L (OR 1.52, 0.7–2.41), while depression also contributed a significant risk (OR 1.09, 0.27–2). There were no significant differences between groups in cortisol awakening response and diurnal cortisol levels. Conclusion Comorbid depression and overweight status are associated with increased hsCRP, and the coexistence of these conditions amplified the risk of clinically elevated hsCRP levels. Overweight status contributed most to the risk of clinically elevated hsCRP levels, but depression also contributed to a significant risk. We observed no differences in cortisol levels between groups.

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Predictors of Anxiety-Induced Sleep Disturbance among in-School Adolescents in Ghana: Evidence from the 2012 Global School-Based Health Survey

Behavioral Sciences ◽

10.3390/bs11020020 ◽

2021 ◽

Vol 11 (2) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Bright Opoku Ahinkorah ◽

Richard Gyan Aboagye ◽

Francis Arthur-Holmes ◽

Abdul-Aziz Seidu ◽

James Boadu Frimpong ◽

...

Keyword(s):

Logistic Regression ◽

Sleep Disturbance ◽

Emotional Disorders ◽

Health Survey ◽

Safety Concern ◽

Statistical Significance ◽

Outcome Variable ◽

Multivariable Logistic Regression Analysis ◽

School Based ◽

Multivariable Logistic Regression

(1) Background: Psychological problems of adolescents have become a global health and safety concern. Empirical evidence has shown that adolescents experience diverse mental health conditions (e.g., anxiety, depression, and emotional disorders). However, research on anxiety-induced sleep disturbance among in-school adolescents has received less attention, particularly in low- and middle-income countries. This study’s central focus was to examine factors associated with t anxiety-induced sleep disturbance among in-school adolescents in Ghana. (2) Methods: Analysis was performed using the 2012 Global School-based Health Survey (GSHS). A sample of 1342 in-school adolescents was included in the analysis. The outcome variable was anxiety-induced sleep disturbance reported during the past 12 months. Frequencies, percentages, chi-square, and multivariable logistic regression analyses were conducted. Results from the multivariable logistic regression analysis were presented as crude and adjusted odds ratios at 95% confidence intervals (CIs) and with a statistical significance declared at p < 0.05. (3) Results: Adolescents who went hungry were more likely to report anxiety-induced sleep disturbance compared to their counterparts who did not report hunger (aOR = 1.68, CI = 1.10, 2.57). The odds of anxiety-induced sleep disturbance were higher among adolescents who felt lonely compared to those that never felt lonely (aOR = 2.82, CI = 1.98, 4.01). Adolescents who had sustained injury were more likely to have anxiety-induced sleep disturbance (aOR = 1.49, CI = 1.03, 2.14) compared to those who had no injury. Compared to adolescents who never had suicidal ideations, those who reported experiencing suicidal ideations had higher odds of anxiety-induced sleep disturbance (aOR = 1.68, CI = 1.05, 2.71). (4) Conclusions: Anxiety-induced sleep disturbance among in-school adolescents were significantly influenced by the psychosocial determinants such as hunger, loneliness, injury, and suicidal ideation in this study. The findings can help design appropriate interventions through effective strategies (e.g., early school-based screening, cognitive-behavioral therapy, face-face counseling services) to reduce psychosocial problems among in-school adolescents in Ghana.

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Efficacy and safety of 5 mg olanzapine for nausea and vomiting management in cancer patients receiving carboplatin: integrated study of three prospective multicenter phase II trials

BMC Cancer ◽

10.1186/s12885-021-08572-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Senri Yamamoto ◽

Hirotoshi Iihara ◽

Ryuji Uozumi ◽

Hitoshi Kawazoe ◽

Kazuki Tanaka ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cancer Patients ◽

Phase Ii ◽

Low Dose ◽

Nausea And Vomiting ◽

Efficacy And Safety ◽

Multivariable Logistic Regression ◽

Related Risk ◽

Total Control

Abstract Background The efficacy of olanzapine as an antiemetic agent in cancer chemotherapy has been demonstrated. However, few high-quality reports are available on the evaluation of olanzapine’s efficacy and safety at a low dose of 5 mg among patients treated with carboplatin regimens. Therefore, in this study, we investigated the efficacy and safety of 5 mg olanzapine for managing nausea and vomiting in cancer patients receiving carboplatin regimens and identified patient-related risk factors for carboplatin regimen-induced nausea and vomiting treated with 5 mg olanzapine. Methods Data were pooled for 140 patients from three multicenter, prospective, single-arm, open-label phase II studies evaluating the efficacy and safety of olanzapine for managing nausea and vomiting induced by carboplatin-based chemotherapy. Multivariable logistic regression analyses were performed to determine the patient-related risk factors. Results Regarding the endpoints of carboplatin regimen-induced nausea and vomiting control, the complete response, complete control, and total control rates during the overall study period were 87.9, 86.4, and 72.9%, respectively. No treatment-related adverse events of grade 3 or higher were observed. The multivariable logistic regression models revealed that only younger age was significantly associated with an increased risk of non-total control. Surprisingly, there was no significant difference in CINV control between the patients treated with or without neurokinin-1 receptor antagonist. Conclusions The findings suggest that antiemetic regimens containing low-dose (5 mg) olanzapine could be effective and safe for patients receiving carboplatin-based chemotherapy.

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Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Diagnostic and Prognostic Research ◽

10.1186/s41512-020-00089-w ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Jessica K. Sexton ◽

Michael Coory ◽

Sailesh Kumar ◽

Gordon Smith ◽

Adrienne Gordon ◽

...

Keyword(s):

Logistic Regression ◽

Prediction Model ◽

Risk Prediction ◽

Late Pregnancy ◽

Risk Prediction Model ◽

Past Century ◽

Reporting Standards ◽

Robust Method ◽

Predictive Values ◽

Multivariable Logistic Regression

Abstract Background Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around the timing of birth to reduce the risk of stillbirth from 35 weeks of gestation in Australia, a high-resource setting. Methods This is a protocol for a cross-sectional study of all late-pregnancy births in Australia (2005–2015) from 35 weeks of gestation including 5188 stillbirths among 3.1 million births at an estimated rate of 1.7 stillbirths per 1000 births. A multivariable logistic regression model will be developed in line with current TransparentReporting of a multivariable prediction model forIndividualPrognosis orDiagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be described through univariable regression analysis. To generate a final model, elimination by backward stepwise multivariable logistic regression will be performed. The model will be internally validated using bootstrapping with 1000 repetitions and externally validated using a temporally unique dataset. Overall model performance will be assessed with R2, calibration, and discrimination. Calibration will be reported using a calibration plot with 95% confidence intervals (α = 0.05). Discrimination will be measured by the C-statistic and area underneath the receiver-operator curves. Clinical usefulness will be reported as positive and negative predictive values, and a decision curve analysis will be considered. Discussion A robust method to predict a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for obstetric use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards.

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Liver fat content is independently associated with microalbuminuria in a normotensive, euglycaemic Chinese population: a community-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-044237 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044237

Author(s):

Xiaoming Li ◽

Mingfeng Xia ◽

Hui Ma ◽

Yu Hu ◽

Hongmei Yan ◽

...

Keyword(s):

Logistic Regression ◽

Blood Glucose ◽

Density Lipoprotein ◽

Fat Content ◽

Lipoprotein Cholesterol ◽

Liver Fat ◽

Community Based ◽

Liver Fat Content ◽

Cross Sectional ◽

Multivariable Logistic Regression

ObjectiveNon-alcoholic fatty liver disease (NAFLD) is associated with microalbuminuria (MA) in patients with diabetes/pre-diabetes. Whether this association is mediated by blood glucose and blood pressure (BP) remains unclear. This study investigated whether liver fat content (LFC) was associated with MA in a normotensive and non-diabetic population.DesignA cross-sectional substudy.SettingsLFC was determined from the hepatic/renal echogenicity ratio at ultrasound. MA was defined as an albumin-to-creatinine ratio (ACR) of 30–300 µg/mg (early- morning urine sample). Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate LFC as a predictor of MA.ParticipantsBetween May 2010 and June 2011, this cross-sectional, community-based study enrolled residents from Shanghai (China), aged ≥40 years and with normal glucose tolerance and BP.ResultsA total of 550 residents (median age, 57 years; 174 men) were enrolled and stratified according to LFC quartiles. ACR (p<0.001) and MA prevalence (p=0.012) increased across the LFC quartiles. Multivariable logistic regression showed that the OR for MA (per SD increase in LFC) was 1.840 (95% CI 1.173 to 2.887, p=0.008) after adjustment for potential confounders including age, gender, waist-hip ratio, blood urea nitrogen, systolic and diastolic BP, fasting blood glucose, postprandial glucose, low-density lipoprotein-cholesterol, triglycerides, high-density lipoprotein-cholesterol, total cholesterol, estimated glomerular filtration rate and lipid-lowering drugs. The ROC analysis revealed that the optimal LFC cut-off value for predicting MA was 6.82%.ConclusionLFC is independently associated with MA in normotensive, euglycaemic middle-aged and elderly Chinese individuals. Screening for MA in people with NAFLD might facilitate early intervention to minimise kidney disease risk.

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