| Background:Due to the improvement of health awareness and widespread implementation of gastrointestinal endoscopy,the detected number of individuals with gastric and duodenal polyps increased and accounted for 6%and 4.6%of those examined,respectively.But in most cases,these findings are accidental.Patients with gastroesophageal reflux disease tend to be long-term users of proton pump inhibitors,which were related to the occurrence and development of polyps in the stomach base.The prevalence of polyps increased with the exposure prolongation of proton pump inhibitor.Digestive tract polyps may be neoplastic or non-neoplastic(e.g.,hyperplastic or inflammatory polyps).Given the potential malignant tendency of some digestive tract polyps,endoscopic monitoring or resection may be required.However,not all individuals have access to endoscopic screening or a history of medication.Therefore,it is urgently necessary to identify the risk factors for digestive tract polyps to reliably find subjects at increased risk for polyps so that effective prevention and intervention strategies can be established when appropriate.Obesity is a direct cause or significant risk factor for many gastrointestinal and liver diseases,such as reflux esophagitis,non-alcoholic fatty liver disease,and gallstones.The association between body mass index(BMI)and colorectal adenomatous polyps has been verified in a subset of the population.The study found an increased prevalence of adenomatous polyps in the highest BMI quartile group compared to the lowest BMI quartile group.Metabolic disorders were also significantly associated with the incidence of gastric and colorectal adenomatous polyps.Of note,obesity often naturally coexists with dyslipidemia,insulin resistance and hypertension,suggesting that the increased risk of gastrointestinal polyps in obese people may be related to multiple metabolic abnormalities.But all obesity phenotypes are not created equally.Several prior studies have revealed that a subset of obese individuals without metabolic abnormalities,known as metabolically healthy obesity(MHO),makes up a significant proportion of the obese adult population.Metabolically unhealthy obesity(MUO)is the opposite phenotype.In addition,people with normal weight have a certain proportion of abnormal metabolic phenotype,which is called "metabolically unhealthy nonobese(MUNO)".Consequently,the unique subphenotypic concepts of obesity,such as metabolically healthy nonobese(MHNO),MHO,MUNO and MUO,have raised in response to the proper time and conditions.Recent evidence suggests that obesity phenotype combined with different metabolic profiles seems to be more accurate than obesity alone in predicting the risk of colorectal cancer,suggesting that specific phenotypes can be given clinical attention to prevent and intervene early against gastrointestinal tumors.However,to date,no study has explored the relationship between metabolically defined obesity type and the risk of gastrointestinal polyps as an early symptom of gastrointestinal cancer.Gastrointestinal polyps are different in sex groups,whether the relationship between obesity phenotypes and digestive tract polyps has sex differences is also a problem worth studying.Objective:1.To systematically evaluate the relationship between different obesity phenotypes and the occurrence risk of digestive tract polyps according to obesity and metabolic status.2.To explore whether there are gender differences in the relationship between different obesity phenotypes and polyp occurrence in digestive tract.3.To provide a new angle and evidence to clarify the relationship between obesity,metabolic abnormalities and the occurrence of digestive tract polyps,and to provide a new idea for the identification of high-risk occurrence groups of digestive tract polyps and for clinical prevention and intervention.Methods:1.Study PopulationThe 9278949 adult patients were finally identified in the National inpatient sample(NIS)database after strict inclusion and exclusion criteria,such as patients with serious diseases.2.Data CollectionIndividuals with gastric and duodenal polyps,colon polyps and rectal polyps were identified by using the corresponding International Classification of Diseases-10th Revision-Clinical Modification(ICD-10-CM)diagnostic codes.Demographic data of patients,including information on age,sex,race/ethnicity,smoking and drinking history,and common comorbidities,were also extracted from the database.3.DefinitionObesity was defined as BMI≥25 kg/m2.Metabolically unhealthy individuals were defined as having at least two of the following three components of metabolic syndrome:(1)fasting blood glucose≥6.10 mmol/L;(2)triglycerides≥1.70 mmol/L or high-density lipoprotein cholesterol<1.00 mmol/L;and(3)systolic blood pressure≥130 mmHg or diastolic blood pressure≥85 mmHg.Then,individuals were classified into four categories:(1)MHNO:metabolically healthy nonobese;(2)MHO:metabolically healthy obese;(3)MUNO:metabolically unhealthy nonobese;and(4)MUO:metabolically unhealthy obese.4.Statistical AnalysisContinuous variables conforming to normal distribution were described by mean value(standard deviation).Classification variables are described by counting(percentage).Univariate analysis of variance was used to compare continuous variables,while the chi-square test was used to compare categorical variables.Multiple comparisons were made using Bonferroni correction.Using MHNO,a low-risk group,as the reference,multivariable logistic regression was performed to identify higher risk subgroups of the occurrence of digestive polyps and calculate odd ratio(OR)and 95%confidence interval(95%CI).To report adjusted OR for digestive polyps,four multivariable logistic regression models were generated with age,race,smoking,alcohol consumption,coronary heart disease,liver-related diseases,stomach-related diseases,intestine-related diseases,electrolyte disturbance and the medications(glucocorticoids,antibiotics,antiplatelet agents,opioid analgesics,insulin and oral hypoglycemic agents)as covariates.This study evaluated the relationship between different metabolic obesity phenotypes and the occurrence of digestive tract polyps by gender grouping.In addition,the study population was divided into subgroups according to obesity status combined with hyperlipidemia,hyperglycemia and hypertension and obesity status combined with the number of metabolically unhealthy components.Women were further grouped according to menopausal status to determine independent risk factors for digestive tract polyps in menopausal women.A two-sided p value<0.05 was considered significant.R Studio(2022.12.0+353),R(4.1.1)and SPSS 25.0 software(SPSS Inc.,Chicago,IL,USA)was used to analyze the data.Results:1.Patient characteristics based on metabolic obesity phenotypeCompared with participants with MHNO(54.18±19.62)or MHO(50.87±15.84),those in the MUNO(68.94±13.28)or MUO(61.24±12.83)groups were older(p<0.001).Participants in the MHO categories were more likely to be women than those in the other three categories.The proportion of white people in the MHO group was lower than that in the other three phenotypes(p<0.001).Among the four metabolic obesity phenotypes,the MHNO group had the lowest percentage of smokers(17.01%)and the highest percentage of alcoholics(9.52%).As expected,participants with MUNO or MUO tended to have more metabolic disorders,and the proportion of individuals in these two groups suffering from dyslipidemia and hypertension is more than 90%.2.Prevalence of digestive tract polyps in patients with different metabolic obesity phenotypesCompared with individuals with the MHNO(0.33%)or MHO(0.37%)phenotypes,those with the MUNO(0.50%)and MUO(0.48%)phenotypes had significantly higher prevalence of digestive polyps(p<0.05).Namely,the prevalence of digestive polyps in metabolically unhealthy subjects was higher than that in metabolically healthy subjects,regardless of obesity status.Unexpectedly,a statistically significant difference was not found between MUNO and MUO phenotypes(p>0.05);that is,obesity status seemed to have little effect on the occurrence of digestive polyps in metabolically unhealthy individuals.Regarding stomach and duodenum polyps or colon polyps,individuals with the MHO phenotypes had a significantly higher prevalence of digestive polyps than individuals with the MHNO phenotypes(p<0.05),which suggested that obese subjects are more likely to develop stomach and duodenum polyps or colon polyps than nonobese subjects among metabolically healthy people.3.Independent risk factors for the occurrence of digestive polypsFor stomach,duodenum and colon polyps,multinomial logistic regression model demonstrated that compared with the MHNO phenotype,the MHO,MUNO and MUO phenotypes were all risk factors in the general population,males and females(p<0.001)after adjusting for the potential confounders of age,race,smoking,alcohol consumption,coronary heart disease,liver-related diseases,stomach-related diseases,intestine-related diseases,electrolyte disturbance and the medications(glucocorticoids,antibiotics,antiplatelet agents,opioid analgesics,insulin and oral hypoglycemic agents).In the general population and females,the adjusted odds ratios for rectal polyps remained significantly increased in subjects with the MUNO and MUO phenotypes(all p<0.01).However,only individuals with the MUO phenotype exhibited an increased occurrence of rectal polyps(OR=1.29,95%CI:1.12-1.48,p<0.01)in males.4.Unhealthy phenotypes were independent risk factors for digestive tract polyps in menopausal womenWe found that MHO,MUNO and MUO phenotypes correlated with the occurrence of stomach/duodenum polyps(OR=1.31,95%CI:1.17-1.46,p<0.01;OR=1.20,95%CI:1.13-1.28,p<0.01;OR=1.33,95%CI:1.21-1.46,p<0.01,respectively)and colon polyps(OR=1.29,95%CI:1.18-1.40,p<0.01;OR=1.15,95%CI:1.09-1.21,p<0.01;OR=1.30,95%CI:1.20-1.41,p<0.01,respectively)in menopausal female.The MUNO and MUO phenotypes were independent risk factors for rectal polyps(OR=1.10,95%CI:1.00-1.20,p=0.04;OR=1.21,95%CI:1.06-1.38,p=0.01,respectively)in menopausal female.5.Further in-depth subgroup analysisIn the first grouping of the total study population,our results suggested that the prevalence of digestive polyps in individuals in the BMI<25 kg/m2 and only with hyperlipidemia group or BMI<25 kg/m2 and only with hypertension group was higher than that in the BMI<25 kg/m2 and fewer than one metabolic syndrome component group.However,there was no difference in the prevalence of digestive polyps between the BMI<25 kg/m2 and only with hyperlipidemia group or BMI<25 kg/m2 and only with hypertension group and the BMI≥25 kg/m2 and only with hyperlipidemia group or BMI≥25 kg/m2 and only with hypertension group.Similar results were seen when the analysis was restricted to male or female participants,with the exception of the results for rectal polyps.In the secondary grouping,for the total population,males and females,the prevalence of stomach and duodenum polyps,colon polyps or rectal polyps in nonobese patients with more than one metabolic syndrome component was higher than that in nonobese patients without metabolic abnormalities(p<0.05).Nevertheless,we did not observe any difference in the prevalence of stomach and duodenum polyps,colon polyps or rectal polyps between nonobese individuals with one metabolic abnormality and obese individuals with one metabolic abnormality.The same results were noted in the group with two and three metabolic abnormalities.Conclusion:1.Compared with the MHNO phenotype,the MHO,MUNO and MUO phenotypes were risk factors for stomach and duodenum polyps or colon polyps in the total population,males and females;MUNO and MUO phenotypes were risk factors for rectal polyps in the total population and females.2.Our study indicates that in the general population,the prevalence of digestive tract polyps in metabolically unhealthy subjects was higher than that in metabolically healthy subjects,regardless of obesity status,which suggests that the effect of metabolism on the occurrence of digestive tract polyps may be stronger than that of obesity,and clinical intervention should not only focus on obesity but also on metabolic abnormalities.3.Sex differences in the association between metabolic obesity phenotypes and the occurrence of digestive tract polyps were highlighted in our study.Background:Digestive system cancers(DSC)pose a serious threat to human health and a heavy burden to society.A status report on the global burden of cancer worldwide using the Global Cancer Statistics 2020 estimated that major DSC(esophagus cancer,stomach cancer,colorectal cancer,liver cancer and pancreas cancer)comes in at 25.8%of newly diagnosed cancers and 35.4%of all cancer deaths.Of note,patients with cancer are at a high risk of readmission due to the inherent complexity of their comorbid,surgical complication,and psychosocial conditions.Readmissions are major problems for the U.S.health care system because readmissions are associated with inadequate quality of care and increased health care costs.Furthermore,unplanned readmissions may cost the Centers for Medicare&Medicaid Services more than $17 billion annually.While some inevitable readmissions occur as a result of natural course of disease,early identification of factors associated with high-risk readmissions can lead to effective prevention and intervention strategies to optimize short-and long-term clinical outcomes and reduce healthcare costs.However,current data on readmission risk factors for patients with DSC are extremely limited.Obesity increases the hospital readmission risk of various diseases,such as acute myocardial infarction,end-stage renal disease,colorectal cancer and so on.The study found that non-obese patients were 21.20%less likely to be readmitted to the hospital than obese patients;obesity-related comorbidities are associated with longer hospital stays and higher readmission rates in obese patients of colorectal cancer.Therefore,our study speculated that obesity may be an important risk factor for readmission in DSC patients,but there is no systematic study on the relationship between obesity and readmission risk in DSC patients.Of note,not all obesity phenotypes are created equally,obesity often naturally coexists with insulin resistance,dyslipidemia and hypertension,which have a direct impact on health and promote the occurrence and development of cancers.However,it also cannot be ignored that obesity is not always associated with metabolic abnormalities.A metabolically healthy phenotype,known as metabolically healthy obesity(MHO),may occur in about 25-30%of the obese population.A "one size fits all" approach to tackling obesity may be ineffective,and there is a need to better understand the relationship between metabolically related subtypes of obesity and disease development and reduce reliance on healthcare.However,no study has yet systematically examined the association between metabolically defined obesity type and the short-or long-term readmission risk of DSC(neoplasm of esophagus,stomach,duodenum,small Intestine,large intestine,rectum,anal canal,anus,liver and pancreas).Stratification of obese individuals according to their metabolic phenotype is important for identifying individuals at high risk of readmission.Objective:1.The purpose of this study is to understand this important knowledge gap in two readmission cohorts by combining obesity and metabolic health status into a composite variable to assess the individual and joint effects of the two exposures and provide a reference for clinical prevention and readmission reduction programs.2.To evaluate the association between metabolically defined types of obesity and the risk of secondary outcomes(severe readmissions and unplanned readmissions in DSC patients).Methods:1.Study PopulationWe utilized the Nationwide Readmissions Database(NRD)2018 to study 30-day readmission and 180-day readmission among patients with four major categories of DSC.Using the corresponding International Classification of Diseases-10th Revision-Clinical Modification(ICD-10-CM)diagnostic codes,a total of 12928231 patients who were admitted to the hospital in 2018 were identified in the NRD database.After rigorous inclusion and exclusion criteria,142753 participants and 74566 participants with a primary or secondary discharge diagnosis of DSC at time of index hospitalization were ultimately selected for inclusion in the short-or long-term readmission risk analysis,respectively.2.Data CollectionThe type of cancers in the patient’s digestive system and patient demographic information,including age,sex,income quartile based on household income of the patient’s zip code,patient location,length of stay(LOS),primary expected payment source(Medicare/Medicaid,private insurance,self-pay and other insurance types)and common comorbidities to calculate Charlson’s Comorbidity,were also obtained from the NRD database according to the corresponding ICD-10-CM code.3.DefinitionObesity was defined as body mass index(BMI)≥ 25 kg/m2 in this study.Metabolically unhealthy status was defined as having at least one of the following three components of metabolic syndrome except for waist circumference collinear with BMI:(1)fasting blood glucose≥6.1 mmol/L;(2)triglycerides≥1.7 mmol/L or high-density lipoprotein cholesterol<1.0 mmol/L;and(3)systolic blood pressure≥130 mmHg or diastolic blood pressure≥85 mmHg.Individuals were classified into four metabolic obesity phenotypes as follows:(1)MHNO:metabolically healthy nonobese;(2)MHO:metabolically healthy obese;(3)MUNO:metabolically unhealthy nonobese;and(4)MUO:metabolically unhealthy obese.DSC in our study refers to the combined neoplasm name of the esophagus,stomach,duodenum,small intestine,large intestine,rectum,anal canal,anus,liver and pancreas.Neoplasm of upper digestive tract was defined as combined neoplasm including neoplasm of esophagus,stomach and duodenum.Neoplasm of lower digestive tract included small intestine,large intestine,rectum,anal canal and anus.4.OutcomesOur primary outcomes of interest were short-(30-day)or long-term(180-day)readmission risk of DSC after discharge from index hospitalization.Secondary outcomes of interest included:(1)severe readmission(LOS>7 days),and(2)unplanned hospitalization.5.Statistical AnalysisContinuous variables conforming to normal distribution were expressed as mean(standard deviation)and categorical variables as frequency counts(percentages).The chi-square test was used to compare categorical variables,while variance testing was used to compare continuous variables.Multiple comparisons were made using Bonferroni correction.Using MHNO,a low-risk group,as the reference,multivariable Cox regression model was performed to identify higher risk subgroups of the 30-day or 180-day readmission of DSC and secondary outcomes and to calculate hazard ratio(HR)and 95%confidence interval(95%CI).To report adjusted HR for DSC outcomes,age,sex,primary expected payment source,patient location,Deyo-Charlson Comorbidity Index,LOS at index hospitalization,severe hospitalization at index hospitalization were selected as covariates.Relevant variables were selected as covariates if p<0.05 in univariate analysis.In addition,we analyzed the cumulative risk of 30-and 180-day readmissions and secondary outcomes in patients with different DSC classified by obesity and metabolic status.R Studio(2022.12.0+353),R(4.1.1)and SPSS 25.0 software(SPSS Inc.,Chicago,IL,USA)was used to conduct all statistical analyses in our study.A two-sided p value<0.05 was considered significant.Results:1.Patient characteristics based on metabolic obesity phenotype at index hospitalizationPatients in the MHO categories had the lowest age level and male proportions in 30-day readmission cohort(56.70± 12.30 years;46.48%)and 180-day readmission cohort(56.94±12.47 years;47.03%).Compared with patients with MHNO or MHO in two cohorts,those in the MUNO or MUO groups were older(p<0.001),which indicates that older patients with digestive cancers may have poorer metabolic status.As expected,participants with MUNO or MUO tended to have more common comorbidities,such as myocardial infarction,congestive heart failure,peripheral vascular disease,cerebrovascular disease,dementia,chronic pulmonary disease,connective tissue disease,ulcer disease,hemiplegia,moderate/severe renal disease,leukemia,lymphoma,acquired immune deficiency syndrome.Medicare/medicaid and private insurance were the main way(over 90%)of hospitalization payment for majority of DSC patients.Individuals with the MHNO phenotypes had fewer proportion of severe hospitalizations at index hospitalization(30-day cohort:23.45%;180-day cohort:23.50%,p<0.001)compared to MHO,MUNO and MUO.2.Short-and long-term readmission risk for different DSC classified by obesity and metabolic health status Patients were followed over 26.63±7.85 days after index hospitalization in 30-day readmission cohort,and the readmission rate was 19.04%.For neoplasm of upper digestive tract,the 30-day readmission rate of MHO phenotype with the greatest cumulative risk was higher than that of MHNO and MUNO phenotype.Compared to MHNO phenotype(15.16%),higher 30-day readmission rates were observed in MUNO(16.43%)and MUO(16.46%)phenotypes in patients with neoplasm of lower digestive tract(p<0.001)and the cumulative 30-day readmission risk of these two phenotypes is high.Compared with MUNO(21.60%),MUO(23.69%)patients with neoplasm of liver had a higher rate of 30-day readmission and the greatest cumulative risk.The MUO phenotype(26.43%)in patients with neoplasm of pancreas had higher rate of 30-day readmission than MHNO(22.94%)and MUNO(23.00%)phenotypes.Following up 129.18±72.55 days,no difference was found in the long-term readmission rate among four metabolic health statuses in patients with neoplasm of upper digestive tract(p=0.063)and lower digestive tract(p=0.203).However,unlike the short-term readmission rate,the long-term readmission rate of liver cancer patients with the MUO phenotype(40.45%)was higher than that of MHNO phenotype(35.59%).For neoplasm of pancreas,the long-term readmission rate of the MUO(47.10%)phenotype was higher than that of MHNO(37.70%)and MUNO(40.07%)phenotype(p<0.001).3.Unhealthy phenotypes were short-and long-term readmission risk factors of DSCParticipants with the MUNO phenotype had 1.147-fold increased risks of 180-day readmission(p<0.001)in patients with neoplasm of upper digestive tract.MUNO phenotype had 1.073-fold(p=0.002)increased risks of 30-day readmission and 1.067-fold(p=0.004)increased risks of 180-day readmission in patients with neoplasm of lower digestive tract.In patients with neoplasm of liver,MUO phenotypes were independent risk factors of 30-day readmission(HR=1.152,p=0.014),while MUNO(HR=1.190,p<0.001)and MUO(HR=1.274,p<0.001)phenotypes were independent risk factors of 180-day readmission.MUNO and MUO phenotypes were independent risk factors of 30-day(HR=1.104,p=0.003;HR=1.209,p<0.001)and 180-day(HR=1.206,p<0.001;HR=1.395,p<0.001)readmission in patients with pancreatic neoplasm.4.Unhealthy phenotypes were risk factors of secondary outcomes in patients with DSCFor neoplasm of upper digestive tract,MUNO phenotype was a risk factor for unplanned hospitalization within 180 days.In patients with neoplasm of lower digestive tract,30-day unplanned hospitalization rate of MUNO phenotype was higher than that of MHNO phenotype.For neoplasm of liver,the MUNO and MUO phenotypes were risk factors for severe hospitalizations and unplanned hospitalization within 30 days and 180 days compared with the MHNO phenotype.For neoplasm of pancreas,the MUNO and MUO phenotypes were risk factors for 180-day severe hospitalizations and 30-day or 180-day unplanned hospitalization,compared with the MHNO phenotype.Conclusion:1.The MHO,MUNO and MUO phenotypes were risk factors for the short-or long-term readmission,severe hospitalizations and unplanned hospitalization of DSC compared with the MHNO phenotype.2.The effect of metabolic status on the short-or long-term readmission of liver or pancreas cancer may be stronger than that of obesity,highlighting clinical intervention should focus on not only obesity but also metabolic abnormalities.Background:Non-alcoholic fatty liver disease(NAFLD)affecting about 1.7 billion people worldwide,characterized by excessive accumulation of lipids in the liver,is the most common chronic liver disease in the world.The incidence of NAFLD has been increasing year by year,parallel to the rising trend of obesity.China has the highest prevalence,incidence and related annual mortality of NAFLD in Asia,and is expected to become the country with the highest number of NAFLD patients and liver-related deaths in the world.Thus,effective control of NAFLD in China will have a significant impact on the global burden of liver disease.Therefore,there is an urgent need to identify and clarify the risk factors that promote the occurrence of NAFLD.Despite huge investment in NAFLD-related drug development,there is still no effective treatment for NAFLD.Clearly,identifying and eliminating risk factors that contribute to the occurrence and progression of NAFLD is a necessary and promising strategy to reduce NAFLD.Most studies focus on the mechanism of lipid accumulation in the liver caused by abnormal liver lipid metabolism,which leads to the occurrence of NAFLD.There are few studies on the role of different types of dyslipidemia in the occurrence and development of NAFLD,and their conclusions are inconsistent.In 60527 individuals from two medical centers,the elevation of low-density lipoprotein cholesterol(LDL-C)level within the normal range appeared to make a significant contribution to an increased occurrence risk of NAFLD.After adjusting for various metabolic risk factors,NAFLD was associated with higher fasting triglyceride(TG),lower serum high density lipoprotein cholesterol(HDL-C),but LDL-C levels was not independently associated with the occurrence of NAFLD.However,a detailed description,whether the time affects the association between components of dyslipidemia and the occurrence of NAFLD,has been lacked in adults over the past decades.Remnant cholesterol(Remnant-C)is the residue produced by triglyceride-rich lipoproteins(TRLs)metabolism,that is,chylomicrons(CM)and very low-density lipoprotein(VLDL)are catalyzed by lipoprotein lipase(LPL)to lose TG and produce metabolic residues rich in cholesterol esters.Recently,studies have shown that remnant-C is highly correlated with cardiovascular disease and insulin resistance(IR)in the general population.The exploration on the relationship between serum remnant-C levels and the occurrence of NAFLD is also needed.To our knowledge,our study is the first and largest analysis to evaluate the association between serum remnant-C levels and NAFLD risk in a longitudinal retrospective cohort.Clarifying this relationship will be of great significance for improving the allocation of health care resources,preventing and managing NAFLD-related diseases,and thus reducing the social medical burden.Objective:In this longitudinal retrospective cohort study,we aimed to explore the association of the components of dyslipidemia and serum remnant-C levels with the NAFLD risk in a Chinese cohort of middle aged and elderly individuals,in an attempt to expand our understanding of the remnant-C as an occurrence risk factor of NAFLD.Methods:1.Study PopulationThis is a longitudinal study and the data were retrospectively reviewed.All subjects in the current study are from the 13876 individuals who recruited in the Shandong cohort of the Risk Evaluation of cAncers in Chinese diabeTic Individuals:a lONgitudinal(REACTION)study.We included 6634 participants who had more than one visit during the study period with an average follow-up time of 43.34 months.The date of the first recruited participant was April 2011,and the end of the follow-up was July 2017.After rigorous inclusion and exclusion criteria,5834 participants were eventually included in the follow-up analysis.2.Data CollectionEach subject was interviewed face-to-face at baseline and follow-up to obtain demographic characteristics,questionnaires,physical examination and fasting blood.Data are collected at local screening points by trained investigators to minimize error by data collectors.The lipid profile measurements including TG,total cholesterol(TC),LDL-C,and HDL-C were performed using an autoanalyzer(ARCHITECTci16200 System,Abbott,Illinois,USA).Remnant-C was estimated as TC minus LDL-C minus HDL-C.The differences between batches and within batches of the above serological tests were controlled below 5%.3.OutcomeThe primary outcome was NAFLD status at the end of the follow-up.The well-trained investigators and clinical technicians periodically review follow-up records to determine outcome information.All medical records related to outcome were evaluated by the outcome adjudication committee.According to the guidelines of the Hepatology Branch of the Chinese Medical Association,NAFLD was diagnosed by B-type ultrasonography.In brief,the definition of NAFLD:(1)No history of excessive alcohol consumption(alcohol for men<30 g/d,female<20g/d)and other specific causes of fatty liver disease;(2)B-type ultrasonography shows the diffusion-enhanced near-field echo and gradual decay of the far-field echo in the liver region with one of the following conditions:mild to moderate hepatomegaly with peripheral and marginal passivation;the structure of the hepatic lacunae cannot be clearly displayed;the blood flow distribution was normal,but the blood flow signal was reduced;or the unclear or incomplete right liver lobe and capsule of diaphragm muscle.4.Statistical AnalysisNormally distributed continuous parameters were represented as the mean ± standard deviation,while nonnormally distributed continuous variables were represented as the medians with interquartile ranges.Categorical variables were summarized as numbers(percentage).To analyze differences of remnant-C distribution at baseline between the sex,diabetes status,cardiovascular disease status and body mass index(BMI,kg/m2)categories,data were tested by the nonparametric test.The association between lipid concentrations and NAFLD incident were evaluated by unadjusted and adjusted Cox regression analysis models to calculate hazard ratio(HR)and 95%confidence interval(95%CI).The potential confounders that may affect the association between lipid concentrations and NAFLD incident were adjusted,including age,sex,hip circumference(HC),BMI,systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),diabetes status and cardiovascular disease status.R Studio(2022.12.0+353),R(4.1.1 and SPSS 25.0 software(SPSS Inc.,Chicago,IL,USA)was used to conduct all statistical analyses in our study.All p values were two-tailed,andp values less than 0.05 were considered statistically significant.Results:1.Baseline characteristics of the subjectsThe mean age of the subjects was 56.94 years old,39.06%were males,median BMI was 25.08 kg/m2,and median HC was 97.00cm.Diabetes and cardiovascular disease were present in 29.16%and 6.05%of participants,respectively.The age of males was higher than that of females(57.74±7.51 vs.56.43±7.24,p<0.001),but the BMI level of males was lower than that of females(24.96(22.64,27.34)kg/m2 vs.25.20(22.81,27.59)kg/m2,p=0.024).Systolic and diastolic blood pressure levels were higher in males than in females(p<0.001).In addition,males had higher FPG levels(5.94(5.49,6.65)vs.5.77(5.36,6.39),p<0.001)and prevalence of diabetes(31.29%vs.27.79%,p=0.004)than females.There was no significant difference in prevalence of cardiovascular disease between the sex groups(p=0.661).2.Baseline Lipid Profile of Study SubjectsThe lipid alterations characteristic of atherogenic dyslipidemia(TG>1.69 mmol/L and HDL-C<1.03 mmol/L in males or<1.29 mmol/L in females)are present in 9.65%of the baseline population.Baseline TC,HDL-C,LDL-C levels were higher in females than in males(p<0.001).Baseline TG/HDL levels in males were higher than that in females(p=0.001).Females had a higher percentage of atherosclerotic dyslipidemia changes than males(12.77%vs.4.78%,p<0.001).As BMI increases,remnant-C level increases.Remnant-C levels are higher in individuals with cardiovascular disease than levels in individuals without cardiovascular disease.Individuals with diabetes have higher levels of remnant-C than those without diabetes.3.Baseline lipid concentrations and NAFLD eventsAfter adjusting for age,sex,HC,BMI,SBP,DBP,FPG,diabetes and cardiovascular... |
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