Analysis Of Clinical Characteristics Of Nonalcoholic Fatty Liver Disease In Obese Patients And Exploration Of Related Risk Factors

Background:Non-alcoholic fatty liver disease(NAFLD)is a disease that affects approximately one quarter of the global population,characterized by liver lipid accumulation,chronic liver inflammation,and liver fibrosis,ultimately leading to end-stage liver disease requiring liver transplantation.NAFLD is closely related to obesity,and many studies have reported the clinical characteristics of NAFLD in normal weight,overweight,and moderately obese patients,but there is less research on the differences within the obese population and NAFLD in patients with high body mass index(BMI)obesity.Therefore,this study included mild,moderate,severe,and super obese populations,and analyzed and compared the clinical characteristics of NAFLD in different obese populations to provide more appropriate screening and treatment recommendations for these populations.Objective:To analyze and compare the characteristics of NAFLD in obese patients with different degrees of obesity and explore the risk factors associated with NAFLD steatosis and liver fibrosis.Methods:This study included obese patients who were admitted to Qilu Hospital of Shandong University for weight loss surgery between June 2019 and September 2022.Clinical data were collected,and patients were reclassified into four groups according to the World Health Organization(WHO)standard combined with clinical data:mild obesity(BMI:30-34.9 kg/m2),moderate obesity(BMI:35-39.9 kg/m2),severe obesity(BMI:40-49.9 kg/m2),and super obesity(BMI≥50 kg/m2).The body measurement indicators,laboratory indicators,and imaging data of each group were analyzed and compared using independent sample t-tests,non-parametric tests,chi-square tests,single-factor correlation analysis,and multiple linear regression equations to explore the impact of various factors on NAFLD liver steatosis and fibrosis.Results:A total of 1009 weight loss surgery patients were included in this study,and 430 patients met the inclusion and exclusion criteria,including 87 males(20.23%)and 343 females(79.77%).After propensity score matching for age and gender,there were 19 patients(11.18%)with mild obesity,39 patients(22.94%)with moderate obesity,78 patients(45.88%)with severe obesity,and 34 patients(20%)with super obesity.As the degree of obesity increased,the levels of triglycerides,fasting insulin,homeostatic model assessment of insulin resistance(HOMA-IR),and controlled attenuation parameter(CAP)also increased,while the level of albumin decreased(P<0.05).There was a positive correlation between the degree of obesity and the degree of NAFLD steatosis(P=0.024),but no significant correlation with fibrosis grade(P=0.081).Multivariate analysis showed that height(β=0.213,P<0.05),waist-to-hip ratio(β=0.191,P<0.05),platelets(β=0.193,P<0.05),albumin(β=-0.277,P<0.05),total bilirubin(β=0.188,P<0.05),and uric acid(β=0.194,P<0.05)could predict the degree of NAFLD liver steatosis,while uric acid(β=0.187,P<0.05),triglycerides(β=0.206,P<0.05),estradiol(β=0.174,P<0.05),and testosterone(β=-0.268,P<0.05)could significantly predict liver fibrosis.Conclusion:(1)All obese patients face a high risk of complications such as diabetes,hypertension,hyperlipidemia,and hyperuricemia;the degree of NAFLD liver steatosis increases gradually with the degree of obesity,but there is no significant difference in fibrosis grade.(2)Height,waist-to-hip ratio,platelets,albumin,total bilirubin,and uric acid can predict the degree of liver lipid accumulation in patients.(3)Uric acid,triglycerides,estradiol,and testosterone can significantly predict the degree of liver fibrosis,and the body may regulate hormone levels to alleviate the progression of liver fibrosis.