Metabolic Dysfunction-Associated Fatty Liver Disease And Risk Of Cardiovascular Disease:A Cohort Study Among The Uyghurs In Xinjiang

Object:1.This study aimed to describe the epidemic characteristics of metabolic dysfunction-associated fatty liver disease(MAFLD),incidence of cardiovascular disease(CVD),and relationship between MAFLD and incident CVD among Uyghur in Xinjiang Corps.2.To optimize the management of patients with MAFLD,our study aimed to evaluate and compare the screening value of non-invasive indicators such as the fatty liver index(FLI),hepatic steatosis index(HSI),lipid accumulation product(LAP),visceral adiposity index(VAI),and Zhejiang University index(ZJU),as well as other traditional indicators for MAFLD.We aimed to find the optimal screening tool for rural Uyghur adults.Methods:1.In this prospective cohort study,the 51 st Regiment of the Farm,the regiment with Uyghurs as its main residents,was selected as the survey site.The target participants were permanent Uygur residents aged 18 and above.The baseline survey of the cohort was conducted by on-site centralized investigation from August to September 2016,and the participants were divided into MAFLD group and non-MAFLD group.Three follow-ups were conducted in June 2019,July 2020,and June 2021.A total of 12,508 patients were effectively followed up.We further excluded 1064 participants who had a history of CVD,the longitudinal analysis comprised 11,444 individuals who completed the follow-up(follow-up rate: 97.6%).2.Follow-up was consistent with baseline survey,including questionnaire,physical examination,blood biochemical indicators,and abdominal ultrasonography.The outcome event was the occurrence of CVD events,which were collected through questionnaire self-report,hospitalization records and social security data.3.Statistical Product and Service Solutions version 26 was used for data analysis.To study the relationship between MAFLD and CVD,Chi-square test,t-test,analysis of variance,Mann–Whitney U-test,Logistic regression and COX regression were used for univariate,multivariate and subgroup analysis.R version4.1.1 was used to perform Kaplan-Meier estimation and plot the forest.In addition,receiver operating characteristic curves were analyzed and plotted to evaluate the screening value of non-invasive indicators for MAFLD.Results:1.In the baseline population of the cohort,the prevalence of MAFLD was 16.55%(2118/12,794).The cohort was followed up for a median period of 4.7 years,and the incidence of CVD was 10.40%(1190/11,444).2.The incidence of CVD in the MAFLD group was 18.38%(309/1681),which was higher than 9.02%(881/9763)in non-MAFLD group.After multivariate adjustment,the risk of CVD in the MAFLD group was 1.37 times higher than that in the non-MAFLD group.3.When the subgroup analysis was conducted by sex,age,cardiometabolic risk factors(abdominal obesity,overweight,low HDL-C,high TG,obesity,dyslipidemia,and diabetes),and moderate-high risk hepatic fibrosis,MAFLD was still increased the risk of CVD.4.Among the non-invasive evaluation indexes,FLI,HSI,ZJU,and LAP had good screening values for MAFLD,with all indexes having AUCs > 0.7.FLI and BMI were recommended as simple screening tools for MAFLD when compared with other traditional indicators.The optimal cut-off value of FLI for MAFLD screening was 45(male: sensitivity 84.83%,specificity 69.57%;female:sensitivity 80.11%,specificity 74.23%).The optimal cut-off value of BMI for MAFLD screening was 27.4(sensitivity 78.47%,specificity 76.30%)in males and 28.0(sensitivity 79.56%,specificity 75.41%)in females,respectively.Conclusion:1.In rural Uyghur adults of Xinjiang,the incidence of CVD was higher than the average level reported in China.2.The relationship between MAFLD and CVD was independent of other risk factors including cardiometabolic risk factors such as abdominal obesity,overweight,low HDL-C,high TG,obesity,T2 DM,and dyslipidaemia.3.The risk of CVD was increased in the presence of both MAFLD and medium-high risk hepatic fibrosis.4.Among FLI,HSI,LAP,VAI and ZJU,the FLI has the best performance.Both the FLI and BMI could be considered as simple screening tools for MAFLD in Uyghur populations of rural Xinjiang.