Cohort Study On Liver Enzymes And The Risk Of Nonalcoholic Fatty Liver Disease In Uygur People Of Xinjiang Corps

Objective:To describe the incidence and epidemic characteristics of nonalcoholic fatty liver disease(NAFLD)among Uygur people in the third division of Xinjiang Corps.To reveal the dose-response relationship between the baseline serum liver enzyme level and the risk of NAFLD,and the influence of the interaction between serum liver enzyme level and the main risk factors of NAFLD on the risk of NAFLD.To evaluate the predictive value of ZJU index on the risk of NAFLD in population,and provide theoretical basis for early screening and primary prevention of NAFLD in this area.Methods:1......In this study,the 6th Company,8th Company,11th Company,12th Company and 13th Company of the 51st Regiment of the Third Division of the Corps were selected as the baseline investigation sites,and the permanent residents of Uygur people were taken as the research objects.A baseline survey was conducted from August to September,2016,and three follow-ups were conducted in 2019,2020 and 2021,respectively.The follow-up contents were consistent with the baseline,and the final events were mainly collected.A total of 14,321 subjects participated in the study,excluding incomplete baseline data,long-term going out and unable to cooperate,hepatobiliary diseases,previous drinking history and lost visits,and finally analyzing the data of 10,597 people.At the same time,social security and hospitalization information from 2016 to 2021 were continuously collected to ensure the accuracy of the final data.Chi-square test was used to compare the differences between groups of classified variables,and Mann-Whitney U test was used to compare continuous variables.Cox proportional hazard model was used to analyze the correlation between liver enzyme elevation and NAFLD risk,Kaplan-Meier curve was used to estimate the cumulative incidence of NAFLD events,and subgroup analysis was used to explore the correlation between liver enzyme elevation and NAFLD risk factors.The liver enzyme indexes were divided into quartiles,Cox proportional hazard model was used to evaluate the risk of each quartile and NAFLD,and restricted cubic line(RCS)was used to explore the dose-response relationship between each liver enzyme index and the risk of NAFLD.COX proportional hazard model was used to evaluate the interaction between serum liver enzyme elevation and main risk factors of NAFLD on the risk of NAFLD.2.According to the level of ZJU index,the subjects were divided into four groups(Q1～Q4).Kaplan-Meier curve was used to estimate the cumulative incidence of NAFLD events,and Cox regression model was used to analyze the association between ZJU index and the risk of NAFLD.The dose-response relationship between ZJU index and the risk of NAFLD was analyzed by RCS.The lower receiver operating characteristic curve area(ROC)was used to evaluate the predictive value of ZJU index on the risk of NAFLD.Results:1......The median follow-up time was 4.92 years.A total of 992 people developed NAFLD,and the cumulative incidence rate was 9.4%(8.6%for males and 10.1%for females),with females being higher than males(P<0.001).2.Elevated liver enzymes are associated with increased risk of NAFLD.The incidence of NAFLD in the group with elevated liver enzymes(17.0%)is higher than that in the group with normal liver enzymes(7.7%)(2=158.70,P<0.001;HR:1.399,95%CI:1.218-1.707).3.In Cox proportional risk model,after adjusting age,sex,obesity,hypertension,diabetes,abnormal renal function,smoking,BMI,TC,TG,HDL-C and LDL-C,AST,GGT and ALT are positively correlated with the risk of ALP and NAFLD.The RCS results showed that there was a linear dose-response relationship between ALP and GGT and NAFLD(GGT:PNonlinear=0.053,PGeneral trend<0.001;ALP:PNonlinear=0.232,PGeneral trend<0.001),AST and ALT have a nonlinear dose-response relationship with the risk of NAFLD(AST:PNonlinear=0.002,PGeneral trend<0.001;ALT:PNonlinear=0.005,PGeneral trend<0.001).4.Transactional analysis showed that the coexistence of high levels of AST,GGT,ALT and ALP with obesity had a positive interaction on the occurrence of NAFLD,and AST and GGT and dyslipidemia had a positive interaction on the occurrence of NAFLD.5.The ZJU index is related to the risk of NAFLD,showing a nonlinear dose-response relationship(PNonlinear<0.001,PGeneral trend<0.05)6.ZJU index is superior to TyG,LAP,WHtR,HSI and VAI index in identifying the onset of NAFLD,with ROC of 0.816,0.689,0.768,0.786,0.733 and 0.733 respectively.Conclusion:1.The cumulative incidence rate of NAFLD in Xinjiang Uygur is 9.4%,which is lower than that in the whole country and other cities,and women are higher than men.2.Elevated serum AST,GGT,ALT and ALP all increase the risk of NAFLD.3.Elevated levels of serum AST,GGT,ALT and ALP coexist with obesity,and elevated levels of AST and GGT coexist with dyslipidemia significantly increase the risk of NAFLD.4.ZJU index has a good predictive value for the risk of NAFLD in this population.