The Incidence Associations Between Fatty Liver Disease And Hypertension Of Adults In Guilin: A Prospective Cohort Study

Fatty liver disease(FLD)is an underestimated chronic liver disease.In the past 30 years,we have paid more and more attention to FLD,which affected about 25% of the world’s population and affected 1.8 billion people.At present,FLD has surpassed hepatitis and become the largest liver disease in the world.FLD progresses to cirrhosis,liver cancer,and is therefore the second leading cause of liver transplantation in the United States.The total cost of each new diagnosis of FLD in the United States is more than $100 billion a year.The prevalence of FLD is as high as 43% in some areas of China.Hypertension(HTN)is the most important factor in the global burden of diseases and global mortality,killing 10.5 million people each year.The situation is expected to worsen in the coming decades as the global population grows and ages,with more than 1.5 billion people worldwide suffering from HTN by 2025.At the same time,HTN is a major risk factor for cardiovascular diseases,which are one of the most serious diseases threatening human health and ranks the first cause of global death.Therefore,the control of HTN and its burden of complications is an important public health problem all over the world.FLD and HTN are both common chronic diseases and have many common risk factors,suggesting that there may be a complex relationship between the two diseases.Some studies have shown that FLD is an independent risk factor for HTN,but the relationship between HTN and FLD is inconsistent.In view of the above research status,the following work was carried out in this study: 1.The epidemiology of FLD and HTN in Guilin city was investigated by means of cross-sectional study,and the relevant risk factors were analyzed;2.A longitudinal cohort study was conducted to explore the two-way association between FLD and HTN.This study consists of the following two parts: Part Ⅰ The epidemiology and risk factors of fatty liver and hypertensionObjective: This part aims to understand the epidemiology of FLD and HTN in Guilin,and analyze the risk factors of fatty liver and hypertension.Methods: Since 2012,a total of 33,793 people have been included in the health examination cohort in Guilin,while 20,301 people have continuous physical examination datum for 5 years,the object of the present study for 2016 adult health physical examination data,excluding missing abdominal ultrasound,blood pressure,body mass index(BMI),blood lipids,blood uric acid(UA),and other important data of the individual,finally 15023 people were included,and the prevalence of FLD and HTN were calculated.Using multi-factor Logistic regression analysis,we explored the risk factors for those diseases.Results: 1.The prevalence of FLD in the population in a whole,males and females were 21.9%,31.8% and 13.3%,respectively.The prevalence rate increased with the increase of age,and the prevalence rate was the highest(30.9%)at the age of 50-59,and decreased after the age of 60,among which,the prevalence rate was the highest(39.8%)at the age of 50-59 for males and the highest(26.5%)at the age of 60-69 for females.The prevalence of FLD was higher in men before age 60 than in women,and there was no significant difference after age 60.2.The multi-factor Logistic regression analysis showed that the risk factors for FLD included Age,BMI,blood platelet count(PLT),fasting plasma glucose(FPG),triglycerides(TG),low density lipoprotein(LDL),alanine aminotransferase(ALT),UA,HTN,protective factor is high-density lipoprotein(HDL).3.The prevalence of HTN in this study population was 21.1% and increased with age,with the prevalence of hypertension reaching 60.2% in the population ≥70 years old.The prevalence of prehypertension(pre-HTN)is 34.4%.Below age 70 the prevalence of HTN was higher in men than in women,and there was no significant difference above age 70.4.Multivariate Logistic regression analysis showed that risk factors for HTN included Male,Age,pulse(P),BMI,platelet count(PLT),fasting blood glucose(FPG),triglyceride(TG),low-density lipoprotein(LDL),UA and FLD.Conclusions: 1.The prevalence of FLD in the population in this study was 21.9%,and the prevalence was the highest(30.9%)at the age of 50-59.Among which,the prevalence of FLD has significant difference between men and women above age 60.Risk factors for FLD include Age,BMI,PLT,FPG,TG,LDL,ALT,UA,HTN,and protective factor include HDL.2.In this study,the prevalence of HTN in the population was 21.1%,and the prevalence in the population ≥70 years old was as high as 60.2%.Among which,the prevalence of HTN has significant difference above age 70.Risk factors for HTN included Male,Age,P,BMI,PLT,FPG,TG,LDL,UA.Part Ⅱ The bidirectional association between fatty liver and hypertensionObjective: Study the bidirectional association between fatty liver and hypertension using cohort data.Methods: The research object is a cohort with 5 years of continuous physical examination datum from 2012 to 2016,with a total of 20,301 people,excluding individuals missing important independent variables and dependent variables such as abdominal ultrasound,blood pressure,BMI,blood lipids,and UA,finally 15023 who entered the study.First,research the risk of developing hypertension of FLD,the queue selected 2012 patients without high blood pressure,a total of 11762 people were included,using Logistic regression analysis method,comparing the risk of hypertension incidence coefficient(odds ratio,OR)and 95%CI between FLD population and normal population,and according to the overweight/obesity and dyslipidemia to stratification of the research object,layer are analyzed respectively,and the relationship between fatty liver and high blood pressure risk.Furthermore,Logistic regression was used to analyze the association between the risk of hypertension and fatty liver,overweight/obesity and dyslipidemia when they existed alone,in any combination of two or three groups.Second,research the risk of FLD incidence of HTN,the queue screened 2012 fatty liver patients,finally 11475 people were included,using Logistic regression analysis method,comparing the risk of FLD incidence coefficient(odds ratio,OR)and 95%CI between HTN population and normal population,and according to the overweight/obesity and dyslipidemia to stratification of the research object,layer are analyzed respectively,and the relationship between hypertension and fatty liver disease risk.Furthermore,Logistic regression was used to analyze the correlation between the risk of fatty liver disease and hypertension,overweight/obesity and dyslipidemia when they existed alone,any combination of the two or the three combined.Results: 1.In the cohort in this study,the incidence of hypertension in the normal population was 6.0%,and the incidence of fatty liver was 11.6%.The prevalence of fatty liver was 17.2% in the cohort and 33.3% in the hypertensive population.Logistic regression analysis showed that after adjusting for Gender,Age,CHO,TG,HDL,LDL,hyperuricemia,overweight/obesity,OR and 95%CI of patients with fatty liver were 1.22(1.01-1.47)(P < 0.05).In the group analysis,compared with people without fatty liver,overweight/obesity and dyslipidemia,those with simultaneous fatty liver,overweight/obesity and dyslipidemia had the highest risk of hypertension,OR and 95%CI were 3.46(2.67-4.48)(P < 0.05),and the risk of hypertension in other combined groups was also statistically significant(P < 0.05).2.In the cohort in this study,the incidence of fatty liver was 6.3% in the normal population,11.2% in the hypertensive population,16.3% in the cohort,and 28.7% in the fatty liver cohort.Logistic regression analysis results after adjusting for Gender,Age,CHO,TG,HDL,LDL,hyperuricemia,compared with normal people,patients with high blood pressure OR and 95%CI fatty liver is 1.22(1.00-1.1.49)(P < 0.05),and further correction is overweight/obesity,high blood pressure and risk of fatty liver of independent correlation disappears.In the grouping analysis,OR and 95%CI of fatty liver were 1.19(0.63-2.24)in hypertension alone,with no statistical significance(P > 0.05).And people with high blood pressure,overweight/obesity,diabetes,compared to the risk of fatty liver from high to low in turn is also suffering from high blood pressure,overweight/obesity and dyslipidemia,at the same time with overweight/obesity and dyslipidemia,at the same time has high blood pressure and overweight/obese people,ORs and 95%CIs were 7.19(5.36-9.64),5.59(4.36-7.18)and 4.66(3.22-6.75),and had statistical significance(P < 0.05).Conclusions: 1.FLD is a risk factor for the occurrence of HTN.The independent relationship between HTN and the occurrence of FLD is not significant after considering overweight/obesity.2.Combined effect analysis showed that overweight/obesity and dyslipidemia played an important role in the occurrence of FLD and HTN.