title: Interaction of obesity, metabolic syndrome and Framingham risk on steatohepatitis among healthy Taiwanese: population-based nested case-control study.
abstract: BACKGROUND
  There have been scant reports on the cumulative effects of atherosclerotic risk factors on steatohepatitis.
  
  
  METHODS
  We defined cases of steatohepatitis (n = 124) from one health examination center at National Taiwan University Hospital from January to December 2002. We selected controls, matched by age, gender and drinking status. Metabolic syndrome was defined by the modified ATP-III guidelines. High-dimensional interactions of risk factors for steatohepatitis were evaluated.
  
  
  RESULTS
  Steatohepatitis cases had the highest C-reactive protein, lymphocytes, Framingham scores and predicted coronary risks. The odds ratio (OR) of metabolic syndrome for steatohepatitis was the highest (OR = 9.9), followed by high glucose status (OR = 4.5) and obesity (OR = 3.6). The highest area under the ROC curve was metabolic syndrome (area = 0.80), followed by obesity (0.75) and high glucose level (0.73). Metabolic syndrome was the highest population-attributable risk factor (0.59). Significant interaction was found with a three-factor model, including obesity, metabolic syndrome and Framingham risk status, with lesser average prediction error (22.6%), higher average cross-validation consistency (6.3) and lower average prediction error (24.3%). Compared with persons with no risk factors, OR increased as the number of risk factors increased (OR = 3.0 with one risk factor, 17.5 with two risk factors, 10.8 with three risk factors, respectively).
  
  
  CONCLUSIONS
  Metabolic syndrome, inflammation markers and atherosclerotic risk scores are significantly related to steatohepatitis status among the healthy examinee population in Taiwan.
authors.affiliation: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. klchien@ha.mc.ntu.edu.tw
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
authors.forename: Hsiu-Ching
authors.initials: HC
authors.lastname: Hsu
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Chao
authors.forename: Bai-Chin
authors.initials: BC
authors.lastname: Lee
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
authors.forename: Yuan-Teh
authors.initials: YT
authors.lastname: Lee
mesh_terms: D000328:Adult; D044466:Asian People; D050197:Atherosclerosis / Q000209:etiology*; D016022:Case-Control Studies; D005234:Fatty Liver / Q000150:complications*; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D015233:Models, Statistical; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D013624:Taiwan