title: Liver fat content is associated with increased carotid atherosclerosis in a Chinese middle-aged and elderly population: the Shanghai Changfeng study.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease is closely associated with metabolic syndrome and cardiovascular disease (CVD). We investigated whether the liver fat content (LFC) is independently associated with carotid artery intima-media thickness (CIMT) and evaluated the contribution of the LFC to the increased CIMT.
  
  
  METHODS
  We conducted a community-based study among 1809 participants (682 males and 1127 females) from the Changfeng Study who were at least 45 years old. A standard interview, anthropometrics and laboratory parameters were performed for each participant. The CIMT was determined by ultrasonography. A large CIMT value was defined as 75th percentile of the maximum CIMT. A standardised ultrasonographic hepatic-renal ratio was used to assess the LFC.
  
  
  RESULTS
  The median LFC value was 6% (interquartile range, 3-14%), and 34% of the subjects had hepatic steatosis based on the criteria for diagnosis of steatosis by quantitative ultrasound. The maximum CIMT, average CIMT and plaque score were strongly associated with the LFC (β = 0.319, 0.324 and 1.361, respectively; all P < 0.05) after adjustment for age, gender, smoking history, low-density lipoprotein cholesterol and metabolic syndrome. The multiple logistic regression analysis showed that a 1 SD increase in the LFC, the OR for having a large CIMT was 1.350 (95% CI 1.180-1.545; P < 0.001) after adjustment for all potential confounders.
  
  
  CONCLUSIONS
  These results suggest that the LFC is independently associated with carotid atherosclerosis in the Chinese population, and that the risk of atherosclerosis is proportional to the degree of hepatic steatosis.
authors.affiliation: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai 200032, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.forename: Mingfeng
authors.initials: M
authors.lastname: Xia
authors.forename: Hui
authors.initials: H
authors.lastname: Ma
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Yu
authors.initials: Y
authors.lastname: Hu
authors.forename: Hongmei
authors.initials: H
authors.lastname: Yan
authors.forename: Wanyuan
authors.initials: W
authors.lastname: He
authors.forename: Huandong
authors.initials: H
authors.lastname: Lin
authors.forename: Johannes
authors.initials: J
authors.lastname: Jeekel
authors.forename: Naiqing
authors.initials: N
authors.lastname: Zhao
authors.forename: Jian
authors.initials: J
authors.lastname: Gao
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
mesh_terms: D000367:Age Factors; D000368:Aged; D044466:Asian People; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000208:ethnology*; D059168:Carotid Intima-Media Thickness; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000208:ethnology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index