title: Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: the Coronary Artery Risk Development in Young Adults Study.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular mortality. Yet, whether or not NAFLD is independently related to atherosclerosis is unclear. In a population-based cross-sectional sample of middle-aged adults free from liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical atherosclerosis (coronary artery (CAC) and abdominal aortic calcification (AAC)) independent of obesity.
  
  
  METHODS
  Participants from the Coronary Artery Risk Development in Young Adults study with CT quantification of liver fat, CAC and AAC were included (n = 2424). NAFLD was defined as liver attenuation ≤40 Hounsfield Units after exclusion of other causes of liver fat. CAC and AAC presence was defined as Agatston score >0.
  
  
  RESULTS
  Mean participant age was 50.1 ± 3.6 years, (42.7% men, 50.0% black) and BMI was 30.6 ± 7.2 kg/m(2). The prevalence of NAFLD, CAC, and AAC was 9.6%, 27.1%, and 51.4%. NAFLD participants had increased prevalence of CAC (37.9% vs. 26.0%, p < 0.001) and AAC (65.1% vs. 49.9%, p < 0.001). NAFLD remained associated with CAC (OR, 1.33; 95% CI, 1.001-1.82) and AAC (OR, 1.74; 95% CI, 1.29-2.35) after adjustment for demographics and health behaviors. However, these associations were attenuated after additional adjustment for visceral adipose tissue (CAC OR, 1.05; 95% CI, 0.74-1.48, AAC OR = 1.20; 95% CI, 0.86-1.67). There was no interaction by race or sex.
  
  
  CONCLUSIONS
  In contrast to prior research, these findings suggest that obesity attenuates the relationship between NAFLD and subclinical atherosclerosis. Further studies evaluating the role of NAFLD duration on atherosclerotic progression and cardiovascular events are needed.
authors: Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: lvw@northwestern.edu.
authors: Lisa B
authors: LB
authors: VanWagner
authors: Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: h-ning@northwestern.edu.
authors: Hongyan
authors: H
authors: Ning
authors: University of Alabama Birmingham, Birmingham, AL, USA. Electronic address: clewis@mail.dopm.uab.edu.
authors: Cora E
authors: CE
authors: Lewis
authors: University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: christina-shay@ouhsc.edu.
authors: Christina M
authors: CM
authors: Shay
authors: Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: j-wilkins@md.northwestern.edu.
authors: John
authors: J
authors: Wilkins
authors: Vanderbilt University, Nashville, TN, USA. Electronic address: j.jeffreycarr@vanderbilt.edu.
authors: J Jeffrey
authors: JJ
authors: Carr
authors: Wake Forest University, Winston-Salem, NC, USA. Electronic address: jgterry@wakehealth.edu.
authors: James G
authors: JG
authors: Terry
authors: Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: dlj@northwestern.edu.
authors: Donald M
authors: DM
authors: Lloyd-Jones
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. Electronic address: jacob004@umn.edu.
authors: David R
authors: DR
authors: Jacobs
authors: Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: carnethon@northwestern.edu.
authors: Mercedes R
authors: MR
authors: Carnethon
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000209:etiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications*; D055815:Young Adult
keywords: Calcium; Cardiovascular diseases; Epidemiology; Imaging; Liver; Obesity; Risk factors