title: Nonalcoholic fatty liver disease and age are strong indicators for atherosclerosis in morbid obesity.
abstract: OBJECTIVE
  Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients.
  
  
  METHODS
  We studied 314 consecutive obese subjects (223 women; mean age, 45·04 ± 9·34 years; body mass index 44·3 ± 5 kg/m(2) ) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis [carotid intima-media thickness (cIMT) >0·8 mm and/or presence of plaques] were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients.
  
  
  RESULTS
  In obese patients, mean c-IMT was greater in those with NAFLD (P < 0·001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5·96 (95%CI, 1·60-22·25; P = 0·008) in men and 8·26 (95%CI, 4·02-16·99; P < 0·001) in women, and the age-associated OR for atherosclerosis was 1·14 (95%CI, 1·07-1·22; P < 0·001) in men and 1·12 (95%CI, 1·08-1·17; P < 0·001) in women. The sensitivity, specificity and positive and negative predictive values of steatosis for atherosclerosis were 78·70%, 70·50%, 74·00% and 75·60% (AUC = 0·840) in men ≥43·5 years and 86·90%, 52·50%, 68·80% and 76·80% (AUC = 0·761) in women ≥47·5 years, respectively. Agreement between ultrasound-diagnosed steatosis and histology was good (ICC = 0·79). Combined NAFLD and age was the strongest predictor of atherosclerosis in obesity.
  
  
  CONCLUSIONS
  Nonalcoholic fatty liver disease and age may be independent risk factors for carotid atherosclerosis in obese individuals. Obese men and women with steatosis aged over 43·5 and 47·5 years, respectively, should be screened for carotid atherosclerosis. However, further evidence is necessary before suggesting an intervention based on current findings.
authors.affiliation: Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Puig
authors.affiliation: Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Blasco
authors.affiliation: Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Daunis-I-Estadella
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain.
authors.forename: Emili
authors.initials: E
authors.lastname: Loshuertos
authors.affiliation: Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Codina
authors.affiliation: Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Cuba
authors.affiliation: Department of Pathology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Xifra
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain.
authors.forename: Wifredo
authors.initials: W
authors.lastname: Ricart
authors.affiliation: Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
authors.affiliation: Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Federici
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Fernández-Real
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D001706:Biopsy; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness; D005234:Fatty Liver / Q000503:physiopathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009765:Obesity; D009767:Obesity, Morbid / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012306:Risk; D012680:Sensitivity and Specificity