title: The association of nonalcoholic fatty liver disease, obesity, and metabolic syndrome, with systemic inflammation and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  We characterized the association of 3 metabolic conditions - obesity, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) - with increased inflammation and subclinical atherosclerosis.
  
  
  METHODS
  We conducted cross-sectional analysis of 3976 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with adequate CT imaging to diagnose NAFLD. Obesity was defined as BMI ≥ 30 kg/m(2), metabolic syndrome by AHA/NHLBI criteria, and NAFLD using non-contrast cardiac CT and a liver/spleen attenuation ratio (L/S) < 1. Increased inflammation was defined as high sensitivity C-reactive protein (hsCRP) ≥2 mg/L and subclinical atherosclerosis as coronary artery calcium (CAC) > 0. We studied the association of a stepwise increase in number of these metabolic conditions (0-3) with increased inflammation and CAC, stratifying results by gender and ethnicity.
  
  
  RESULTS
  Mean age of participants was 63 (±10) years, 45% were male, 37% white, 10% Chinese, 30% African American, and 23% were Hispanic. Adjusting for obesity, metabolic syndrome and traditional risk factors, NAFLD was associated with a prevalence odds ratio for hsCRP ≥2 mg/L and CAC >0 of 1.47 (1.20-1.79) and 1.37 (1.11-1.68) respectively. There was a positive interaction between female gender and NAFLD in the association with hsCRP ≥2 mg/L (p = 0.006), with no interaction by race. With increasing number of metabolic conditions, there was a graded increase in prevalence odds ratios of hsCRP ≥2 mg/L and CAC >0.
  
  
  CONCLUSIONS
  NAFLD is associated with increased inflammation and CAC independent of traditional risk factors, obesity and metabolic syndrome. There is a graded association between obesity, metabolic syndrome, and NAFLD with inflammation and CAC.
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors: Mahmoud
authors: M
authors: Al Rifai
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Michael G
authors: MG
authors: Silverman
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA.
authors: Khurram
authors: K
authors: Nasir
authors: Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors: Matthew J
authors: MJ
authors: Budoff
authors: Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Ron
authors: R
authors: Blankstein
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Moyses
authors: M
authors: Szklo
authors: Kidney Research Institute, University of Washington, Seattle, WA, USA.
authors: Ronit
authors: R
authors: Katz
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors: Roger S
authors: RS
authors: Blumenthal
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: mjblaha@gmail.com.
authors: Michael J
authors: MJ
authors: Blaha
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D018836:Inflammation Mediators / Q000097:blood; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000208:ethnology*; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000208:ethnology*; D009765:Obesity / Q000175:diagnosis / Q000208:ethnology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: Inflammation; Metabolic syndrome; Nonalcoholic fatty liver disease; Obesity; Subclinical atherosclerosis