title: Computerized tomography measured liver fat is associated with low levels of N-terminal pro-brain natriuretic protein (NT-proBNP). Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  N-terminal pro B-type natriuretic peptide (NT-proBNP) is inversely associated with diabetes mellitus, obesity and metabolic syndrome. We aim to characterize the association between NT-proBNP and nonalcoholic fatty liver disease (NAFLD), a condition strongly associated with metabolic syndrome.
  
  
  METHODS
  4529 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) free of cardiovascular disease, without self-reported liver disease and not diabetic at their baseline visit in 2000-2002 were included in this analysis. NAFLD was defined by a liver attenuation <40 HU. Relative prevalence (RP) for NAFLD was assessed adjusted for age, race, and sex, percentage of dietary calories derived from fat, total intentional exercise, alcoholic drinks per week, and interleukin-6 by quintiles of NT-proBNP. Adjusted linear spline model was used to characterize a non-linear association between NT-proBNP and liver fat. The inflection point (IP) was the NT-proBNP concentration where there was a change in slope in the association between liver attenuation and NT-proBNP.
  
  
  RESULTS
  RP for NAFLD decreased by 30% from the lowest to the highest quintile of NT-proBNP, p=0.01. We observed an inverse linear association between NT-proBNP and liver fat, which plateaued (IP) at an NT-proBNP concentration of 45pg/mL. Linear regression coefficient (SE) per unit of NT-proBNP less than and greater than or equal to IP was of 0.05 (0.02), p=0.001 and 0.0006 (0.0008), p=0.5, respectively; differences between slopes, p<0.0001.
  
  
  CONCLUSIONS
  In this cross-sectional study of a community based multiethnic sample of non-diabetic adults, low levels of NT-proBNP are associated with greater prevalence of NAFLD.
authors.affiliation: Department of Internal Medicine, Division of Renal Diseases and Hypertension, University of Minnesota, 717 Delaware, Mail Code 1932, Minneapolis, MN 55414. Electronic address: sanc0050@umn.edu.
authors.forename: Otto A
authors.initials: OA
authors.lastname: Sanchez
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: mlazo@jhu.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo-Elizondo
authors.affiliation: Department of Cardiology, Mount Sinai St. Luke's Roosevelt Hospital (Bronx-Lebanon Hospital Center). Electronic address: izeb82@gmail.com.
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.affiliation: University of Vermont College of Medicine, Burlington, VT 05405. Electronic address: russell.tracy@uvm.edu.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.affiliation: National College of Natural Medicine, SW Porter Street, Portland, OR 97201. Electronic address: rbradley@ncnm.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Bradley
authors.affiliation: Division of Cardiology, University of Minnesota, 420 Delaware St. SE. Mayo Mail Code 508, Minneapolis, MN 55455. Electronic address: dupre007@umn.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.affiliation: Stanford Cardiovascular Institute, Stanford University. Electronic address: hbahrami@stanford.edu.
authors.forename: Hossein
authors.initials: H
authors.lastname: Bahrami
authors.affiliation: School of Medicine, University of California San Francisco, 33 Parnassus Ave, UC Hall, San Francisco, CA 94143. Electronic address: CarmenAlicia.Peralta@ucsf.edu.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: Division of Cardiology, University of California, San Diego, Sulpizio Cardiovascular Center, 9434 Medical Center Drive, La Jolla, CA 92037. Electronic address: lbdaniels@ucsd.edu.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Division of Cardiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224. Electronic address: jlima@jhmi.edu.
authors.forename: João A
authors.initials: JA
authors.lastname: Lima
authors.affiliation: School of Medicine, University of California, 3350 La Jolla Village Drive, Cardiology Section, mc 9111A, San Diego, CA 92161. Electronic address: amaisel@ucsd.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.affiliation: School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN. Electronic address: jacob004@umn.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Los Angeles Biomedical Research Institute, Division of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA. Electronic address: mbudoff@labiomed.org.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D005260:Female; D006801:Humans; D016014:Linear Models; D050356:Lipid Metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism*; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Hounsfield units; NT-proBNP; Natriuretic peptides; Non-alcohol fatty liver disease