title: Hepatic steatosis is associated with cardiometabolic risk in a rural Indian population: A prospective cohort study.
abstract: OBJECTIVE
  While adiposity and hepatic steatosis are linked to cardiovascular risk in developed countries, their prevalence and impact in low-income countries are poorly understood. We investigated the association of anthropomorphic variables and hepatic steatosis with cardiometabolic risk profiles and subclinical cardiovascular disease (CVD) in a large rural Indian cohort.
  
  
  METHODS
  In 4691 individuals in the Birbhum Population Project in West Bengal, India, we performed liver ultrasonography, carotid ultrasound and biochemical and clinical profiling. We assessed the association of hepatic steatosis and anthropomorphic indices (BMI, waist circumference) with CVD risk factors (dysglycemia, dyslipidemia, hypertension) and subclinical CVD (by carotid intimal-medial thickness).
  
  
  RESULTS
  Rural Indians exhibited a higher visceral adiposity index and pro-atherogenic dyslipidemia at a lower BMI than Americans. Individuals with any degree of hepatic steatosis by ultrasound had a greater probability of dysglycemia (adjusted odds ratio, OR=1.67, 95% CI 1.31-2.12, P<0.0001) and pro-atherogenic dyslipidemia (OR=1.33, 95% CI 1.07-1.63, P=0.009). We observed a positive association between liver fat, adiposity and carotid intimal-medial thickness (CIMT) in an unadjusted model (β=0.02, P=0.0001); the former was extinguished after adjustment for cardiometabolic risk factors.
  
  
  CONCLUSIONS
  In a large population of rural Indians, hepatic steatosis and waist circumference were associated with prevalent cardiometabolic risk and subclinical CVD at lower BMI relative to multi-ethnic Americans, though the association of the former with subclinical CVD was extinguished after adjustment. These results underscore the emerging relevance of hepatic steatosis and adiposity in the developing world, and suggest efforts to target these accessible phenotypes for cardiometabolic risk prevention.
authors.affiliation: Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India. Electronic address: anomitro2010@gmail.com.
authors.forename: Anamitra
authors.initials: A
authors.lastname: Barik
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States. Electronic address: rvshah@partners.org.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: aspahill@bidmc.harvard.edu.
authors.forename: Aferdita
authors.initials: A
authors.lastname: Spahillari
authors.affiliation: Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor, MI, United States. Electronic address: vlmurthy@med.umich.edu.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, MD, United States. Electronic address: bambale1@jhmi.edu.
authors.forename: Bharath
authors.initials: B
authors.lastname: Ambale-Venkatesh
authors.affiliation: Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India. Electronic address: rajesh.iips28@gmail.com.
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Rai
authors.affiliation: Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: kausikdasmail@gmail.com.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Das
authors.affiliation: Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: asantra2000@yahoo.co.in.
authors.forename: Amal
authors.initials: A
authors.lastname: Santra
authors.affiliation: Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: jhembram3@gmail.com.
authors.forename: Jaba Ranjan
authors.initials: JR
authors.lastname: Hembram
authors.affiliation: Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: SHDS@rediffmail.com.
authors.forename: Dilip
authors.initials: D
authors.lastname: Bhattacharya
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: jane.freedman@umassmed.edu.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Freedman
authors.affiliation: Department of Cardiology, Johns Hopkins University, Baltimore, MD, United States. Electronic address: jlima@jhmi.edu.
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.affiliation: Institute for Socioeconomic Research and Development, Delhi, India. Electronic address: das.ranen@gmail.com.
authors.forename: Ranendra
authors.initials: R
authors.lastname: Das
authors.affiliation: Quadra Medical Services, Kolkata, India. Electronic address: pinakpanidr@hotmail.com.
authors.forename: Pinakpani
authors.initials: P
authors.lastname: Bhattacharyya
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States. Electronic address: sdas@partners.org.
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.affiliation: Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India; Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: achowdhury2002@yahoo.co.in.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008875:Middle Aged; D009749:Nutrition Surveys / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population
keywords: Adiposity; Carotid intimal-medial thickness; India; Liver fat; Metabolic disease