The Association between Nonalcoholic Fatty Liver Disease and Bone Mineral Density -- Results from the Third National Health and Nutrition Examination Survey (NHANES III) Öffentlichkeit
Umehara, Toshihiro (2016)
Abstract
Background
Previous studies have suggested that nonalcoholic fatty liver
disease (NAFLD) is associated with lower bone mineral density
(BMD), but data are limited especially in Western countries.
Methods
The cross-sectional study was conducted to assess the association
between NAFLD and BMD. In this study, the author used the National
Health and Nutrition Survey (NHANES) III dataset, and examined the
association in the United States population.
Results
6,126 participants from 40 to 75 year old were selected after
excluding people with hepatitis virus serology, elevated alcohol
consumption, or decreased renal function, and pregnant women. The
exposure, NAFLD, was defined as having moderate to severe hepatic
steatosis. The prevalence of NAFLD was 24.9% among the selected
participants. Multivariate linear regression with the outcome of
BMD was conducted. After controlling for gender/menopausal status,
race, age and BMI, the final model did not show a statistically
significant NAFLD effect on BMD (beta coefficient: -0.007, 95%CI:
-0.016, 0.003).
In the secondary analysis, using serum alanine aminotransferase
(ALT) level, NAFLD group was further categorized into high ALT
NAFLD group and normal ALT NAFLD group. These two groups were used
as exposures, and non-NAFLD group was used as a reference group.
After controlling for gender/menopausal status, race, age and BMI,
the final model showed that high ALT NAFLD has statistically
significant negative effect on BMD (beta coefficient: -0.051, 95%
CI: -0.081, -0.020) at the overall average BMI level, 27 kg/m2. The
interaction term between high ALT NAFLD and BMI showed
statistically significant positive coefficient (beta coefficient:
0.004, 95% CI: 0.001, 0.007), which suggests the high ALT NAFLD
negative effect is attenuated among higher BMI people.
Conclusions
The primary analysis did not support the hypothesis that NAFLD has
an association with lower BMD. The secondary analysis suggested the
possible relationship between NAFLD and lower BMD among people with
low to normal BMI.
Table of Contents
Background/Literature Review 1
Methods 7
Results 17
Discussion 22
Future Directions 27
References 28
Tables 37
Figures and Figure Legends 45
Appendices 50 (Supporting Information 50, SAS Source Codes 56)
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