Association between hepatic steatosis and fibrosis and arthritis among US adults: A population-based study

Lu, Zhiming; Wu, Shaojie; Feng, Eryou; Chen, Xiaoli; Chen, Jinhua; Lin, Feitai

doi:10.1016/j.clinsp.2024.100378

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Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100378 copy

Association between hepatic steatosis and fibrosis and arthritis among US adults: A population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Lipid metabolism factors may play a role in the development of arthritis and hepatic steatosis and fibrosis. The aim of this study was to explore the potential association between arthritis and hepatic steatosis and liver fibrosis.

Materials and methods:

The nationally representative sample from the National Health and Nutrition Examination Survey was analyzed, with data on arthritis diagnosis, subtype, and liver status obtained. Liver status was assessed using transient elastography. Hepatic steatosis was defined as a Controlled Attenuation Parameter (CAP) score ≥263 dB/m, and liver fibrosis status was defined as F0‒F4. Logistic regression models and subgroup analyses stratified by sex were used to evaluate the associations. Smooth curve fitting was used to describe the associations.

Results:

The present study of 6,840 adults aged 20 years or older found a significant positive correlation between arthritis and CAP in multivariate logistic regression analysis (β = 0.003, 95 % CI 0.001 to 0.0041, p < 0.001). Participants with arthritis had a higher risk of hepatic steatosis (OR = 1.248, 95 % CI 1.036 to 1.504, p = 0.020), particularly those with osteoarthritis or degenerative arthritis, but not rheumatoid arthritis (p = 0.847). The positive correlation was maintained in females (β = 0.004, 95 % CI 0.002 to 0.006, p < 0.001), but not in males. There was no significant relationship between arthritis and liver fibrosis (p = 0.508).

Conclusion:

This study indicates that there is a positive correlation between arthritis and hepatic steatosis, particularly in females. Nonetheless, there is no significant relationship between arthritis and the risk of liver fibrosis.

Keywords:
Hepatic steatosis; Liver fibrosis; Arthritis; Controlled attenuation parameter; NHANES

HIGHLIGHTS

Positive correlation between arthritis and hepatic steatosis, particularly in women.

No significant relationship between arthritis and the risk of liver fibrosis.

First study to examine the association between arthritis and both liver steatosis and fibrosis.

	Arthritis (n = 2041)	Non-arthritis (n = 4799)	p-value
Age (years)	60.05 ± 13.71	43.54 ± 16.01	<0.001
Age groups (%)			<0.001
20–39 years	9.26 (7.65, 11.16)	46.37 (44.22, 48.53)
40–59 years	35.3 (32.03, 38.71)	34.67 (32.62, 36.78)
= 60 years	55.44 (52.08, 58.76)	18.96 (17.39, 20.64)
Gender (%)			<0.001
Male	41.32 (38.07, 44.64)	52.47 (50.32, 54.61)
Female	58.68 (55.36, 61.93)	47.53 (45.39, 49.68)
BMI Group (%)	26.62 ± 8.52	26.37 ± 8.38	0.312
< 25	42.82 (39.59, 46.12)	43.1 (40.98, 45.24)
25–30	26.92 (23.98, 30.07)	25.35 (23.53, 27.27)
= 30	30.18 (27.26, 33.27)	31.51 (29.53, 33.57)
Not recorded	0.08 (0.03, 0.24)	0.04 (0.01, 0.11)
Race (%)			<0.001
Mexican American	4.5 (3.75, 5.4)	10.22 (9.34, 11.17)
Other Hispanic	5.82 (4.88, 6.92)	8.26 (7.46, 9.15)
Non-Hispanic White	70.81 (68.31, 73.19)	60.43 (58.55, 62.29)
Non-Hispanic Black	10.35 (9.26, 11.56)	10.6 (9.84, 11.4)
Other races – including multi-racial	8.52 (7.07, 10.23)	10.49(9.61,11.43)
Education (%)			0.016
More than high school	60.14 (56.88, 63.32)	63.72 (61.67, 65.73)
High school or equivalent	28.89 (25.86, 32.12)	25.63 (23.75, 27.6)
Less than high school	10.88 (9.45,12.49)	10.62 (9.68, 11.63)
Not recorded	0.09 (0.03, 0.28)	0.03 (0.01, 0.1)
Poverty-income ratio (%)			0.007
< 1.3	16.96 (14.92, 19.21)	15.25 (14.1, 16.48)
1.3–1.8	9.17 (7.76, 10.8)	7.39 (6.61, 8.24)
> 1.8	62.24 (59.18, 65.2)	66.4 (64.55, 68.2)
Not recorded	11.64 (9.83, 13.73)	10.97 (9.79, 12.26)
Smoking (%) (serum cotinine levels, ng/mL)			0.159
< 0.015	39.89 (36.68, 43.19)	37.99 (35.87, 40.16)
0.015–3	35.34 (32.27, 38.52)	37.81 (35.79, 39.88)
= 3	24.78 (21.97, 27.81)	24.20 (22.4, 26.08)
Daily alcohol drinking status (%)			<0.001
Non-drinkers	5.11 (4.09, 6.37)	7.01 (6.07, 8.07)
Moderate-drinkers	33.99 (30.83, 37.3)	33.75 (31.68, 35.88)
Heavy-drinkers	21.21 (18.44, 24.26)	24.87 (23.04, 26.79)
Binge-drinkers	18.96 (16.52, 21.65)	21.34 (19.61, 23.18)
Not recorded	20.74 (18.44, 23.24)	13.04 (11.81, 14.37)
Physical activity level (%)			<0.001
Inactive	47.27 (44, 50.57)	46.71 (44.56, 48.86)
Less active	2.24 (1.41, 3.55)	1.84 (1.33, 2.53)
Active	22.27 (19.53, 25.28)	26.84 (24.94, 28.83)
Not recorded	28.21 (25.23, 31.39)	24.62 (22.83, 26.49)
History of diabetes (%)			<0.001
Yes	18.59 (16.32, 21.09)	7.88 (6.86, 9.03)
Having HBV infection (%)			<0.001
Yes	1.77 (1.03, 3.02)	0.71 (0.49, 1.03)
Having HCV infection (%)			0.0619
Yes	2.27 (1.56, 3.3)	1.46 (1, 2.12)
Hepatic steatosis (%)			<0.001
Yes	58.27 (54.97, 61.49)	46.67 (44.53, 48.83)
NAFLD (%)			<0.001
Yes	22.66 (19.91, 25.67)	17.83 (16.30, 19.48)	<0.001
Liver fibrosis (%)			<0.001
Yes	17.11 (14.87, 19.61)	12.84 (11.46, 14.35)
Metavir F–F4 (%)			0.001
Absent or mild fibrosis(F0–F1)	82.89 (80.52, 83.70)	87.16 (85.65, 88.54)
Significant fibrosis (F2)	10.11 (8.27, 12.30)	7.69 (6.62, 8.91)
Severe fibrosis (F3)	3.39 (2.53, 4.54)	2.34 (1.80, 3.03)
Cirrhosis (F4)	3.61 (2.71, 4.80)	2.81 (2.14, 3.69)
Which type of arthritis (%)
Osteoarthritis or degenerative arthritis	49.35
Rheumatoid arthritis	15.74
Psoriatic arthritis	1.51
Other	11.31
Not recorded	22.09
Transient Elastography
LSM (kPa)	5.99 ± 4.48	5.61 ± 4.44	0.002
CAP (dB/m)	275.84 ± 58.24	260.10 ± 63.27	<0.001
Waist Circumference (cm)	104.79 ± 15.99	98.45 ± 16.36	<0.001
Laboratory parameters
ALT(U/L)	22.09 ± 16.58	23.31 ± 17.82	0.011
ALP(IU/L)	78.10 ± 25.02	73.65 ± 23.71	<0.001
AST(U/L)	21.66 ± 12.55	22.00 ± 12.93	0.329
Total bilirubin (umoL/L)	7.87 ± 4.32	8.19 ± 5.23	0.018
Total Calcium (mmoL/L)	2.33 ± 0.10	2.32 ± 0.09	<0.001
Uric acid (umoL/L)	322.84 ± 84.50	317.13 ± 84.46	0.013
Creatine Phosphokinase (IU/L)	136.16 ± 147.75	170.89 ± 342.08	<0.001
HSCRP (mg/L)	4.57 ± 10.00	3.34 ± 5.93	<0.001
Direct HDL-Cholesterol (mmoL/L)	1.42 ± 0.44	1.38 ± 0.40	<0.001
Total Cholesterol (mg/dL)	4.92 ± 1.07	4.83 ± 1.03	0.002
Triglycerides(mmoL/L)	1.35 ± 0.93	1.21 ± 0.87	<0.001
Low-Density Lipoproteins (mmoL/L)	2.89 ± 0.91	2.84 ± 0.90	0.160

	Model 1, β (95% CI), p	Model 2, β (95% CI), p	Model 3, β (95% CI), p
Non-arthritis	Reference	Reference	Reference
Arthritis	0.004 (0.003, 0.005) <0.001	0.003 (0.002, 0.005) <0.001	0.003 (0.001, 0.004) <0.001
Non-arthritis	Reference	Reference	Reference
OA or DA	0.004 (0.002, 0.005) <0.001	0.003 (0.001, 0.005) 0.001	0.003 (0.001, 0.005) 0.005
RA	0.004 (0.001, 0.006) <0.001	0.002 (–0.001, 0.005) 0.061	0.002 (–0.001, 0.004) 0.157
Stratified by gender		“Model 2”	“Model 3”
Male
Arthritis	0.003 (0.001, 0.005) 0.001	0.002 (–0.000, 0.004) 0.076	0.002 (–0.000, 0.004) 0.092
Female
Arthritis	0.006 (0.005, 0.008) <0.001	0.004 (0.002, 0.006) <0.001	0.004 (0.002, 0.006) <0.001

	Model 1 OR (95% CI), p	Model 2, OR (95% CI), p	Model 3, OR (95% CI), p
Non-arthritis	Reference	Reference	Reference
Arthritis	1.595 (1.360, 1.872) <0.001	1.313 (1.094, 1.576) 0.003	1.248 (1.036, 1.504) 0.020
Non-arthritis	Reference	Reference	Reference
OA or DA	1.595 (1.279, 1.990) <0.001	1.304 (1.020, 1.670) 0.034	1.256 (0.977, 1.614) 0.076
RA	1.406 (1.030, 1.920) 0.032	1.133 (0.804, 1.595) 0.476	1.034 (0.735, 1.456) 0.847
Stratified by gender		“Model 2”	“Model 3”
Male
OA or DA	1.610 (1.114, 2.329) 0.011	1.204 (0.812, 1.783) 0.355	1.166 (0.774, 1.756) 0.463
RA	1.353 (0.814, 2.249) 0.243	1.112 (0.642, 1.927) 0.705	1.042 (0.616, 1.763) 0.877
Female
OA or DA	1.866 (1.409, 2.470) <0.001	1.369 (0.997, 1.878) 0.052	1.261 (0.912, 1.742) 0.161
RA	1.486 (1.033, 2.139) 0.033	1.116 (0.753, 1.655) 0.584	1.026 (0.672, 1.566) 0.906

	Model 1, β (95% CI), p	Model 2, β (95% CI), p	Model 3, β (95% CI), p
Non-arthritis	Reference	Reference	Reference
Arthritis	0.017 (0.002, 0.032) 0.032	0.013 (–0.002, 0.028) 0.093	0.007 (–0.008, 0.022) 0.349
Non-arthritis	Reference	Reference	Reference
OA or DA	0.013 (–0.005, 0.031) 0.158	0.011 (–0.008, 0.029) 0.261	0.006 (–0.013, 0.024) 0.565
RA	0.023 (0.006, 0.041) 0.007	0.018 (0.001, 0.035) 0.041	0.012 (–0.006, 0.029) 0.183
Stratified by gender		“Model 2”	“Model 3”
Male
Arthritis	0.002 (–0.016, 0.018) 0.862	–0.008 (–0.027, 0.012) 0.426	–0.012 (–0.031, 0.008) 0.240
Female
Arthritis	0.064 (–0.011, 0.140) 0.093	0.037 (0.004, 0.070) 0.026	0.030 (0.003, 0.058) 0.033

	Model 1 OR (95% CI), p	Model 2, OR (95% CI), p	Model 3, OR (95%CI), p
Non-arthritis	Reference	Reference	Model 3,
arthritis	1.401 (1.134, 1.730) 0.002	1.189 (0.936, 1.510) 0.157	1.086 (0.851, 1.385) 0.508
Non-arthritis	Reference	Reference	Reference
OA or DA	1.271 (0.949, 1.702) 0.108	1.082 (0.781, 1.501) 0.635	1.013 (0.720, 1.426) 0.941
RA	1.461 (0.949, 2.248) 0.085	1.208 (0.777, 1.876) 0.401	1.057 (0.706, 1.583) 0.789
Stratified by gender		“Model 2”	“Model 3”
Male
OA or DA	1.221 (0.780, 1.911) 0.382	0.995 (0.612, 1.618) 0.983	0.954 (0.570, 1.597) 0.859
RA	1.234 (0.630, 2.418) 0.540	1.079 (0.549, 2.120) 0.826	0.906 (0.509, 1.612) 0.736
Female
OA or DA	1.617 (1.086, 2.409) 0.018	1.147 (0.730, 1.803) 0.553	1.057 (0.663, 1.686) 0.815
RA	1.891 (1.168, 3.061) 0.010	1.365 (0.822, 2.268) 0.230	1.282 (0.752, 2.183) 0.361

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[1] *Corresponding author. E-mail address:fey9001@126.com (E. Feng).