Common Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease: A Population-based Case-control Study

Kamran B. Lankarani; Mojtaba Mahmoodi; Mehrzad Lotfi; Nima Zamiri; Sayed Taghi Heydari; Fariborz Ghaffarpasand; Mohammad Kazem Fallahzadeh; Meisam Babaeinejad; Najmeh Maharlouei; Omid Mirzaee; Bita Geramizadeh; Payam Peymani

doi:10.4166/kjg.2013.62.6.344

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Lankarani, Mahmoodi, Lotfi, Zamiri, Heydari, Ghaffarpasand, Fallahzadeh, Babaeinejad, Maharlouei, Mirzaee, Geramizadeh, and Peymani: Common Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease: A Population-based Case-control Study

Original Article

Korean J Gastroenterol 2013;62(6):344-351.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.6.344

Common Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease: A Population-based Case-control Study

Kamran B. Lankarani¹, Mojtaba Mahmoodi¹, Mehrzad Lotfi^2,³, Nima Zamiri¹, Sayed Taghi Heydari⁴, Fariborz Ghaffarpasand⁵, Mohammad Kazem Fallahzadeh¹, Meisam Babaeinejad^2,³, Najmeh Maharlouei¹, Omid Mirzaee^1,⁶, Bita Geramizadeh^7,⁸, Payam Peymani¹

¹Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

²Department of Radiology, Namazi Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

³Medical Imaging Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

⁴Department of Biostatistics, Jahrom University of Medical Sciences, Jahrom, Iran

⁵Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

⁶Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

⁷Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

⁸Transplant Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence to: Mojtaba Mahmoodi, Health Policy Research Center, Shiraz School of Medicine, Shiraz University of Medical Sciences, Zand Blvd., Shiraz, Iran. Tel: +98-711-230-9615, Fax: +98-711-230-9615, E-mail: mahmoodimoj@gmail.com

Received 24 April 2013 Revised 31 October 2013 Accepted 18 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Metabolic syndrome is a well-known risk factor for atherosclerosis. Non-alcoholic fatty liver disease (NAFLD) has features of metabolic syndromes. This study aimed to investigate the association between NAFLD and atherosclerosis.

Methods

In a population-based study in southern Iran, asymptomatic adult inhabitants aged more than 20 years were selected through cluster random sampling, and were screened for the presence of fatty liver and common carotid intima-media thickness (CIMT), with abdominal and cervical ultrasonography, respectively. Those with fatty liver were compared to the same number of individuals without fatty liver.

Results

Two hundred and ninety individuals were found to have fatty change on abdominal ultrasonography, and were labeled NAFLD. Compared to normal individuals, NAFLD patients had significantly higher prevalence of increased CIMT (OR, 1.66; p<0.001). Those with hypertension (HTN), diabetes mellitus (DM), higher waist circumference (WC) and older ages had significantly higher prevalence of thick CIMT. Through adjusting the effects of different variables, we indicated that NAFLD could be an independent risk factor for thick common carotid intima-media (OR, 1.90; 95% CI, 1.17–3.09; p=0.009). It was also shown that age could be another independent risk factor for thick CIMT.

Conclusions

Individuals with risk factors such as HTN, DM, and high WC are prone to develop atherosclerosis of the carotid artery. The presence of NAFLD should be considered as another probable independent factor contributing to the development of carotid atherosclerosis.

Keywords: Thickness, intima-media, Artery, common carotid, Liver, fatty

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Fig. 1.

A flow chart of the study.

Fig. 2.

Longitudinal ultrasonographic image of the common carotid artery. Longitudinal ultrasonographic image of the common carotid artery, showing the carotid intima-media thickness in the posterior wall (diameter: 11 mm [A], 7 mm [B]).

Table 1.

Clinical, Anthropometric and Laboratory Findings of Patients with NAFLD and Control Group (Ultrasonographic Normal Liver Group)

	Ultrasonographic NAFLD group (n=290)	Ultrasonographic normal liver group (n=290)	p-value
Hypertension	82 (28.3)	54 (18.6)	＜0.001
Diabtes mellitus	97 (33.4)	34 (11.7)	＜0.001
BMI	28.6±4.2	25±3.8	＜0.001
Normal (＜25)	51 (17.6)	145 (50.0)	＜0.001
Overweight (≥25, ＜30)	142 (49.0)	110 (37.9)
Obese (≥30)	97 (33.4)	35 (12.1)
Waist circumference (cm)	95.2±10.4	86.9±9.0	＜0.001
Waist/hip circumference (cm)	0.889±0.061	0.861±0.063	3 ＜0.001
Systolic blood pressure (mmHg)	119.1±15.9	113.8±14.2	＜0.001
Diastolic blood pressure (mmHg)	78±9.5	74.7±9.2	＜0.001
Metabolic syndrome	91 (31.4)	39 (13.4)	＜0.001
Fasting blood sugar (mg/dL)	101.8±32.9	86.3±13.5	＜0.001
AST (IU/L)	26.9±11.5	23.7±10.1	＜0.001
ALT (IU/L)	31.1±21.1	21.0±11.0	＜0.001
GGT (IU/L)	37.4±27.4	31.8±31.6	＜0.021
ALP (IU/L)	208.1±66.4	194.3±71.9	0.018
Total cholesterol (mg/dL)	198.9±42.1	190.1±40.5	0.011
LDL (mg/dL)	112.4±35.4	108.5±33.4	0.176
HDL (mg/dL)	49.4±10.3	51.0±11.3	0.075
Triglyceride (mg/dL)	167.8±84.1	127.2±60.7	＜0.001
Uric acid (mg/dL)	4.8±1.5	4.3±1.3	＜0.001
Serum ferritin (ng/mL)	114.1±106.2	88.2±92.5	0.002
ANA (IU/L)	3.2±12.8	2.8±3.4	0.70
CIMT (mm)			0.009
＜0.8	197 (67.9)	226 (77.9)
≥0.8	93 (32.1)	64 (22.1)

Values are presented as the mean±SD or n (%).

For the comparison between patient and control data, student's t-test were used for quantitative variables and the chi-square test was used to determine the statistical significance of differences in qualitative variables. p-value less than 0.05 is considered statistically significant.

NAFLD, nonalcoholic fatty liver disease; CIMT, common carotid intima-media thickness.

Table 2.

Comparison between CIMT and Metabolic Syndrome- related Factors

	CIMT ≥0.8 mm (n=157)	CIMT ＜0.8 mm (n=423)	p-value
Age (yr)	54.4±11.4	42.8±10.8	＜0.001
Hypertension	58 (36.9)	78 (18.4)	＜0.001
Diabetes mellitus	52 (33.1)	79 (18.7)	＜0.001
Triglyceride (mg/dL)	153.7±79.7	145.1±74.5	0.251
HDL (mg/dL)	50.7±9.9	50.1±11.2	0.506
Waist circumference (cm)	93.3±9.6	90.3±10.9	0.002
NAFLD	93 (59.2)	197 (46.6)	0.007
Serum ferritin (ng/mL)	110.3±107.7	98±97.5	0.222

Values are presented as the mean±SD or n (%).

For the comparison between those with thick CIMT and subjects with normal CIMT, student's t-test were used for quantitative variables, and the chi-square test was used to determine the statistical significance of differences in qualitative variables. p-value less than 0.05 is considered statistically significant.

CIMT, common carotid intima-media thickness; NAFLD, nonalcoholicfatty liver disease.

Table 3.

Multivariate Analysis for the Risk Factors of CIMT ≥0.8 mm^a

Variable	p-value	OR (CIMT ≥0.8 mm/＜0.8 mm)	95% CI
NAFLD
No		1	−
Yes	0.009	1.91	1.17–3.10
Hypertension
No		1	−
Yes	0.238	1.34	0.82–2.19
Diabetes mellitus
No		1	−
Yes	0.611	1.14	0.68–1.89
Waist circumference^b
Normal		1	−
High	0.054	0.62	0.38–1.01
Age (yr)
18–29		1	−
30–39	0.166	0.27	0.04–1.710
40–49	0.048	3.50	1.01–12.18
50–59 ＜	＜0.001	10.83	3.07–38.20
≥60 ＜	＜0.001	22.76	6.08–85.21

CIMT, common carotid intima-media thickness; NAFLD, nonalcoholic fatty liver disease.

^a Adjusted OR with multiple logistic regression.

^b Waist circumference ＞102 cm in men and ＞88 cm in women was considered high.

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