Nonalcoholic fatty liver disease and age are strong indicators for atherosclerosis in morbid obesity

OBJECTIVE: Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients. DESIGN, PATIENTS AND MEASUREMENTS: We studied 314 consecutive obese subjects (223 women; mean age, 45·04 ± 9·34 years; body mass index 44·3 ± 5 kg/m(2) ) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis [carotid intima-media thickness (cIMT) >0·8 mm and/or presence of plaques] were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients. RESULTS: In obese patients, mean c-IMT was greater in those with NAFLD (P < 0·001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5·96 (95%CI, 1·60-22·25; P = 0·008) in men and 8·26 (95%CI, 4·02-16·99; P < 0·001) in women, and the age-associated OR for atherosclerosis was 1·14 (95%CI, 1·07-1·22; P < 0·001) in men and 1·12 (95%CI, 1·08-1·17; P < 0·001) in women. The sensitivity, specificity and positive and negative predictive values of steatosis for atherosclerosis were 78·70%, 70·50%, 74·00% and 75·60% (AUC = 0·840) in men ≥43·5 years and 86·90%, 52·50%, 68·80% and 76·80% (AUC = 0·761) in women ≥47·5 years, respectively. Agreement between ultrasound-diagnosed steatosis and histology was good (ICC = 0·79). Combined NAFLD and age was the strongest predictor of atherosclerosis in obesity. CONCLUSIONS: Nonalcoholic fatty liver disease and age may be independent risk factors for carotid atherosclerosis in obese individuals. Obese men and women with steatosis aged over 43·5 and 47·5 years, respectively, should be screened for carotid atherosclerosis. However, further evidence is necessary before suggesting an intervention based on current findings.