Abstract 15140: Association Between Liver Fat and Serum Lipoproteins: The Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) affects ∼30% of American adults and is associated with increased cardiovascular risk. We hypothesize that NAFLD is independently associated with dyslipidemia.

Methods: MESA is a cohort of 6,814 participants with lipoprotein assessment via NMR and a cardiac CT that included liver and spleen images in most participants. Exclusion criteria included insufficient imaging, reported cirrhosis, heavy drinking, steroid, class III antiarrhythmic or cholesterol medication use. NAFLD was assessed using the ratio of Hounsfield attenuation between the liver and spleen (L/S). We examined the association between NAFLD, as assessed by L/S ratio, and lipoprotein cholesterol, particle size & concentration. Multivariable robust linear and logistic regression models were used to adjust for cardiovascular risk factors.

Results: Of 3,362 MESA participants, 569 had NAFLD (L/S<1). There was no difference in total or LDL-C among those with and w/o NAFLD (118mg/dl +31 vs 120mg/dl +31, p=0.23). However, participants with NAFLD exhibited higher LDL-P concentration (1435micromol/L+392 vs 1307 micromol/L+368, p<0.0001), and smaller mean particle size (20.47nm +0.74 vs 20.89nm +0.77, p<0.0001), as compared to those without NAFLD. VLDL mean particle size (55.75nm +9.45 vs 49.82nm +8.35, p<0.0001) and concentration (83micromol/L+43 vs 72micromol/L+39, p<0.0001) was also higher in subjects with NAFLD. Prevalence odds ratios by multivariable logistic regression for having the atherogenic dyslipidemia are greater in subjects with greater liver fat severity (table).

Conclusion: NAFLD, identified by L/S<1, is directly associated with LDL concentration and negatively associated with LDL particle size. Increasing NAFLD severity is associated with increasing odds of having atherogenic dyslipidemia. These relationships persist after adjustment for cardiovascular risk factors, including elements of the metabolic syndrome.