Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study

Abstract

Dezhi Yang,1,* Jing Lan,2,* Ji Cen,3,* Yong Han,4– 6 Haofei Hu6– 8 1Department of Cardiology Second Ward, Hechi People’s Hospital, Hechi, People’s Republic of China; 2Department of Gastroenterology, Hechi People’s Hospital, Hechi, People’s Republic of China; 3Department of Nephrology, Hechi People’s Hospital, Hechi, People’s Republic of China; 4Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, People’s Republic of China; 5Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, People’s Republic of China; 6Shenzhen University Health Science Center, Shenzhen University, Shenzhen, People’s Republic of China; 7Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, People’s Republic of China; 8Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yong Han, Department of Emergency, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, People’s Republic of China, Tel [phone], Email [email protected] Haofei Hu, Department of Nephrology, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, People’s Republic of China, Tel [phone], Email [email protected]: Quantification of the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD) risk is limited and controversial. This study aimed to investigate the relationship between hypertension and NAFLD in non-obese Chinese and to use different methods to demonstrate that hypertension is an independent risk factor for NAFLD.Methods: On 16,153 nonobese individuals, a retrospective cohort study was conducted in China to examine the impact of hypertension on incident NAFLD. We compared five methods: multivariable Cox proportional-hazards regression, propensity score-matched (PSM) analysis, propensity score adjustment method (considering the propensity score as a covariate in a multivariable Cox proportional-hazard regression), and two propensity score-based weighted methods-The first one estimated the hypertension effect in the overall study population-inverse probability of treatment weights (IPTW), the other in the hypertensive population-standardized mortality ratio (SMR) weights. We also used a genetic matching (GenMatch) algorithm to match the participants for sensitive analysis.Results: Between 2010 and 2014, 16,153 participants met our inclusion criteria, including 2427 (15.03%) with hypertension. A total of 2321 (14.37%) participants developed NAFLD during the median follow-up of 2.98 years. The crude hazard ratio (HR) between hypertension and incident NAFLD was 2.05 (95% confidence interval (CI): 1.87, 2.25). The adjusted HR depended on the different methods, ranging from 1.09 (95% CI: 0.77, 1.23) for the PSM method to 2.24 (95% CI: 2.05, 2.44) for the SMR weighted analysis. Hypertensive participants with high propensity scores had a higher risk of developing NAFLD in the future. Excluding participants with propensity scores < 8% yielded comparable hazard ratios with a narrower range, from 1.04 to 1.80. After adjusting for the confounding variables, the relationship also existed in the GenMatch cohort as a sensitivity analysis (HR=1.06, 95% CI 1.01– 1.13).Conclusion: Hypertension is a significant cause of NAFLD in Chinese adults in non-obese Chinese adults, with the hazard ratio ranging from 1.09 to 2.24.Keywords: hypertension, non-alcoholic fatty liver disease, propensity-score matching, standardized-mortality-ratio weights, inverse probability of treatment weights

Keywords

• hypertension
• non-alcoholic fatty liver disease
• propensity-score matching
• standardized-mortality-ratio weights
• inverse probability of treatment weights