Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.265
Peer-review started: December 6, 2022
First decision: January 11, 2023
Revised: January 21, 2023
Accepted: February 8, 2023
Article in press: February 8, 2023
Published online: February 27, 2023
Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide, with hyperlipidemia as one of its risk factors. Nephrotic syndrome (NS) is known to cause hyperlipidemia. Since both NAFLD and NS patients are known to have abnormalities in lipid metabolism, patients with NS might be at increased risk of developing NAFLD.
Given the increasing prevalence of NAFLD and associated morbidity and mortality, assessment of risk factors for targeted surveillance is warranted. This might help in early diagnosis of NAFLD and improve outcomes. We hypothesized that the excess synthesized and circulating lipids in patients with NS affect fat metabolism in the liver, increasing the risk of NAFLD.
To conduct a cross-sectional population-based study to assess the prevalence of NAFLD in patients with NS while adjusting for common risk factors.
A large multicenter database (Explorys Inc., Cleveland, OH, United States) was utilized for this study. A cohort of patients with a diagnosis of “Non-Alcoholic fatty liver disease” was identified. Inclusion criteria were age ≥ 18 years, presence of NAFLD, presence of NS. There were no specific exclusion criteria. Univariate and multivariate analyses were performed to adjust for multiple risk factors including age, gender, Caucasian race, nephrotic syndrome, type II diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease. Statistical analysis was conducted using R, and for all analyses, a 2-sided P value of < 0.05 was considered statistically significant.
In multivariate analysis, the odds of having NAFLD amongst patients with NS was 1.85 (95%Cl 1.70-2.02), while the odds also remained high in patients that have type 2 diabetes mellitus (OR 3.84), hypothyroidism (OR 1.57), obesity (OR 5.10), hyperlipidemia (OR 3.09), metabolic syndrome (OR 3.42) and chronic kidney disease (CKD) (OR 1.33).
Our study demonstrates that patients with NS are frequently found to have NAFLD, even when adjusting for common risk factors including CKD. Further studies are required to confirm these findings, investigate causality and assess the utility of surveillance strategies for NAFLD in patients with NS.
Studies assessing associations of NAFLD with other diseases can help identify at-risk populations that may benefit from routine screening. While patients with NS seem to have higher prevalence of NAFLD, further research is required to assess if routine surveillance of patients with NS is cost-effective and improves outcomes.