Research On The Association Between Non-alcoholic Fatty Liver Disease And Dementia

Background:Nonalcoholic fatty liver disease(nonalcoholic fatty liver disease,NAFLD),refers to a chronic liver disease with abnormal accumulation of fat in the liver without a clear cause of liver damage(such as alcohol,viruses,drugs and autoimmunity),which can lead to hepatic steatosis,steatohepatitis,liver fibrosis,and even liver cancer.Among these pathological changes,liver fibrosis is a repair process after liver injury,which will increase the risk of liver cirrhosis and liver cancer,and is an extremely important link in progression of NAFLD disease.At present,NAFLD lacks of specific treatment,and the disease is hidden,in the early stage of the disease is not easy to attract attention.Age,sex,eating habits,and exercise frequency were all confirmed as risk factors for NAFLD onset.NAFLD also affects the process of many diseases,which can not only increase the disability rate and mortality of liver system diseases,but also increase the prevalence of diseases such as diabetes,coronary heart disease and tumor,which has caused great harm to human health.Dementia is a kind of brain function impairment syndrome with cognitive impairment.Its clinical manifestations mainly include language,cognition(calculation,judgment and abstract thinking),personality,memory,visual space change,emotion and so on.According to WHO data,some 35.6 million people worldwide have been diagnosed with dementia.And with the acceleration of global aging and the increase of cardiovascular and cerebrovascular diseases,the prevalence of dementia is increasing year by year.It is estimated that by 2050,the number of dementia will be three times that of the present.People divide dementia into denatured dementia(Alzheimer’s disease,Lewy body dementia)and non-denatured dementia(Vascular dementia,Frontotemporal dementia),among which AD and VaD are the two most common clinical types of dementia.At present,there is no specific treatment for dementia.It is of great significance to find out the risk factors and intervene early to delay the progress of dementia.The relationship between NAFLD and dementia has attracted more and more attention in recent years,and there are still some differences on whether NAFLD has an influence on the prevalence of dementia and its subtypes.China lacks relevant research and reports.This study intends to explore the relationship between NAFLD and dementia among the elderly cohort subjects in rural areas of china to provide more states for further prevention and control.Objective:Based on the elderly population in rural areas of northern China,the main purpose of this study is to explore the relationship between NAFLD and dementia and its subtypes.Methods:This population-based cross-sectional study included 5,765participants(61.83%women)who were aged≥60 years and living in the rural communities in Yanggu County,Shandong.In March-September 2018,data on demographics,lifestyle,and clinical conditions were collected.An abdominal ultrasound examination was used by an experienced clinical radiologist to evaluate NAFLD,and the participants were divided into two groups:NAFLD group and normal control group,and according to NAFLD severity,it was divided into three subgroups:mild,moderate and severe,and dementia was divided into three subgroups:mild,moderate and severe.The NFS value was calculated to evaluate the severity of liver fibrosis.The cognitive function was evaluated by a structured neuropsychological test battery,and multivariate Logistic regression models were used to analyse the relationship between non-alcoholic fatty liver disease and various dementias.Results:The study included 5129 subjects with an average age of(71.06±5.97)years,including 712 cases of non-alcoholic fatty liver disease(NAFLD)group and4417 cases of normal group;292 cases of dementia patients,including 188 cases of AD patients and 96 cases of VaD patients.Compared with the control group,the age of the subjects in NAFLD group was significantly lower than that in the normal group(69.62±4.96 VS.71.29±6.08),a higher percentage of women(74.2%VS.59.81%),type 2 diabetes mellitus(31.60%VS.11.93%),obesity(57.30%VS.13.45%),hypertension(79.13%VS.64.94%),coronary heart disease(30.20%VS.20.83%)and stroke(19.94%VS.15.70%)increased significantly,the levels of alanine aminotransferase(25.49± 17.29 VS.18.62± 12.49),platelet count(213.69±56.13 VS.207.45±55.83)and albumin(44.88±3.92 VS.44.11±4.08)were significantly increased.There was no significant difference in education level,blood alanine aminotransferase and ApoE-ε4 genotype carrying ratio between NAFLD and control groups.The risk of dementia(OR=1.44,95%CI=1.01-2.04)and VaD(OR=2.03,95%CI=1.21-3.39)increased significantly after adjusting for a variety of factors,including age,sex and educational level.The risk of mild NAFLD increased not significantly,while that of moderate and severe NAFLD patients increased significantly.After adjusting for smoking,alcohol consumption,obesity,APOE genotype,hypertension,diabetes,coronary heart disease and stroke,NAFLD subjects had a higher risk of dementia and VaD than the controls,but there was no statistical difference;Moderate NAFLD increased the risk of dementia by 0.94 times(OR=2.04,95%CI=1.23-3.39),the risk of VaD increased by 1.32times(OR=2.32,95%CI=1.06-5.08);the risk of dementia in severe NAFLD increased by 2.29 times(OR=3.29,95%CI=1.33-8.14),the difference was statistically significant;the risk of VaD increased by 4.03 times(OR=5.03,95%CI=1.26-20.03),but there was no statistical difference.Moreover,as NAFLD severity increases,the higher the risk of dementia and VaD(P for trend<0.05).Severe NFS levels increase the risk of developing VaD,with a statistically significant difference,and increase the risk of developing dementia,and AD,but the difference is not statistically significant;mild to moderate NFS levels have a non-significant effect on the risk of developing dementia,its subtypes and VaDconclusions:1.Moderate and severe NAFLD are risk factors for dementia.2.Among different subtypes of dementia,NAFLD patients have a high risk of VaD,while the impact on the risk of dementia is not significant.3.Severe levels of NFS increased the risk of VaD dementia.