Nonalcoholic fatty liver disease is associated with blood pressure in hypertensive and nonhypertensive individuals from the general population with normal levels of alanine aminotransferase.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been associated with hypertension in specific population groups and in cases with elevated levels of alanine aminotransferase (ALT). This study aimed to determine the strength of the association between NAFLD with prevalent hypertension and with high-normal blood pressure (BP) in nonhypertensive individuals from the general population regardless of ALT levels. METHODS: The observational study included 454 participants selected randomly from the general population aged 50-75 years old. Adjusted odds ratios and 95% confidence intervals (CIs) of NAFLD with hypertension were calculated by binary multivariate regression analysis controlling for traditional risk factors and ALT levels. Similar calculations were performed to assess the independent association of NAFLD with high-normal systolic (130-139 mmHg) and diastolic (85-89 mmHg) BP in the subgroup of nonhypertensive participants. RESULTS: The prevalence of NAFLD was 38.5% (95% CI, 34.0-43.0) in the entire sample and 49.5% (95% CI, 44.9-54.1) in hypertensive participants. The percentage of cases with hypertension was 21.2% greater in individuals with NAFLD than those without NAFLD (95% CI, 11.8-30.6, P<0.0005). NAFLD was independently associated with prevalent hypertension with an adjusted odds ratio of 1.71 (95% CI, 1.10-2.65, P=0.017). Among nonhypertensive participants, NAFLD was also independently associated with high-normal systolic BP (adjusted odds ratio 2.13, 95% CI, 1.08-4.20, P=0.029) but not with high-normal diastolic BP. CONCLUSION: In middle-aged and old adults from the general population, NAFLD is associated with an independent risk of identifying hypertension and high-normal systolic BP. Detection of NAFLD, even with normal ALT levels, should serve as an opportunity to identify metabolic and BP abnormalities and intensify lifestyle modification.

Does diagnosis of metabolic syndrome predict the likelihood of peripheral arterial disease as defined by a low ankle-brachial index?

BACKGROUND: There is limited information about whether a diagnosis of metabolic syndrome (MS) predicts peripheral arterial disease independently of diabetes. This study assessed whether MS adds prognostic information beyond that relating to diabetes in the identification of a low ankle-brachial index (ABI). DESIGN: Cross-sectional population-based study of people aged 50-75 years. METHODS: Eight hundred and fifty-eight participants were randomly selected. The likelihood of low ABI (<0.90) was calculated according to MS status before and after excluding diabetes. The National Cholesterol Education Panel and the International Diabetes Federation (IDF) definitions of MS were used. RESULTS: The prevalence of National Cholesterol Education Panel-defined and IDF-defined MS, and low ABI was 57.8, 61.1 and 7.5%, respectively. When there were participants with three or more criteria for MS, participants with only three criteria, and participants with four or five criteria were compared with participants without MS, the odds ratio for low ABI was 1.89 (95% confidence interval, 1.08-3.30), 1.34 (0.70-2.60) and 2.70 (1.45-5.03), respectively. The association of MS and low ABI lost statistical significance after excluding diabetes. No difference was observed using the IDF definition of MS. CONCLUSION: Screening of participants with MS does not improve the identification of abnormal ABI provided by diabetes.