Associations between hemoglobin concentrations and the development of incidental metabolic syndrome or nonalcoholic fatty liver disease

Blood cell parameters and risk of nonalcoholic fatty liver disease: a comprehensive Mendelian randomization study

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is on the rise globally, and past research suggests a significant association with various blood cell components. Our goal is to explore the potential correlation between whole blood cell indices and NAFLD risk using Mendelian randomization (MR).

METHODS

We analyzed data from 4,198 participants in the 2017-2018 National Health and Nutrition Examination Survey to investigate the link between blood cell indicators and NAFLD. Using various methods like weighted quantile sum and multivariate logistic regression, we assessed the association. Additionally, two-sample Mendelian randomization were employed to infer causality for 36 blood cell indicators and NAFLD.

RESULTS

Multivariate logistic regression identified 10 NAFLD risk factors. Weighted quantile sum revealed a positive correlation (p = 6.03e-07) between total blood cell indices and NAFLD, with hemoglobin and lymphocyte counts as key contributors. Restricted cubic spline analysis found five indicators with significant nonlinear correlations to NAFLD. Mendelian randomization showed a notable association between reticulocyte counts and NAFLD using the inverse-variance weighted method.

CONCLUSIONS

Hematological markers pose an independent NAFLD risk, with a positive causal link found for reticulocyte count. These results emphasize the importance of monitoring NAFLD and investigating specific underlying mechanisms further.

Idiopathic erythrocytosis: A diagnostic and management challenge with emerging areas for exploration

Despite published algorithms for approaching the work-up of erythrocytosis, a significant proportion of patients are left with uncertainty as to its aetiology and prognosis. The term 'idiopathic erythrocytosis' (IE) is applied when known primary and secondary aetiologies have been ruled out. However, the assignment of secondary aetiologies is not always straightforward or evidence based, which can lead to misdiagnosis and heterogeneity in cohort studies. Furthermore, new studies have identified germline or somatic mutations that may affect prognosis. Epidemiological and cohort data are inconsistent as to whether IE increases the risk for complications such as arterial and venous thromboembolism, clonal transformation or comorbid conditions. Randomized trials assessing the role of phlebotomy for long-term management of IE have not been performed, so treatment remains a vexing problem for clinicians. Standardization of terminology and testing strategies, including comprehensive genetic screening in clinical research, are key to refining our understanding of IE.

Microarray analysis identifies coding and non-coding RNA markers of liver injury in whole body irradiated mice

Radiation injury from medical, accidental, or intentional sources can induce acute and long-term hepatic dysregulation, fibrosis, and cancer. This long-term hepatic dysregulation decreases quality of life and may lead to death. Our goal in this study is to determine acute changes in biological pathways and discover potential RNA biomarkers predictive of radiation injury. We performed whole transcriptome microarray analysis of mouse liver tissue (C57BL/6 J) 48 h after whole-body irradiation with 1, 2, 4, 8, and 12 Gray to identify significant expression changes in mRNAs, lncRNAs, and miRNAs, We also validated changes in specific RNAs through qRT-PCR. We used Ingenuity Pathway Analysis (IPA) to identify pathways associated with gene expression changes. We observed significant dysregulation of multiple mRNAs across all doses. In contrast, miRNA dysregulation was observed upwards of 2 Gray. The most significantly upregulated mRNAs function as tumor suppressors: Cdkn1a, Phlda3, and Eda2r. The most significantly downregulated mRNAs were involved in hemoglobin synthesis, inflammation, and mitochondrial function including multiple members of Hbb and Hba. The most significantly upregulated miRNA included: miR-34a-5p, miR-3102-5p, and miR-3960, while miR-342-3p, miR-142a-3p, and miR-223-3p were most significantly downregulated. IPA predicted activation of cell cycle checkpoint control pathways and inhibition of pathways relevant to inflammation and erythropoietin. Clarifying expression of mRNA, miRNA and lncRNA at a short time point (48 h) offers insight into potential biomarkers, including radiation markers shared across organs and animal models. This information, once validated in human models, can aid in development of bio-dosimetry biomarkers, and furthers our understanding of acute pathway dysregulation.

Correlation of White Blood Cell, Neutrophils, and Hemoglobin with Metabolic Syndrome and Its Components

Background

Metabolic syndrome (MetS) is a global health problem. White blood cell (WBC), neutrophils and neutrophil-to-lymphocyte ratio (NLR) are valid indicators involved in acute and chronic inflammation. The aims of our study were to analyze the correlation and severity of these indicators with MetS and its components, and explore the diagnostic value of their combined tests for MetS.

Methods

A total of 7726 subjects were recruited, and laboratory biomarkers were collected. The differences of indicators between MetS group and non-MetS group were analyzed. The linear trend between each indicator and the increasing number of metabolic disorders was analyzed using trend variance test. The correlation between each indicator and MetS with its components was analyzed by logistic regression.

Results

The levels of WBC, neutrophil, and hemoglobin grew significantly in the MetS group compared to non-MetS group, and gradually increased with the increased number of MetS disorders. Logistic regression analysis indicated significant correlations between WBC, neutrophils, and hemoglobin with MetS and its components. ROC curve analysis showed WBC, neutrophils, and hemoglobin served as good predictors for MetS, especially in adults aged under 40.

Conclusion

Our study indicated that WBC, neutrophils, and hemoglobin are efficient indicators for predicting MetS and evaluate its severity.

Associations between red blood cell count and metabolic dysfunction-associated fatty liver disease(MAFLD)

BACKGROUND

Some studies found that red blood cell count (RBC) was an unrecognized risk factor for non-alcoholic fatty liver disease (NAFLD). While the epidemiological data underpinning the evidence is very limited. As there are some differences between the latest criteria of metabolic dysfunction-associated fatty liver disease (MAFLD) and NAFLD, itis necessary to evaluate the relationship between RBC and MAFLD.

METHODS

We performed a cross-sectional analysis of the National Health and Nutritional Examination Survey (NHANES)2017-2018 cohort, including 4477 participants. Hepatic steatosis was determined when the value of controlled attenuation parameter (CAP) obtained by Fibroscan was ≥274 dB/m. Multivariate logistic regression analysis was used to estimate the association between RBC and MAFLD. We estimated the adjusted odds ratio (OR) of RBC for MAFLD, and the nonlinear relationship between RBC and MAFLD was further described using smooth curve fittings and threshold-effect analysis.

RESULTS

We found that MAFLD risk was significantly higher according to RBC quartiles. The adjusted odds ratio (OR) and 95% confidence intervals (CIs)for the highest RBC quartile were 1.5(1.0, 2.3) for male and 1.1 (0.8, 1.6) for female, respectively. As for male, a non-linear relationship was discovered between RBCs and MAFLD, with a RBC threshold of 4.2. The effect sizes and confidence intervals on the right side of the inflection point were 1.5 (1.0, 2.0) (P for nonlinearity = 0.027). The sensitivity analysis showed a similar result.

CONCLUSION

We demonstrated that that elevated RBC level is associated with the higher risk of MAFLD in male. The positive relationship was not significant in females after full adjustment. Our finding provided novel evidence indicating that RBCs might be a potential biomarker for MAFLD.

Effects of heavy metal, vitamin, and curry consumption on metabolic syndrome during menopause: a Korean community-based cross-sectional study

OBJECTIVE

To determine the associations between metabolic syndrome (MetS) during menopause and serum heavy metal levels and vitamin and curry consumption.

METHODS

A data set of 7,131 pre- and postmenopausal women aged ≥ 20 years collected between 2009 and 2017 was used to obtain information on sociodemographic, lifestyles, family histories, food intakes, and serum heavy metal levels and MetS. Logistic regression was used to identify associations between the presence of MetS and risk factors and to predict risks of MetS based on marginal effects.

RESULTS

Our results show that postmenopausal women had a higher risk of MetS than premenopausal women. During postmenopause elevations in the levels of serum cadmium by one unit increased the risk of MetS by 33% (OR 1.33; 95% CI, 1.03-1.72, P = 0.028). Risks of MetS in pre- and postmenopausal women, when serum Hb levels increased by 1 unit increased 21% (OR 1.21; 95% CI, 1.09-1.33, P < 0.001) and 26% (OR 1.26; 95% CI, 1.16-1.38, P < 0.001), respectively. Furthermore, the risk of MetS risk in pre- and postmenopausal women was increased 2.49-fold and 2.79-fold by a 1% increase in HbA1c level (OR 2.49; 95% CI, 1.97-3.16, P < 0.001) and (OR 2.79; 95% CI, 2.30-3.38, P < 0.001), respectively. High curry consumption reduced the risk of MetS significantly more than low curry consumption (OR 0.60; 95% CI, 0.39-0.91, P = 0.017) in premenopausal women. Furthermore, an increase in daily vitamin B2 intake by 1 mg reduced the risk of MetS by 45% (OR 0.55; 95% CI, 0.32-0.94, P = 0.028) in postmenopausal women.

CONCLUSION

Vitamin B2 and curry supplementation may protect against MetS. Further work is needed to reduce risk factors associated with heavy metals and determine the effects of vitamins and curry consumption on MetS during menopause.

The association between the metabolic syndrome and iron status in pre- and postmenopausal women: Korean National Health and Nutrition Examination Survey (KNHANES) in 2012

We aim to determine the association between Fe status and the metabolic syndrome (MetS) during menopause. Records of 1069 premenopausal and 703 postmenopausal Korean women were retrieved from the database of the fifth Korean National Health and Nutrition Examination Survey (KNHANES V 2012) and analysed. The association between the MetS and Fe status was performed using multivariable-adjusted analyses, subsequently develop a prediction model for the MetS by margin effects. We found that the risk of Fe depletion among postmenopausal women was lower than premenopausal women (PR = 0·813, 95 % CI 0·668, 0·998, P = 0·038). The risk of the MetS was 2·562-fold lower among premenopausal women with than without Fe depletion (PR = 0·390, 95 % CI 0·266, 0·571, P < 0·001). In contrast, the risk of the MetS tended to be higher among postmenopausal women with than without Fe depletion (PR = 1·849, 95 % CI 1·406, 2·432, P < 0·001). When the serum ferritin levels increased, the risk of the MetS increased in both premenopausal women and postmenopausal women. The margin effects showed that an increase in serum Hb and ferritin was associated with an increase in the risk of the MetS according to menopausal status and age group. Therefore, ferritin is the most validated and widely used Fe marker, could be a potential clinical value in predicting and monitoring the MetS during menopause. Further prospective or longitudinal studies, especially, clinically related studies on menopause and Fe status, are needed to clarify the causality between serum ferritin levels and the MetS that could offer novel treatments for the MetS.

Hemoglobin concentration is associated with the incidence of metabolic syndrome

BACKGROUND

An association between hemoglobin and metabolic syndrome (MetS) has been reported. However, the relationships between hemoglobin and individual MetS components remain unclear. Therefore, we investigated these associations at baseline and at the 3-year follow-up.

METHODS

We enrolled 9960 middle-aged and elderly subjects (6726 women and 3234 men) and performed a 3-year follow-up cohort study. All subjects completed a questionnaire and underwent anthropometric measurements and laboratory tests. Logistic regression models were developed to assess the association between hemoglobin and MetS and its components.

RESULTS

MetS was present in 45.1% of women and 41.4% of men at baseline. The hemoglobin concentration was positively correlated with SBP, DBP, TGs, WC, FPG, insulin, HOMA-IR, BMI and uric acid (p < 0.05). The mean hemoglobin concentration was higher in subjects with hypertension, high TGs, abdominal obesity or elevated FPG (p < 0.01). At follow-up, elevated hemoglobin correlated with an increased incidence and ORs for MetS, high TGs, low HDL-c, hyperuricemia and NAFLD but not abdominal obesity, BP or FPG in women. Increased hemoglobin corresponded with an increased incidence and ORs for MetS, abdominal obesity, low HDL-c, hyperuricemia and NAFLD but not BP, high TGs or FPG in men.

CONCLUSIONS

Hemoglobin may play a role in predicting new-onset MetS in both women and men. Hemoglobin was notably correlated with future risk of high TGs, low HDL-c, hyperuricemia, and NAFLD among women and abdominal obesity, low HDL-c, hyperuricemia, and NAFLD among men.

Red Blood Cell Count: An Unrecognized Risk Factor for Nonalcoholic Fatty Liver Disease

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD) is becoming a global public health challenge. A convenient NAFLD indicator will greatly facilitate risk appraisal and prevention. As a readily available and inexpensive hematological index in routine clinical examinations, red blood cells (RBCs) are gaining increasing attention in many diseases, such as metabolic syndrome, but their association with NAFLD is unknown.

METHODS

This health management cohort study included 27,112 subjects (17,383 non-NAFLD and 9,729 NAFLD) with up to 5 years of follow-up (median 2.8 years). NAFLD was diagnosed by ultrasonography. NAFLD severity was categorized as mild, moderate, or severe. The generalized estimation equation (GEE), an extension of generalized linear models that allows for analysis of repeated measurements, was used to analyze the association between RBC count and NAFLD.

RESULTS

Overall, 4,332 of 17,383 (24.9%) subjects without NAFLD at baseline developed NAFLD. Incident NAFLD risk was positively associated with RBC count. After adjustment for hemoglobin and other confounders, the risk of incident NAFLD was 21%, 32%, and 51% higher in the second, third, and fourth RBC count quartiles, respectively, than in the lowest quartile. In 1,798 of 9,476 (19.0%) subjects with NAFLD at baseline, the severity of NAFLD increased. NAFLD progression risk increased progressively as RBC count increased (P for trend < 0.001). Every one-unit (10¹² cells/L) increase in RBC count was associated with a 53% [OR 1.53 (95% CI 1.32-1.77)] increased risk for NAFLD progression.

CONCLUSIONS

Elevated RBC count was independently associated with a high risk of NAFLD incidence and progression. This finding revealed a convenient NAFLD risk indicator.

Association between hemoglobin levels and non-alcoholic fatty liver disease in patients with young-onset type 2 diabetes mellitus

This retrospective study aimed to investigate the relationship between hemoglobin (Hb) levels and non-alcoholic fatty liver disease (NAFLD) in patients with young-onset type 2 diabetes mellitus (T2DM). Data were collected for 296 patients with young-onset T2DM admitted to the first Affiliated Hospital of Guangxi Medical University from May 2017 to January 2020. Subjects were divided into NAFLD (n = 186) and non-NAFLD groups (n = 110). Patients with NAFLD had significantly higher Hb levels (p = 0.001). According to logistic regression analysis, Hb levels were significantly correlated with NAFLD after adjusting for confounding factors [odds ratio (OR) = 1.024, 95% confidence interval = 1.003-1.046, p = 0.028]. Subjects were also grouped according to Hb quartiles. After adjusting for sex and body mass index (BMI), the OR (95%CI) for NAFLD significantly increased with increasing Hb levels (p for trend = 0.009). Patients were also divided into lean (BMI <25 kg/m², n = 139) and overweight/obese groups (BMI ≥25 kg/m², n = 157), with adjusted ORs (95%CI) for the highest quartiles of 1.797 (0.559-5.776) and 6.009 (1.328-27.181), respectively. Further quartile classification of Hb according to sex showed adjusted OR (95%CI) for the highest compared with the lowest quartile of 2.796 (1.148-6.814) for males and 2.945 (0.482-17.997) for females. In conclusion, high Hb levels were associated with the presence of NAFLD in patients with young-onset T2DM, especially in males and overweight/obese patients.

Association between Hemoglobin Levels and Colorectal Polyps in Asymptomatic Chinese Adults

Methods

A cross-sectional analysis was performed among 1633 asymptomatic adults who underwent colonoscopy examinations during routine health check-ups at the First Affiliated Hospital, College of Medicine, Zhejiang University, between 2015 and 2018.

Results

A total of 449 (27.50%) participants were diagnosed with colorectal polyps, and those with colorectal polyps had significantly higher hemoglobin levels than did those without colorectal polyps. Hemoglobin levels were positively associated with the prevalence of colorectal polyps, with rates of 16.43%, 26.20%, 32.17%, and 35.87% among participants with hemoglobin levels in the first, second, third, and fourth quartiles, respectively (P for trend < 0.001). Stepwise multiple regression analysis showed that elevated hemoglobin levels independently increased the risk of colorectal polyps (odd ratio = 1.017; 95% confidence interval: 1.008–1.026).

Conclusion

Elevated hemoglobin levels were significantly and independently associated with the prevalence and risk of colorectal polyps in asymptomatic adults.

The interaction between current smoking and hemoglobin on the risk of advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease

BACKGROUND

Higher hemoglobin levels have been associated with an increased risk for nonalcoholic fatty liver disease. Although the mechanism underlying this association is elusive, smoking has been previously related to both higher hemoglobin concentrations and an increased risk of fibrosis in nonalcoholic fatty liver disease. The present study was conducted to investigate formally the interaction among current smoking, hemoglobin levels, and risk for advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease.

PATIENTS AND METHODS

We examined 433 Turkish patients with biopsy-proven nonalcoholic fatty liver disease. Advanced fibrosis (F ≥ 3) was identified on liver biopsy in 80 cases, whereas 84 patients were current smokers. Logistic regression models were used to evaluate the effect of current smoking on risk for advanced fibrosis, after adjusting for the effects of age, sex, BMI, diabetes, and metabolic syndrome.

RESULTS

Preliminary analyses revealed the presence of substantial statistical interaction between current smoking and hemoglobin levels (P < 0.001). In separate multivariable analyses conducted in the entire cohort and in the subgroups of patients with high and low hemoglobin levels (according to median value in the study cohort: 14.4 g/l), current smoking was associated with increased risk for advanced fibrosis in patients with high hemoglobin (odds ratio: 3.32, 95% confidence interval: 1.23-7.21, P < 0.01) but neither in those with low hemoglobin (odds ratio: 0.71, 95% confidence interval: 0.28-1.81, P = 0.52) nor in the entire study cohort (odds ratio: 1.18, 95% confidence interval: 0.73-2.14, P = 0.79).

CONCLUSION

Hemoglobin acts as a modifier in the association between current smoking and advanced fibrosis in nonalcoholic fatty liver disease.

Noninvasive indices for predicting nonalcoholic fatty liver disease in patients with chronic kidney disease

Background

Data on clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in patients with chronic kidney disease (CKD) are scarce. We investigated the clinical features and risk factors of NAFLD using noninvasive serum markers in CKD patients and attempted the temporal validation of a predictive model for CKD based on NAFLD.

Methods

This retrospective cross-sectional study was conducted in a single tertiary center. We enrolled 819 CKD patients and evaluated the predictive performance of relevant clinical and laboratory markers for the presence of NAFLD in both derivation (data from 2011 to 2014, n = 567) and validation (data from 2015 to 2016, n = 252) groups.

Results

In the derivation group, NAFLD was observed in 89 patients (15.7%; mean body mass index (BMI), 24.6 kg/m²; median estimated glomerular filtration rate (eGFR), 28.0 ml/min). BMI, hemoglobin, serum alanine aminotransferase, eGFR, and triglyceride-glucose index were used to derive a prediction model for the presence of NAFLD. Using the cutoff value of 0.146, the area under the receiver operating characteristic curve (AUROC) for the prediction of NAFLD was 0.850. In the validation group, NAFLD was observed in 51 patients (20.2%; mean BMI, 25.4 kg/m²; median eGFR, 36.0 ml/min). Using the same prediction model and cutoff value, the AUROC was 0.842. NAFLD prevalence in CKD patients was comparable to that in the general population, increasing over time.

Conclusions

Our model using BMI, renal function, triglyceride-glucose index, serum alanine aminotransferase, and hemoglobin accurately predicted the presence of NAFLD in CKD patients.

A simple clinical model predicts incident hepatic steatosis in a community-based cohort: The Framingham Heart Study

BACKGROUND AND AIMS

The factors associated with incident hepatic steatosis are not definitively known. We sought to determine factors associated with incident hepatic steatosis, as measured on computed tomography, in the community.

METHODS

We studied Framingham Heart Study participants without heavy alcohol use or baseline hepatic steatosis who underwent computed tomography scans between 2002-2005 (baseline) and 2008-2011 (follow-up). We performed a stepwise logistic regression procedure to determine the predictors associated with incident hepatic steatosis.

RESULTS

We included 685 participants (mean age: 45.0 ± 6.2 years, 46.8% women). The incidence of hepatic steatosis in our sample was 17.1% over a mean 6.3 years of follow-up. Participants who developed hepatic steatosis had more adverse cardiometabolic profiles at baseline compared to those free of hepatic steatosis at follow-up. Multivariable stepwise regression analysis showed that a simple clinical model including age, sex, body mass index, alcohol consumption and triglycerides was predictive of incident hepatic steatosis (C statistic = 0.791, 95% CI: 0.748-0.834). A complex clinical model, which included visceral adipose tissue volume and liver phantom ratio added to the simple clinical model, and had improved discrimination for predicting incident hepatic steatosis (C statistic = 0.826, 95% CI: 0.786-0.866, P < .0001).

CONCLUSIONS

The combination of demographic, clinical and imaging characteristics at baseline was predictive of incident hepatic steatosis. The use of our predictive model may help identify those at increased risk for developing hepatic steatosis who may benefit from risk factor modification although further investigation is warranted.

Association Between Serum Hemoglobin Levels and Non Alcoholic Fatty Liver Disease in a Mexican Population

INTRODUCTION AND AIM

Nonalcoholic fatty liver disease (NAFLD) is closely associated with overweight and obesity, becoming one of the most prevalent hepatic diseases nowadays. Circulating hemoglobin (Hb) concentration is significantly higher in people with NAFLD, compared to healthy patients. While liver biopsy remains the gold standard for NAFLD diagnosis, it is not the best technique due to adverse events that may occur. Therefore it is important to find less invasive and more sensitive markers. This study aimed to determine the association of serum Hb levels in patients with steatosis and fibrosis as a noninvasive marker.

MATERIAL AND METHODS

A 1,186 patient cross-sectional study nested in a randomized clinical trial (NCT01874249) was conducted. Patients were diagnosed by ultrasound for hepatic steatosis and fibroscan for fibrosis; blood test and anthropometric measurements were also assessed.

RESULTS

Serum Hb increased proportionally related to the steatosis level, being significantly higher in patients with severe steatosis than in patients with moderate and mild steatosis.

CONCLUSION

Patients with non-alcoholic fatty liver disease showed elevated levels of circulating Hb, evidence that suggests that Hb exerts a protective role, as it may act as an antioxidant and may counteract the adverse effects of this disease.

Elevated Hemoglobin Level Is Associated With Advanced Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

OBJECTIVES

Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy-proven NAFLD.

METHODS

A total of 117 children (85 boys, mean age 12 years) with ultrasound evidence of NAFLD undergoing liver biopsy for diagnosis of nonalcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care center. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than nonalcoholic were excluded, before liver biopsy was performed.

RESULTS

A total of 41 NAFLD (boys 29, mean age 11.2 years) and 76 NASH (boys 56, mean age 12.8 years) children were studied. Alanine transaminase levels were significantly higher in NASH group compared with NAFLD group (P = 0.05), and homeostatic model assessment of insulin resistance and triglycerides levels (P = 0.03 and 0.02, respectively). Regarding hematological components: red cell count, Hb, hematocrit, and RDW values were all significantly higher in NASH group compared with NAFLD group (P < 0.05 for each parameter).

CONCLUSIONS

Children with NASH were more likely to have high levels of RDW compared to those with steatosis only. Moreover, NASH was associated with higher red cell count, Hb, and hematocrit. If confirmed in future follow-up studies, hematological parameters may be introduced in algorithms for NASH risk prediction.