Mediating effect analysis of serum triglyceride in the non-linear association between serum retinol and non-alcoholic fatty liver disease
Objective To investigate the mediating effect of serum triglyceride(TG)in the non-linear association between serum retinol and non-alcoholic fatty liver disease(NAFLD).Methods This study incorporated cross-sectional data of 8 394 participants aged over 20 years in the National Health and Nutrition Examination Survey database from 2005 to 2006 and from 2017 to 2018.According to the quartile of serum retinol level,participants were divided into 4 groups,namely group Q1(0.024-1.498 μmol/L)with 2 448 cases,group Q2(＞1.498-1.829 μmol/L)with 2 113 cases,group Q3(＞1.829-2.220 μmol/L)1,934 cases,and group Q4(＞2.220-8.762 μmol/L)with 1 899 cases.Baseline data of patients with different serum retinol levels were compared.The hepatic steatosis index(HSI)was used as the risk indicator of NAFLD.Logistic regression model was used to analyze the risk factors of NAFLD.Restricted cubic splines were used to simulate the non-linear association between serum retinol and NAFLD.The participants were divided into non-obese group(BMI＜30 kg/m2)and obese group(BMl≥30 kg/m2),and risk factors of NAFLD among populations with different BMI were explored using logistic regression model.Mediated effect analysis was used to examine the correlation of TG in different BMI populations with serum retinol and NAFLD.Results Gender,age,race,education level,BMI,waist circumference,hypertension,diabetes,weekly moderate-intensity activity duration,daily sitting time,smoking status,daily alcohol consumption,daily dietary calories,vitamin A intake,TBil,TG,TC,AST,ALT,ALP and albumin levels were compared among patients with different serum retinol levels,which all showed statistically significant differences(all P＜0.05).Logistic regression model showed that after adjusting age,gender,race,smoking status,alcohol consumption,education,diabetes,hypertension,daily dietary calories,vitamin A intake,and BMI,the probability of NAFLD in groups Q2,Q3 and Q4 was higher than that of group Q1(OR=1.37,1.58,1.52,all P＜0.05).The association between serum retinol and NAFLD was non-linear:when serum retinol ≤1.85 μmol/L,the risk of NAFLD was reduced as serum retinol level increased(P＜0.05);when serum retinol＞1.85 μmol/L,the risk of NAFLD was increased as serum retinol level increased(P＜0.05).In non-obese patients,serum retinol was an independent influencing factor of NAFLD(OR=1.21,P＜0.05),and TG had a partial mediated effect between serum retinol and NAFLD,with the mediated effect accounting for 43.6％.In obese adults,there was no significant correlation between serum retinol and NAFLD(P＞0.05),and TG had no mediated effects in the correlation between serum retinol and NAFLD.Conclusion Serum retinol levels were associated with the progression of NAFLD,especially in non-obese adults,which may be mediated by TG.
万方数据
维普
