High prevalence of apolipoprotein B dyslipoproteinemias in non-alcoholic fatty liver disease: The lifelines cohort study

Objective

Cardiovascular disease (CVD) is a major adverse consequence of non-alcoholic fatty liver disease (NAFLD). The association of NAFLD with various apolipoprotein B (apoB) dyslipoproteinemias is unclear. We determined the prevalence of specific apoB dyslipoproteinemias in subjects with suspected NAFLD.

Methods

This study was conducted among 22,865 fasting adults living in the northern part of the Netherlands (Lifelines Cohort Study). Six apoB dyslipoproteinemias were defined using an algorithm derived from apoB, total cholesterol and triglycerides. NAFLD was defined as Fatty Liver Index (FLI) ≥ 60. Advanced hepatic fibrosis was defined as NAFLD fibrosis score (NFS) ≥ 0.676.

Results

4790 participants (20.9%) had an FLI ≥ 60. NAFLD subjects were older, more likely to be men, more obese and more often had diabetes and metabolic syndrome (P < 0.001 for each). Among NAFLD subjects, any apoB dyslipoproteinemia was present in 61.5% vs. 16.5% in subjects without NAFLD (P < 0.001). Elevated chylomicrons were not observed in NAFLD. In univariate analysis, NAFLD was associated with a higher prevalence of each apoB dyslipoproteinemia vs. subjects with an FLI < 60 (P < 0.001), except for low density lipoprotein (LDL) dyslipoproteinemia. Additionally, each apoB dyslipoproteinemia was independently associated with NAFLD in age- and sex-adjusted logistic regression analysis, including the apoB dyslipoproteinemias together (P < 0.001). The prevalence of apoB dyslipoproteinemias was not altered in subjects with NFS ≥ 0.676.

Conclusions

NAFLD rather than advanced hepatic fibrosis is independently associated with increased prevalence of chylomicrons + very low-density lipoproteins (VLDL) remnants, VLDL, LDL and VLDL + LDL dyslipoproteinemias. ApoB dyslipoproteinemias may contribute to increased CVD risk associated with NAFLD.

Keywords

• apoB dyslipoproteinemias; 
• Cardiovascular diseases; 
• Hepatic fibrosis; 
• Non-alcoholic fatty liver disease