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Abstract Details
Non-alcoholic fatty liver disease and cognitive function in middle-aged adults: the CARDIA study
BMC Gastroenterol. 2021 Mar 2;21(1):96. doi: 10.1186/s12876-021-01681-0.
Yariv Gerber123, Lisa B VanWagner4, Kristine Yaffe5, James G Terry6, Jamal S Rana75, Jared P Reis8, Stephen Sidney7
Author information
1Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel. yarivg@tauex.tau.ac.il.
2Kaiser Permanente Northern California, Oakland, CA, USA. yarivg@tauex.tau.ac.il.
3School of Public Health, University of California Berkeley, Berkeley, CA, USA. yarivg@tauex.tau.ac.il.
4Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
5Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
6Vanderbilt University Medical Center, Nashville, TN, USA.
7Kaiser Permanente Northern California, Oakland, CA, USA.
8National Heart Lung and Blood Institute, Bethesda, MD, USA.
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease (CVD) risk factors that have been linked to cognitive decline. Whether NAFLD is associated with cognitive performance in midlife remains uncertain.
Methods: Coronary Artery Risk Development in Young Adults study participants with CT examination and cognitive assessment at Y25 (2010-2011; n = 2809) were included. Cognitive function was reassessed at Y30. NAFLD was defined according to liver attenuation and treated both continuously and categorically (using ≤ 40 and ≤ 51 Hounsfield units to define severity) after exclusion for other causes of liver fat. Cognitive tests including the Digit Symbol Substitution (processing speed), Rey Auditory Verbal Learning (verbal memory), and Stroop (executive function) were analyzed with standardized z-scores. Linear models were constructed to (a) examine the cross-sectional associations of NAFLD with cognitive scores and (b) evaluate its predictive role in 5-year change in cognitive performance.
Results: Participants' mean age (Y25) was 50.1 (SD 3.6) years (57% female; 48% black), with 392 (14%) having mild NAFLD and 281 (10%) having severe NAFLD. NAFLD was positively associated with CVD risk factors and inversely associated with cognitive scores. However, after adjustment for CVD risk factors, no associations were shown between NAFLD and cognitive scores (all βs ≈ 0). Similarly, no associations were observed with 5-year cognitive decline. CVD history, hypertension, smoking, diabetes and hypertriglyceridemia showed stronger associations with baseline cognitive scores and were predictive of subsequent cognitive decline (all P ≤ .05).
Conclusion: Among middle-aged adults, inverse associations between NAFLD and cognitive scores were attenuated after adjustment for CVD risk factors, with the latter predictive of poorer cognitive performance both at baseline and follow-up.