Sex-Based Differences and Risk Factors for Comorbid Nonalcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study

Figures & data

Table 1 Clinical Characteristics of the Study Participants

	Male Total (n=352)	Female Total (n=358)	t/χ²/Z	P
Age (years)	34.06±11.03	35.37±12.05	1.51	0.137
Years of education (years)	11.34±3.49	10.71±4.68	−0.201	0.044
Age at onset (years)	24.35±8.59	25.23±9.40	1.31	0.192
Duration of illness (years)	9.78±7.86	10.33±8.91	0.87	0.384
Illness episode			2.246	0.134
Mania	220/352 (62.5%)	204/358(57%)
Depression	132/352 (37.5%)	154/358 (43%)
Psychotic symptoms			0.049	0.824
No	255/352 (72.4%)	262/358(73.2%)
Yes	97/252 (27.6%)	96/358(26.8%)
Marital status			8.228	0.016
Single	126/352 (35.8%)	95/358 (26.5%)
Married	163/352 (46.3%)	178/358 (49.7%)
Others	63/352 (17.9%)	85/358 (23.8%)
Cardiometabolic
SBP (mmHg)	123.45±9.15	120.96±9.74	−3.523	<0.001
DBP (mmHg)	78.44±8.73	76.75±9.79	−2.424	0.016
BMI (kg/m^2)	24.62±3.74	24.24±4.56	−1.181	0.238
Glucose (mmol/L)	5.13±1.39	5.29±1.69	1.423	0.156
ALT (U/L)	21(13, 35)	13(9, 19)	−9.223	<0.001
AST (U/L)	21(15, 30.75)	17(13, 22)	−6.181	<0.001
ALP (U/L)	72.95±20.33	65.67±36.01	−3.306	<0.005
GGT (U/L)	24(16.25, 38.75)	14(11, 20.25)	−11.211	<0.001
TC (mmol/L)	4.04(3.42, 4.59)	4.11(3.6, 4.67)	−1.42	0.156
TG (mmol/L)	1.24(0.89, 1.72)	1.06(0.75, 1.53)	−3.718	<0.001
HDL (mmol/L)	1.07(0.93, 1.25)	1.25(1.07, 1.46)	5.999	<0.001
Uric acid (μmol/L)	396.42±103.97	316.67±90.54	−10.905	<0.001
Apo A1 (g/L)	1.16(1, 1.36)	1.23(1.08, 1.42)	3.461	<0.005
ApoB (g/L)	0.79(0.64, 0.96)	0.75(0.62, 0.9)	−1.568	0.117
TyG (g/L)	8.46(8.12, 8.89)	8.34(7.96, 8.78)	−2.836	0.006
Prevalence of NAFLD	179/352 (50.9%)	138/358 (38.5%)	10.874	<0.001

Note: Bold font indicates that the p-value is less than 0.05.

Abbreviations:SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamine transpeptidase; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; Apo A1: apolipoprotein A1; ApoB, apolipoprotein B; TyG, triglyceride-glucose index; NAFLD, nonalcoholic fatty liver disease.

Table 2 Comparison of Parameter Differences Between Males and Females in Patients with BD Manifesting NAFLD

	Male Total (n=179)	Female Total (n=138)	t/χ²/Z	P
Age (years)	35.81±10.92	39.43±11.85	−2.82	0.006
Years of education (years)	11.45±3.59	9.93±4.54	3.30	<0.001
Age at onset (years)	24.96±8.24	26.66±9.39	−1.71	0.088
Duration of illness (years)	10.68±7.88	13.25±10.12	−2.55	0.011
Illness episode			14.78	<0.001
Mania	109/179 (60.9%)	84/138 (60.9%)
Depression	70/179 (39.1%)	54/138 (39.1%)
Psychotic symptoms			1.28	0.258
No	126/179 (70.4%)	105/138 (76.1%)
Yes	53/179 (29.6%)	33/138 (23.9%)
Marital status			18.12	<0.001
Single	69/179 (38.5%)	23/138 (16.7%)
Married	78/179 (43.6%)	81/138 (58.7%)
Others	32/179 (17.9%)	34/138 (24.6%)
Cardiometabolic
SBP(mmHg)	124.11±8.99	123.36±9.66	0.71	0.477
DBP(mmHg)	79.34±9.11	77.93±11.97	1.19	0.236
BMI (kg/m^2)	26.73±3.41	27.23±4.56	−1.12	0.261
Glucose (mmol/L)	5.47±1.73	5.88±2.28	−1.79	0.084
ALT (U/L)	28(17, 43)	15.5(10.75, 25.25)	−6.52	<0.001
AST (U/L)	22(16, 31)	17.5(14, 23)	−4.454	<0.001
ALP (U/L)	74.65±21.91	71.57±22.26	1.24	0.217
GGT (U/L)	32(22, 48)	18(13, 29.25)	−6.94	<0.001
TC (mmol/L)	4.25(3.63, 4.88)	4.33(3.82, 4.84)	−0.658	0.511
TG (mmol/L)	1.51(1.05, 2.17)	1.39(0.95, 1.94)	−1.598	0.011
HDL (mmol/L)	1.04(0.9, 1.17)	1.18(1.05, 1.37)	−5.846	<0.005
Uric acid (μmol/L)	409.95±107.34	338.95±87.26	6.32	<0.001
Apo A1 (g/L)	1.15(0.99, 1.31)	1.19(1.05, 1.38)	−2.134	0.074
ApoB (g/L)	0.86(0.7, 1.03)	0.83(0.69, 0.97)	−0.988	0.323
TyG (g/L)	8.73(8.33, 9.19)	8.66(8.27, 9.12)	−0.695	0.487

Note: Bold font indicates that the p-value is less than 0.05.

Abbreviations:SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamine transpeptidase; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; Apo A1: apolipoprotein A1; ApoB, apolipoprotein B; TyG, triglyceride-glucose index.

Table 3 Comparison of Parameters in Male Patients with BD

	NAFLD Group (n=179)	Non-NAFLD Group (n=173)	t/χ²/Z	P
Age (years)	35.81±10.92	32.25±10.90	−3.06	<0.005
Years of education (years)	11.45±3.59	11.22±3.40	−0.61	0.543
Age at onset (years)	24.96±8.24	23.71±8.90	−1.36	0.173
Duration of illness (years)	10.68±7.88	8.85±7.76	−2.19	0.029
Illness episode			0.40	0.527
Mania	109/179 (60.9%)	111/173 (64.2%)
Depression	70/179 (39.1%)	62/173 (35.8%)
Psychotic symptoms			0.77	0.381
No	126/179 (70.4%)	129/173 (74.6%)
Yes	53/179 (29.6%)	44/173 (25.4%)
Marital status			1.36	0.306
Single	69/179 (38.5%)	57/173 (32.9%)
Married	78/179 (43.6%)	85/173 (49.1%)
Others	32/179 (17.9%)	31/173 (18.0%)
Cardiometabolic
SBP (mmHg)	124.11±8.99	122.77±9.29	−1.37	0.171
DBP (mmHg)	79.34±9.11	77.51±8.25	−1.96	0.051
BMI (kg/m^2)	26.73±3.41	22.44±2.67	−13.12	<0.001
Glucose (mmol/L)	5.47±1.73	4.78±0.77	−4.83	<0.001
ALT (U/L)	28(17, 43)	16(11, 25)	−6.617	<0.001
AST (U/L)	22(16, 31)	20(14, 30)	−2.037	0.042
ALP (U/L)	74.65±21.91	71.18±18.47	−1.61	0.018
GGT (U/L)	32(22, 48)	20(13.5, 28)	−7.019	0.035
TC (mmol/L)	4.25(3.63, 4.88)	3.85(3.27, 4.41)	−4.3	0.028
TG (mmol/L)	1.51(1.05, 2.17)	1.05(0.81, 1.42)	−6.379	<0.001
HDL (mmol/L)	1.04(0.9, 1.17)	1.14(0.96, 1.30)	−3.597	<0.005
Uric acid (μmol/L)	409.95±107.34	382.43±98.74	−2.50	0.031
Apo A1 (g/L)	1.15(0.99, 1.31)	1.17(1.01, 1.40)	−1.377	0.169
ApoB (g/L)	0.87±0.27	0.73±0.21	−5.57	0.027
TyG (g/L)	8.73(8.33, 9.19)	8.31(7.99, 8.56)	−7.32	<0.001

Note: Bold font indicates that the p-value is less than 0.05.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamine transpeptidase; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; Apo A1: apolipoprotein A1; ApoB, apolipoprotein B; TyG, triglyceride-glucose index.

Table 4 Comparison of Parameters in Female Patients with BD

	NAFLD Group (n=138)	Non-NAFLD Group (n=220)	t/χ²/Z	P
Age (years)	39.43±11.85	32.83±11.49	−5.23	<0.001
Years of education (years)	9.93±4.54	11.20±4.72	2.52	0.012
Age of onset (years)	26.66±9.39	24.34±9.32	−2.29	0.023
Duration of illness (years)	13.25±10.12	8.50±7.54	−5.08	<0.001
Illness episode			1.38	0.239
Mania	84/138 (60.9%)	120/220 (54.5%)
Depression	54/138 (39.1%)	100/220 (45.5%)
Psychotic symptoms			0.96	0.326
No	105/138 (76.1%)	157/220 (71.4%)
Yes	33/138 (23.9%)	63/220 (28.6%)
Marital status			11.96	<0.005
Single	23/138 (16.7%)	72/220 (32.7%)
Married	81/138 (58.7%)	97/220 (44.1%)
Others	34/138 (24.6%)	51/220 (23.2%)
Cardiometabolic
SBP (mmHg)	123.36±9.66	119.45±9.51	−3.77	<0.001
DBP (mmHg)	77.93±11.97	76.01±8.08	−1.81	0.071
BMI (kg/m^2)	27.23±4.56	22.38±3.44	−11.44	<0.001
Glucose (mmol/L)	5.88±2.28	4.93±1.05	−5.32	<0.001
ALT (U/L)	15.5(10.75, 25.25)	12(8, 17)	−4.643	<0.001
AST (U/L)	17.5(14, 23)	16(13, 22)	−1.466	0.143
ALP (U/L)	71.57±22.26	61.98±42.05	−2.47	0.014
GGT (U/L)	18(13, 29.25)	13(10, 17)	−6.363	<0.001
TC (mmol/L)	4.33(3.82, 4.84)	4.01(3.49, 4.55)	−3.279	<0.005
TG (mmol/L)	1.39(0.95, 1.94)	0.93(0.67, 1.33)	−6.64	<0.001
HDL (mmol/L)	1.18(1.05, 1.37)	1.29(1.09, 1.55)	−3.552	<0.001
Uric acid (μmol/L)	338.95±87.26	302.69±89.96	−3.76	<0.001
Apo A1 (g/L)	1.19(1.05, 1.38)	1.25(1.1, 1.43)	−2.01	0.044
ApoB (g/L)	0.83(0.69, 0.97)	0.72(0.58, 0.84)	−4.71	<0.001
TyG (g/L)	8.66(8.27, 9.12)	8.18(7.82, 8.55)	8.36	<0.001

Note: Bold font indicates that the p-value is less than 0.05.

Abbreviations:SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamine transpeptidase; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; Apo A1: apolipoprotein A1; ApoB, apolipoprotein B; TyG, triglyceride-glucose index.

Table 5 Risk Factors for NAFLD in Male Patients with BD

Variables	β	OR	95% CI	P
BMI (kg/m^2)	0.486	1.626	1.449–1.824	<0.001
Glucose (mmol/L)	0.497	1.644	1.219–2.218	<0.001
ApoB (g/L)	1.776	5.908	1.821–19.171	<0.005

Note: bold font indicates that the p-value is less than 0.05.

Abbreviations:OR, odds ratio; CI, confidence interval; BMI, body mass index; ApoB, apolipoprotein B.

Table 6 Risk Factors for NAFLD in Female Patients with BD

Variables	β	OR	95% CI	P
BMI (kg/m^2)	0.25	1.284	1.192–1.383	<0.001
Duration of illness (years)	0.04	1.039	1.008–1.071	0.017
GGT (U/L)	0.04	1.041	1.016–1.067	<0.001
TyG (g/L)	0.77	2.157	1.283–3.625	<0.005

Note: Bold font indicates that the p-value is less than 0.05.

Abbreviations:OR, odds ratio; CI, confidence interval; BMI, body mass index; GGT, glutamine transpeptidase; TyG, triglyceride-glucose index.

Figure 1 The predictive value of influencing factors on NAFLD in male patients with BD. (A) ROC curve of BMI in predicting NAFLD; (B) ROC curve of Glucose in predicting NAFLD; (C) ROC curve of ApoB in predicting NAFLD.

Figure 2 The predictive value of influencing factors on NAFLD in female patients with BD. (A) ROC curve of BMI in predicting NAFLD; (B) ROC curve of Duration of illness in predicting NAFLD; (C) ROC curve of GGT in predicting NAFLD; (D) ROC curve of TyG in predicting NAFLD.