Epicardial adipose tissue volume is associated with non-alcoholic fatty liver disease and cardiovascular risk factors in the general population

Figures & data

Figure 1 Flow chart of the enrolled participants who met the requirements.

Figure 2 Prevalence of non-alcoholic fatty liver disease, CIMT ≥0.8 mm, and CAC score >0, by epicardial adipose tissue quartiles.

Abbreviations: CIMT, carotid intima-media thickness; CAC, coronary artery calcium; NAFLD, non-alcoholic fatty liver disease.

Table 1 Baseline characteristics of the entire cohort stratified by quartiles of epicardial adipose tissue

	Overall (n=2,238)	Quartiles of EAT volume				P-value
		1st quartile (n=559)	2nd quartile (n=560)	3rd quartile (n=560)	4th quartile (n=559)
Age, years	55.6±7.8	51.7±6.7	55.0±7.3	56.0±7.5	59.8±7.4	<0.0001
Gender (%)						<0.0001
Men	982	137 (13.95)	216 (22.00)	282 (28.72)	347 (35.34)
Women	1,256	422 (33.60)	344 (27.39)	278 (22.13)	212 (16.88)
Education level, (%)						<0.0001
Illiterate or primary	206	29 (14.08)	48 (23.30)	55 (26.70)	74 (35.92)
Middle/high school	1,392	331 (23.78)	355 (25.50)	333 (23.92)	373 (26.80)
College or above	640	199 (31.09)	157 (24.53)	172 (26.88)	112 (17.50)
Income, ¥/month, (%)*						0.0015
≤3,000	1,262	282 (22.35)	306 (24.25)	345 (27.34)	329 (26.07)
3,001–5,000	868	245 (28.23)	220 (25.35)	195 (22.47)	208 (23.96)
>5,001	108	32 (29.63)	34 (31.48)	20 (18.52)	22 (20.37)
Smoking, (%)						<0.0001
Never	1,667	466 (27.95)	447 (26.81)	402 (24.12)	352 (21.12)
Current smoker	470	81 (17.23)	100 (21.28)	130 (27.66)	159 (33.83)
Former smoker	101	12 (11.88)	13 (12.87)	28 (27.72)	48 (47.52)
Physical activity, (%)						0.2083
Inactive	670	152 (22.69)	173 (25.82)	175 (26.12)	170 (25.37)
Moderately active	155	44 (28.39)	40 (25.81)	41 (26.45)	30 (19.35)
Very active	1,413	363 (25.69)	347 (24.56)	344 (24.35)	359 (25.41)
BMI (kg/m^2)	25.12±3.43	22.94±2.90	24.78±2.91	25.81±2.79	26.97±3.71	<0.0001
Underweight	28	19 (67.86)	5 (17.86)	3 (10.71)	1 (3.57)	<0.0001
Normal weight	1,095	424 (38.72)	302 (27.58)	225 (20.55)	144 (13.15)	<0.0001
Overweight or obese	1,079	109 (10.10)	243 (22.52)	322 (29.84)	405 (37.53)	<0.0001
Abdomen circumference (cm)	86.94±9.93	79.48±8.56	85.34±7.63	89.23±8.25	93.68±9.17	<0.0001
Hip circumference (cm)	98.61±7.28	95.12±6.84	98.35±6.58	99.81±6.97	101.17±7.29	<0.0001
SBP (mmHg)	133.00±20.18	125.65±17.58	132.51±19.59	133.93±20.01	139.90±20.86	<0.0001
DBP (mmHg)	83.72±13.03	79.70±12.18	83.21±12.32	84.77±13.03	87.21±13.42	<0.0001
Fasting blood glucose (mg/dL)	5.57±1.42	5.28±1.13	5.47±1.48	5.67±1.42	5.87±1.55	<0.0001
Triglycerides (mmol/L)	1.74±1.42	1.38±1.01	1.75±1.57	1.81±1.18	2.02±1.71	<0.0001
Total cholesterol (mmol/L)	4.92±0.94	4.81±0.86	4.90±0.96	4.94±0.90	5.05±1.03	0.0002
HDL (mmol/L)	1.22±0.28	1.34±0.29	1.22±0.28	1.19±0.27	1.15±0.24	<0.0001
LDL (mmol/L)	2.69±0.61	2.57±0.59	2.67±0.63	2.73±0.60	2.81±0.60	<0.0001
ALT (U/L)	22.61±17.13	20.19±18.89	21.49±13.36	24.10±15.60	24.65±19.58	<0.0001
AST (U/L)	24.14±10.96	23.86±14.13	24.14±9.77	24.10±8.35	24.36±10.83	0.9385
Cr (μmol/L)	76.67±15.17	72.98±11.88	75.52±16.45	77.25±15.11	80.93±15.74	<0.0001
Diabetes (%)	272	27 (9.93)	51 (18.75)	82 (30.15)	122 (41.18)	<0.0001
Hypertension (%)	1,045	170 (16.27)	236 (22.58)	276 (26.41)	363 (34.74)	<0.0001
Hyperlipidemia (%)	1,142	184 (16.11)	277 (24.26)	325 (28.46)	356 (31.17)	<0.0001

Notes: Values are mean ± SD, n (%). The cut-off points of the quartiles are 93.87, 127.46, and 172.72 cm³.

* 29 people did not register their income level information.

Abbreviations: EAT, epicardial adipose tissue; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 2 Cardiovascular risk factors of the entire cohort stratified by quartiles of epicardial adipose tissue

	Overall (n=2,238)	1st quartile (n=559)	2nd quartile (n=560)	3rd quartile (n=560)	4th quartile (n=559)	P-value
CVH metrics (%)						<0.0001
0	13 (0.58)	0 (0.00)	1 (7.69)	2 (15.38)	10 (76.92)
1	100 (4.47)	8 (8.00)	15 (15.00)	29 (29.00)	48 (48.00)
2	319 (14.25)	36 (11.29)	66 (20.69)	91 (28.53)	126 (39.50)
3	519 (23.19)	72 (13.87)	126 (24.28)	148 (28.52)	173 (33.33)
4	609 (27.21)	152 (24.96)	161 (26.44)	169 (27.75)	127 (20.85)
≥5	678 (30.29)	291 (42.92)	191 (28.17)	121 (17.85)	75 (11.06)
CIMT (%)						<0.0001
<0.8 mm	1,127 (50.36)	373 (33.10)	281 (24.93)	273 (24.22)	200 (17.75)
≥0.8 mm	1,111 (49.64)	186 (16.74)	279 (25.11)	287 (25.83)	359 (32.31)
CAC score (%)						<0.0001
=0	1,886 (84.27)	555 (29.43)	533 (28.26)	503 (26.67)	295 (15.64)
>0	352 (15.73)	4 (1.14)	27 (7.67)	57 (16.19)	264 (75.00)
NAFLD (%)	1,221 (54.56)	158 (28.26)	290 (51.79)	359 (64.11)	414 (74.06)	<0.0001

Abbreviations: CVH, cardiovascular health; CAC, coronary artery calcium; CIMT, carotid intima-media thickness; NAFLD, non-alcoholic fatty liver disease.

Table 3 The OR (95% CI) of EAT affected CIMT and CAC score

	CIMT >0.8 mm		CAC score >0
	OR (95% CI)	P-value	OR (95% CI)	P-value
Model 1	1.033 (1.023, 1.044)	<0.0001	1.230 (1.204, 1.258)	<0.001
EAT volume (per 10 cm^3)
Model 2	1.006 (0.998, 1.015)	0.1371	1.213 (1.186, 1.242)	<0.001
EAT volume (per 10 cm^3)
Model 3	1.004 (0.996, 1.013)	0.3083	1.214 (1.186, 1.243)	<0.001
EAT volume (per 10 cm^3)
Model 4	1.001 (0.993, 1.009)	0.8114	1.26 (1.225, 1.295)	<0.001
EAT volume (per 10 cm^3)

Notes: Model 1 without any adjustments; model 2 adjusted for age and gender; model 3 adjusted for model 2+ smoking status, hypertension, and diabetes mellitus; model 4 adjusted for model 3+ BMI.

Abbreviations: EAT, epicardial adipose tissue; CIMT, carotid intima-media thickness; CAC, coronary artery calcium.

Table 4 Multivariate logistic regression analysis of risk for higher EAT volume elevation between groups with or without nonalcoholic fatty liver disease

	OR	95% CI		P-value
		Lower bound	Upper bound
Model 1	3.346	2.811	3.983	P<0.0001
Model 2	3.073	2.547	3.708	P<0.0001
Model 3	2.787	2.296	3.383	P<0.0001
Model 4	1.407	1.117	1.773	P<0.005

Notes: Model 1 without any adjustments; model 2 adjusted for age and gender; model 3 adjusted for model 2+ smoking status, level of education and income, hypertension, and diabetes mellitus; model 4 adjusted for model 3+ hip circumference, abdomen circumference, TG, LDL, HDL, ALT, BMI, and physical activity.