Abstract


Background: Fatty liver is one of the most common forms of chronic liver disease and is associated with significant morbidity and mortality. The current standard of care for the treatment of patients with fatty liver is limited and focuses on lifestyle interventions. Activation of the renin-angiotensin-aldosterone-system (RAAS) has been implicated in the pathogenesis of fatty liver. However, there is limited data regarding the association of RAAS with fatty liver in large cohort studies. To address this gap we investigated this association in the Jackson Heart Study (JHS).

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Background: Fatty liver is one of the most common forms of chronic liver disease and is associated with significant morbidity and mortality. The current standard of care for the treatment of patients with fatty liver is limited and focuses on lifestyle interventions. Activation of the renin-angiotensin-aldosterone-system (RAAS) has been implicated in the pathogenesis of fatty liver. However, there is limited data regarding the association of RAAS with fatty liver in large cohort studies. To address this gap we investigated this association in the Jackson Heart Study (JHS).

Methods: The JHS is a community based, observational study of African Americans above the age of 21 years. Our study population consisted of 2,940 participants (1,910 females and 1,030 males) who had data on liver attenuation. Liver fat content was estimated by measurement of liver attenuation in Hounsfield units (HU) on CT scans. Previous studies have determined that measurement of liver attenuation on unenhanced CT scans accurately predicts fatty liver, with lower attenuation corresponding to higher liver fat content. Univariate regression analysis was performed to investigate the association between serum aldosterone concentration and liver HU on CT scans. A multivariate model was constructed to investigate the persistence of the serum aldosterone and liver attenuation relationship. Further, stratified models were employed to check for the presence of gender-specific differences.

Results: Each doubling of serum aldosterone levels was associated with 0.99 HU decrease in liver attenuation (95% CI:-1.35, -0.64, p-value < 0.001). This association remained significant after adjusting for factors such as age, gender, body mass index (BMI) and alcohol intake -0.826 (95% CI: -1.178, -0.474, p-value < 0.001). Upon subgroup analysis by gender, it was determined that the aldosterone and liver attenuation correlation was only significant in women.

Conclusion: Our data demonstrate a positive association of aldosterone levels with fatty liver in African American women.These findings suggest that RAAS blockers may have a therapeutic role in fatty liver treatment in specific population subgroups. African Americans have lower prevalence of fatty liver. Further studies are needed to determine the presence of similar findings in other ethnic groups.

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