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Targher G, Mantovani A, Grander C, et al. Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study. Nutr Metab Cardiovasc Dis. 2021;31(12):3464-3473doi: 10.1016/j.numecd.2021.08.037.
Targher, G., Mantovani, A., Grander, C., Foco, L., Motta, B., Byrne, C. D., Pramstaller, P. P., & Tilg, H. (2021). Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study. Nutrition, metabolism, and cardiovascular diseases : NMCD, 31(12), 3464-3473. https://doi.org/10.1016/j.numecd.2021.08.037
Targher, Giovanni, et al. "Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study." Nutrition, metabolism, and cardiovascular diseases : NMCD vol. 31,12 (2021): 3464-3473. doi: https://doi.org/10.1016/j.numecd.2021.08.037
Targher G, Mantovani A, Grander C, Foco L, Motta B, Byrne CD, Pramstaller PP, Tilg H. Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study. Nutr Metab Cardiovasc Dis. 2021 Nov 29;31(12):3464-3473. doi: 10.1016/j.numecd.2021.08.037. Epub 2021 Aug 24. PMID: 34627696.
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Nutr Metab Cardiovasc Dis. 2021 Nov 29;31(12):3464-3473. doi: 10.1016/j.numecd.2021.08.037. Epub 2021 Aug 24.

Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study.

Nutrition, metabolism, and cardiovascular diseases : NMCD

Giovanni Targher, Alessandro Mantovani, Christoph Grander, Luisa Foco, Benedetta Motta, Christopher D Byrne, Peter P Pramstaller, Herbert Tilg

Affiliations

  1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. Electronic address: [email protected].
  2. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
  3. Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria.
  4. Institute for Biomedicine, Eurac Research (Affiliated to the University of Lübeck), Bolzano, Italy.
  5. Institute for Biomedicine, Eurac Research (Affiliated to the University of Lübeck), Bolzano, Italy; Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
  6. Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, UK.

PMID: 34627696 DOI: 10.1016/j.numecd.2021.08.037

Abstract

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is the leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD), both with and without type 2 diabetes mellitus (T2DM). Cardiac autonomic dysfunction is a risk factor for CVD morbidity and mortality. The aim of this pilot study was to assess whether there is an association between NAFLD and impaired cardiac autonomic function.

METHODS AND RESULTS: Among the first 4979 participants from the Cooperative Health Research in South Tyrol (CHRIS) study, we randomly recruited 173 individuals with T2DM and 183 age- and sex-matched nondiabetic controls. Participants underwent ultrasonography and vibration-controlled transient elastography (Fibroscan®, Echosens) to assess hepatic steatosis and liver stiffness. The low-to-high-frequency (LF/HF) power ratio and other heart rate variability (HRV) measures were calculated from a 20-min resting electrocardiogram (ECG) to derive a measure of cardiac sympathetic/parasympathetic imbalance. Among the 356 individuals recruited for the study, 117 had NAFLD and T2DM, 56 had T2DM alone, 68 had NAFLD alone, and 115 subjects had neither condition. Individuals with T2DM and NAFLD (adjusted odds ratio [OR] 4.29, 95% confidence intervals [CI] 1.90-10.6) and individuals with NAFLD alone (adjusted OR 3.41, 95% CI 1.59-7.29), but not those with T2DM alone, had a substantially increased risk of having cardiac sympathetic/parasympathetic imbalance, compared with those without NAFLD and T2DM. Logistic regression models were adjusted for age, sex, body mass index (BMI), hypertension, dyslipidemia, insulin resistance, hemoglobin A1c (HbA1c), C-reactive protein (CRP), and Fibroscan®-measured liver stiffness.

CONCLUSIONS: NAFLD was associated with cardiac sympathetic/parasympathetic imbalance, regardless of the presence or absence of T2DM, liver stiffness, and other potential confounding factors.

Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Keywords: CANS; Cardiac autonomic nervous system; NAFLD; Non-alcoholic fatty liver disease; Parasympathetic; Sympathetic; Type 2 diabetes

Conflict of interest statement

Declaration of competing interest Nothing to declare.

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