Association between Metabolic Dysfunction-associated Fatty Liver Disease and Cognitive Impairment

Qiang Yu; Ruixin He; Haowen Jiang; Ji Wu; Zhifeng Xi; Kang He; Yongbo Liu; Tao Zhou; Mingxuan Feng; Ping Wan; Hexin Yan; Qiang Xia

doi:10.14218/JCTH.2021.00490

Association between Metabolic Dysfunction-associated Fatty Liver Disease and Cognitive Impairment

J Clin Transl Hepatol. 2022 Dec 28;10(6):1034-1041. doi: 10.14218/JCTH.2021.00490. Epub 2022 Feb 17.

Authors

Qiang Yu¹, Ruixin He^{2

3}, Haowen Jiang⁴, Ji Wu¹, Zhifeng Xi¹, Kang He¹, Yongbo Liu¹, Tao Zhou¹, Mingxuan Feng¹, Ping Wan¹, Hexin Yan⁵, Qiang Xia¹

Affiliations

¹ Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.
⁵ Department of Anesthesiology and Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Abstract

Background and aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a newly proposed term based on modified criteria. Although nonalcoholic fatty liver disease (NAFLD) has been well-documented as a multisystem disease, research on the correlation of MAFLD and extra-hepatic diseases is limited. This study aimed to clarify the association of MAFLD, as well as NAFLD status with cognitive function.

Methods: A total of 5,662 participants 20-59 years of age who underwent cognitive tests and liver ultrasonography in the Third National Health and Nutrition Examination Survey were included in the analysis. Cognitive function was evaluated using three computer-administered tests, the serial digit learning test (SDLT), the simple reaction time test (SRTT) and the symbol digit substitution test (SDST).

Results: Participants with MAFLD had significantly poorer performance on the SRTT [odds ratio (OR) 1.47, 95% confidence interval (CI): 1.14-1.89)]. MAFLD with moderate-severe liver steatosis was associated with higher risks of scoring low in the SDLT (OR 1.37, 95% CI: 1.04-1.82) and SRTT (OR 1.55, 95% CI: 1.19-2.02). NAFLD combined with metabolic dysfunction, instead of NAFLD without metabolic disorders, was associated an increased risk of a low SRTT score (OR 1.44, 95% CI: 1.10-1.82). MAFLD patients had a high probability of fibrosis, prediabetes, and diabetes and were also significantly associated with increased risks based on the SDST or SRTT score.

Conclusions: MAFLD was significantly associated with increased risk of cognitive impairment, especially among MAFLD patients with a high degree of liver fibrosis, moderate-severe steatosis, or hyperglycemia.

Keywords: Cognitive dysfunction; Metabolic dysfunction-associated fatty liver disease; NHANES; Nonalcoholic fatty liver disease.