NAFLD progression risk increased progressively as RBC count increased (P for trend < 0.001). In 1,798 of 9,476 (19.0%) subjects with NAFLD at baseline, the severity of NAFLD increased. After adjustment for hemoglobin and other confounders, the risk of incident NAFLD was 21%, 32%, and 51% higher in the second, third, and fourth RBC count quartiles, respectively, than in the lowest quartile. Incident NAFLD risk was positively associated with RBC count. Results: Overall, 4,332 of 17,383 (24.9%) subjects without NAFLD at baseline developed NAFLD. The generalized estimation equation (GEE), an extension of generalized linear models that allows for analysis of repeated measurements, was used to analyze the association between RBC count and NAFLD. NAFLD severity was categorized as mild, moderate, or severe. Methods: This health management cohort study included 27,112 subjects (17,383 non-NAFLD and 9,729 NAFLD) with up to 5 years of follow-up (median 2.8 years). As a readily available and inexpensive hematological index in routine clinical examinations, red blood cells (RBCs) are gaining increasing attention in many diseases, such as metabolic syndrome, but their association with NAFLD is unknown. A convenient NAFLD indicator will greatly facilitate risk appraisal and prevention. Objective: Nonalcoholic fatty liver disease (NAFLD) is becoming a global public health challenge. 8Beijing Institute of Pharmacology and Toxicology, Beijing, China.7Department of Biostatistics, School of Public Health, Shandong University, Jinan, China.6College of Chemical Engineering and Materials Science, Shandong Normal University, Jinan, China.5Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.4Health Management Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.3Shandong Institute of Endocrine and Metabolic Disease, Jinan, China.2Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China.
Fang Zhong 1,2,3 Liying Guan 4 Haiyan Lin 4 Meng Zhao 2,3,5 Yiming Qin 6 Qihang Li 1,2,3 Zhongshang Yuan 7 Guang Yang 8 Ling Gao 1,2,3,5 Jiajun Zhao 1,2,3,5*
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