Published online May 16, 2024. doi: 10.12998/wjcc.v12.i14.2359
Revised: February 18, 2024
Accepted: April 2, 2024
Published online: May 16, 2024
Processing time: 118 Days and 3 Hours
Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (Ar
To investigate the correlation between fatty liver and mental disorders, thus ne
Data on NAFLD and ArLD were retrieved from the genome-wide association studies catalog, while information on mental disorders, including Alzheimer's disease, schizophrenia, anxiety disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, multiple personality dis
After excluding weak instrumental variables, a causal relationship was identified between fatty liver disease and the occurrence and development of some psychia
Associations were found between genetic predisposition to fatty liver disease and an increased risk of a broad range of psychiatric disorders, namely bipolar disorder, OCD, and PTSD, highlighting the significance of preven
Core Tip: Non-alcoholic fatty liver disease and alcohol-related liver disease are the predominant forms of chronic liver diseases, with their incidence gradually increasing due to changing lifestyle habits. Observational studies have indicated a potential association between fatty liver and psychiatric disorders, necessitating Mendelian randomization studies to eluci
- Citation: Xu WM, Zhang HF, Feng YH, Li SJ, Xie BY. Genetically predicted fatty liver disease and risk of psychiatric disorders: A mendelian randomization study. World J Clin Cases 2024; 12(14): 2359-2369
- URL: https://www.wjgnet.com/2307-8960/full/v12/i14/2359.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v12.i14.2359
As is extensively documented, non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ArLD) have emerged as the most important causes of hepatic injury, and their incidence is steadily increasing due to changes in lifestyle habits[1]. The former is a chronic liver condition associated with obesity and metabolic syndrome, with a pre
While psychiatric disorders can be treated via various approaches, according to the World Health Organization (WHO), their incidence increases on a yearly basis[6]. Although the relationship between fatty liver and psychiatric disorders remains elusive, a higher prevalence of metabolic syndrome is observed in patients with psychiatric disorders[7]. Common psychiatric disorders, such as bipolar disorder, depressive disorder, or schizophrenia, may be associated with metabolic syndrome or substance abuse[8]. Elwing et al[9] observed a higher prevalence of major depression as well as anxiety disorders in NAFLD patients. At the same time, the incidence of ArLD is closely associated with excessive and chronic alcohol consumption, with addictive misuse of alcohol considered a highly prevalent psychiatric disorder[10]. For instance, anxiety is a common comorbidity in patients with alcohol abuse, causing significant discomfort and cognitive impairment[11].
Mendelian randomization (MR) is an approach for investigating causality between exposures and outcomes of interest[12] that utilizes single nucleotide polymorphisms (SNPs) as unconfounded proxies for exposures, thereby circumventing residual confounders and reverse causality commonly present in conventional observational studies[13]. The MR design represents a crucial strategy for causal inference without randomized clinical trials (RCTs), given that genetic variants are randomly assorted during meiosis, mimicking an RCT[14]. There is a non-negligible relationship between fatty liver and mental disorders, necessitating a comprehensive understanding of their shared characteristics to facilitate the develop
In this study, all data were derived from the Genetic Alliance's publicly available compilation of statistical data from genome-wide association studies (GWAS). All original studies underwent a thorough ethical review process and ob
Summary statistics on fatty liver disease and psychiatric disorders were collected from published GWAS to explore the causal effect of fatty liver disease on the risk of psychiatric disorders using two-sample MR.
The MR Approach was constructed based on three primary assumptions: (1) Genetic variants as instrumental variables (IVs) should be significantly associated with the risk factor of interest; (2) the genetic variants used should not be asso
Summary statistics on fatty liver disease were downloaded from published GWAS. The GWAS Catalog database is pub
Ref. | Outcome | PMID | Sample size | |
Cases | Controls | |||
Bellenguez et al[17], 2022 | Alzheimer’s disease | 35379992 | 39106 | 401577 |
Watson et al[18], 2019 | Anorexia nervosa | 31308545 | 16992 | 55525 |
Schoeler et al[19], 2023 | Anxiety disorder | 37106081 | 282802 | |
Demontis et al[20], 2023 | Attention deficit hyperactivity disorder | 36702997 | 38691 | 186843 |
Stahl et al[21], 2019 | Bipolar disorder | 31043756 | 20352 | 31358 |
Howard et al[22], 2019 | Major depressive disorder | 30718901 | 246363 | 561190 |
Cross-Disorder Group of the Psychiatric Genomics Consortium[23], 2019 | Multiple disorders | 31835028 | 232964 | 494162 |
IOCDF-GC, OCGAS[24], 2018 | Obsessive-compulsive disorder | 28761083 | 2688 | 7037 |
Nievergelt et al[25], 2019 | Post-traumatic stress disorder | 31594949 | 30000 | 170000 |
Trubetskoy et al[26], 2022 | Schizophrenia | 35396580 | 76775 | 243649 |
The genetic instruments for each exposure trait or disease were meticulously chosen from the corresponding GWASs, surpassing the threshold of genome-wide significance (P < 5 × 108). Independent SNPs were defined by R2 < 0.001 and clump window > 10 kb without linkage disequilibrium (LD) were proposed as instrumental variables. LD among SNPs for each risk factor was calculated based on 1000 genomes LD reference panel European population[27] using the PLINK clumping approach (PLINK: a tool set for whole-genome association and population-based linkage analyses)[28].
The variance in fatty liver disease explained by the IVs was calculated, and weak IVs bias was analyzed using F-statistics. R2 was calculated based on the effect estimates (β) and allele frequencies (EAF) of each single SNP using the following formula: R2 = 2× EAF (1-EAF) × β2[29]. The F value was further calculated according to the formula F = R2 × (N-2)/(1-R2)[30]. F value > 10 was considered a strong genetic IV; otherwise, the SNP was discarded.
An assessment of heterogeneity across SNPs was conducted using Cochran's Q statistics. The primary analytical method used to examine causal associations was the random-effect inverse-variance-weighted model[31]. The MR-Egger method was used to determine the pleiotropic effects of the instrumental SNPs[32].
F values for each SNP were individually calculated, and SNPs with values greater than 10 were retained, suggesting a low risk of bias due to weak IVs. Consequently, all SNPs in this study had F-statistics larger than 10 (Table 2).
Exposure/Outcome | SNPs | R2 | F-statistic |
Alcohol-related liver disease | |||
Alzheimer’s disease | / | / | / |
Anorexia nervosa, anxiety disorder, attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, multiple disorders, obsessive-compulsive disorder, post-traumatic stress disorder, schizophrenia | rs738408 | 0.11 | 57352.08 |
Non-alcoholic fatty liver disease | |||
Alzheimer’s disease | rs28601761, rs3747207, rs73001065 | 0.04 | 35089.81 |
Anorexia nervosa, anxiety disorder, attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, multiple disorders, obsessive-compulsive disorder, post-traumatic stress disorder, schizophrenia | rs3747207, rs429358 | 0.02 | 26942.59 |
ArLD: In the ArLD population, one SNP (rs738408) was retained following screening and filtering. The findings indicated that ArLD significantly elevates the likelihood of developing attention deficit hyperactivity disorder (ADHD) (OR: 5.81, 95%CI: 5.59-6.03, P < 0.01), bipolar disorder (BD) (OR: 5.73, 95%CI: 5.42-6.05, P = 0.03), obsessive-compulsive disorder (OCD) (OR: 6.42, 95%CI: 5.60-7.36, P < 0.01), and post-traumatic stress disorder (PTSD) (OR: 5.66, 95%CI: 5.33-6.01, P < 0.01). In contrast, there was no evidence suggesting that ArLD increased the risk of anorexia nervosa (OR: 0.97, P = 0.37), anxiety disorder (OR: 1.00, P = 0.14), major depressive disorder (MDD) (OR: 1.00, P = 0.88), multiple personality disorders (OR: 0.96, P = 0.47), and schizophrenia (OR: 0.97, P = 0.14) (Figure 2). Considering that only one SNP was included, tests for heterogeneity and pleiotropy could not be performed.
NAFLD: In the NAFLD population, 3 SNPs (rs28601761, rs3747207, and rs73001065) were included in the analysis of their association with Alzheimer's disease. At the same time, 2 SNPs (rs3747207 and rs429358) were analyzed for their asso
As fatty liver disease has emerged as a leading cause of chronic liver disease worldwide, and with a deeper understand
According to the WHO, 5.1% of the global burden of disease can be attributable to alcohol misuse, ranking it as the seventh leading risk factor globally[33]. Of note, persistent alcohol use disorder is strongly correlated with progressive hepatic damage and increased mortality[34]. Among patients diagnosed with fatty liver disease, non-interrupted con
Alcohol dependence and BD frequently coexist, with chronic alcoholism being associated with 24%-62% of BD cases worldwide[42]. Prolonged alcohol consumption can exert detrimental effects on both the immune system and nervous system while also increasing the frequency and severity of emotional episodes in individuals with BD[43]. Abnormalities in the N-methyl-d-asperate (NMDA) receptor play a critical role in the occurrence and development of BD. Conversely, ethanol acts on the brain to inhibit NMDA receptors, thereby elevating the risk of BD[44]. However, the risks of fatty liver appear to outweigh the risks associated with alcohol abuse, and patients with NAFLD seem to be at a higher risk com
NAFLD is closely linked to metabolic disorder syndrome that is characterized by obesity, insulin resistance, and hyperlipidemia[50]. Animal experiments have validated that metabolic syndrome can lead to astrogliosis and micro
The combination of fatty liver and persistent inflammation is associated with neuroinflammation, disruptions in neu
This is the first study to explore the causal relationship between psychiatric disorders and fatty liver disease using a two-sample MR analysis with pooled GWAS-level statistics, thereby minimizing potential confounding and reverse cau
In summary, this MR study provides genetic evidence supporting a causal relationship between fatty liver disease and psychiatric disorders. Our results collectively suggest that ArLD is a risk factor for ADHD, bipolar disorder, OCD, and PTSD. Moreover, our findings highlight a correlation between the presence of NAFLD and a higher risk of bipolar disorder, OCD, and PTSD. Thus, patients with fatty liver disease should be more vigilant to prevent the onset of mental disorders.
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