Higher afamin concentrations are associated with higher fatty liver indices: Population-based KORA F4/FF4 study

Previous studies suggest that afamin is associated with steatotic liver diseases (SLD). However, the exact role of afamin in SLD development and fibrogenesis remains unclear. Potential modifying effects of sex and glucose tolerance status have also not been examined. Therefore, we investigated the associations of afamin with steatotic liver diseases and fibrosis defined by non-invasive tests and assessed for possible effect modifications.

This study included 3080 participants from the population-based KORA F4/FF4 cohort. Cross-sectional and prospective associations (follow-up time 6.5 years) between afamin and NAFLD liver fat score (NAFLD LFS), hepatic steatosis index, fatty liver index and the fibrosis-4 index were assessed using multiple linear regression models. Models were adjusted for age, sex, body mass index, smoking status, alcohol consumption, physical activity, metabolic parameters, medication and subclinical inflammation.

In the cross-sectional analysis, afamin concentrations were positively associated with NAFLD LFS (β = .32; 95% CI .27-.37), hepatic steatosis index (β = .33; 95% CI .26-.39) and fatty liver index (β = 1.78; 95% CI 1.47-2.08) (all p < .001), but not with fibrosis-4 index. In the prospective analysis, higher afamin levels were associated with a higher increase only in NAFLD LFS (p < .001). Cross-sectional and prospective associations between afamin and NAFLD LFS were more pronounced in men than in women (p_interaction < .001 and .022; respectively). Cross-sectional associations between afamin and NAFLD LFS were also stronger in individuals with prediabetes or diabetes compared to those with normal glucose tolerance (p_interaction < .001).

Higher afamin concentrations are positively associated with NAFLD LFS with potential effect modification by sex and glucose tolerance status.