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Interaction of TM6SF2 E167K and PNPLA3 I148M variants in NAFLD in northeast China
Min Xu1, Yiling Li
Corresponding author
lyl-72@163.com

Corresponding author at: 155 Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
, Shuang Zhang2, Xinyi Wang2, Jianhua Shen2, Shuwen Zhang2
Department of Medicine, Division of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; comprises a spectrum of diseases ranging from simple steatosis and non-alcoholic steatohepatitis to progressive hepatic fibrosis&#44; cirrhosis and eventually hepatocellular carcinoma without excessive alcohol consumption <a class="elsevierStyleCrossRef" href="#bib0160">&#91;1&#93;</a>&#46; Along with the increasing prevalence of obesity and lifestyle changes&#44; NAFLD has recently become the most common chronic liver disease in developed Western countries and affects 20&#8211;34&#37; of individuals <a class="elsevierStyleCrossRef" href="#bib0165">&#91;2&#93;</a>&#46; NAFLD also affects 25&#37; of the population in Japan <a class="elsevierStyleCrossRef" href="#bib0170">&#91;3&#93;</a> and 15&#37; of the population in China <a class="elsevierStyleCrossRef" href="#bib0175">&#91;4&#93;</a>&#46; Although the morbidity rate of NAFLD is relatively low in Asian populations&#44; it is worth noting that due to lifestyle&#44; the prevalence of NAFLD has increased dramatically in the last two decades <a class="elsevierStyleCrossRef" href="#bib0180">&#91;5&#93;</a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Similar to other complex diseases&#44; the pathogenesis of NAFLD is affected by multiple factors&#44; such as obesity&#44; dyslipidaemia&#44; insulin resistance&#44; type 2 diabetes mellitus &#40;T2DM&#41;&#44; gut microbiota&#44; genetic background and epigenetic factors <a class="elsevierStyleCrossRef" href="#bib0185">&#91;6&#93;</a>&#44; but the underlying mechanism remains unclear&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A genome-wide association study in 2008 identified a variant &#40;rs738409&#41; of <span class="elsevierStyleItalic">PNPLA3</span> that is strongly associated with the fat content of the liver <a class="elsevierStyleCrossRef" href="#bib0190">&#91;7&#93;</a>&#46; Our subsequent study confirmed that the variant is also associated with steatosis severity <a class="elsevierStyleCrossRef" href="#bib0195">&#91;8&#93;</a>&#46; Recently&#44; scholars discovered that the Glu167Lys <span class="elsevierStyleItalic">TM6SF2</span> variant breaks the normal function of TM6SF2 and is associated with increased liver fat content <a class="elsevierStyleCrossRef" href="#bib0200">&#91;9&#93;</a>&#46; TM6SF2 is highly expressed in the liver and small intestine&#44; and in the rs5852926 variant&#44; cytosine is substituted by thymine in coding nucleotide 499&#44; which results in glutamate being replaced by lysine at residue 167 <a class="elsevierStyleCrossRef" href="#bib0200">&#91;9&#93;</a>&#46; Subsequent studies have confirmed that the variant is associated with NAFLD in both adults <a class="elsevierStyleCrossRef" href="#bib0205">&#91;10&#93;</a> and children <a class="elsevierStyleCrossRef" href="#bib0210">&#91;11&#93;</a>&#44; and the association has been confirmed in different ethnic groups <a class="elsevierStyleCrossRefs" href="#bib0200">&#91;9&#44;12&#44;13&#93;</a>&#46; Indeed&#44; the association has been proven by meta-analysis <a class="elsevierStyleCrossRef" href="#bib0225">&#91;14&#93;</a>&#46; However&#44; there are a limited number of studies based on Chinese populations&#44; and the results are inconsistent <a class="elsevierStyleCrossRefs" href="#bib0220">&#91;13&#44;15&#93;</a>&#46; Furthermore&#44; a study based on a Japanese population found that the <span class="elsevierStyleItalic">TM6SF2</span> variant was not associated with biopsy-proven histological features <a class="elsevierStyleCrossRef" href="#bib0235">&#91;16&#93;</a>&#46; Our study aimed to confirm the association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD in northeast China and investigate whether <span class="elsevierStyleItalic">TM6SF2</span> variant is associated with the degree of steatosis&#46; In addition&#44; given that the <span class="elsevierStyleItalic">PNPLA3</span> I148M variant and body mass index &#40;BMI&#41; have been shown to be associated with NAFLD&#44; we attempted to determine whether there is an interaction between them in NAFLD in a Chinese population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0045">Subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">Our study included 158 patients with NAFLD diagnosed by FibroScan recruited from an outpatient liver clinic at the First Affiliated Hospital of China Medical University in Shenyang&#44; China&#44; between October 2014 and December 2015&#46; During and after data collection&#44; we still had access to information identifying individual participants&#46; The patients were confirmed to have hepatic steatosis via liver FibroScan with a controlled attenuation parameter &#40;CAP&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>238&#44; which was classified into three categories&#58; mild&#44; moderate&#44; and severe for CAP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>238&#44; CAP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>259&#44; and CAP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>292&#44; respectively&#44; as reported by Sasso et al&#46; <a class="elsevierStyleCrossRef" href="#bib0240">&#91;17&#93;</a>&#46; All examinations were performed by one experienced radiologist&#44; who was unaware of the patients&#8217; clinical details and laboratory findings&#46; The exclusion criteria included ethanol intake &#62;140<span class="elsevierStyleHsp" style=""></span>g&#47;week for male&#44; 70<span class="elsevierStyleHsp" style=""></span>g&#47;week for female&#44; receiving total parenteral nutrition&#44; hepatitis B and hepatitis C virus positivity&#44; presence of liver disease &#40;such as Wilson&#39;s disease&#44; hemochromatosis&#44; alpha1-antitrypsin deficiency&#44; autoimmune liver disease&#44; drug-induced liver injury&#41;&#44; use of hepatotoxic drugs&#44; use of drugs that promote steatosis&#44; and use of hepatotoxic drugs&#46; In addition&#44; 158 ethnic-matched controls without NAFLD by FibroScan were recruited from primary care outpatient clinics at the same institution&#46; All participants were of Han ethnicity&#46; Written informed consent was obtained using a protocol approved by the ethics committee &#40;&#91;2012&#93;81&#41; of the First Affiliated Hospital of China Medical University&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0050">Clinical parameters</span><p id="par0025" class="elsevierStylePara elsevierViewall">Age and sex were self-reported&#46; BMI was calculated according to the measured height and weight at the time of recruitment&#46; Obesity was defined as BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>25&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#bib0245">&#91;18&#93;</a>&#46; Venous blood samples were obtained from the subjects after an overnight fast &#40;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; The alanine aminotransferase &#40;ALT&#41;&#44; aspartate aminotransferase &#40;AST&#41;&#44; gamma-glutamyl transpeptidase &#40;GGT&#41;&#44; alkaline phosphatase &#40;ALP&#41;&#44; total cholesterol &#40;TC&#41;&#44; high-density lipoprotein cholesterol &#40;HDL-C&#41;&#44; low-density lipoprotein cholesterol &#40;LDL-C&#41;&#44; triglyceride &#40;TG&#41;&#44; and fasting blood glucose &#40;FBG&#41; levels were measured using an automated analyser&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0055">Genotyping</span><p id="par0030" class="elsevierStylePara elsevierViewall">DNA was extracted from EDTA-anticoagulated blood samples using a DNA extraction protocol &#40;Tiangen DP329&#41;&#46; Genotyping of PNPLA3 rs738409 and TM6SF2 rs58542926 polymorphisms was then performed using PCR-based assays with an AB 7900 Fast Real-Time PCR instrument &#40;TaqMan SNP Genotyping Assays&#44; Assay ID&#58; C&#95;7241&#95;10 for PNPLA3 rs738409&#44; C&#95;89463510&#95;10 for TM6SF2 rs58542926&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0060">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Continuous variables with a normal distribution are presented as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#59; otherwise&#44; the data are described by the median &#40;interquartile range&#41;&#46; Categorical data are described by numbers&#46; The <span class="elsevierStyleItalic">PNPLA3</span> genotypic value was coded in an additive manner&#44; i&#46;e&#46;&#44; 0&#44; 1 and 2 denote the II&#44; IM and MM genotypes&#44; respectively&#44; whereas the <span class="elsevierStyleItalic">TM6SF2</span> genotypic value was coded as a dominant genetic model&#44; i&#46;e&#46;&#44; 0 denotes the CC genotype&#44; and 1 denotes the CT and TT genotypes&#46; The Hardy&#8211;Weinberg equilibrium &#40;HWE&#41; of the genotype distribution was examined using the chi-square test&#44; with <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05 indicating HWE&#46; An independent <span class="elsevierStyleItalic">t</span> test or ANOVA was used to compare continuous data&#46; The associations between genotype and continuous variables were tested using linear regression models&#46; The chi-square test was used to compare categorical variables&#46; The associations between genotype and categorical variables were tested using logistic regression models&#46; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered to indicate a significant difference&#46; All statistical analyses were performed using SPSS 20&#46;0 &#40;IBM&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0065">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Details about the physical and clinical characteristics of the patients and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">TM6SF2</span> rs58542926 genotype was found to be in HWE for both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5026 for the control group and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6664 for the NAFLD group&#41;&#46; The frequency of the Glu167Lys <span class="elsevierStyleItalic">TM6SF2</span> variant was relatively low in the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; MAF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;1&#37;&#41;&#44; and the frequency of the Glu167Lys <span class="elsevierStyleItalic">TM6SF2</span> variant was significantly higher in the NAFLD group than in the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#46; The frequency of the Glu167Lys <span class="elsevierStyleItalic">TM6SF2</span> variant was associated with the degree of steatosis&#44; with T allele frequencies of 8&#46;1&#37;&#44; 9&#46;0&#37;&#44; and 27&#46;3&#37; in mild&#44; moderate&#44; and severe cases&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0070">Association of TMS6F2 rs58542926 variant with NAFLD and degree of steatosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Discrete trait analysis showed that <span class="elsevierStyleItalic">TM6SF2</span> rs58542926 was associated with NAFLD in a dominant model &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;036&#41;&#46; A multivariate binary regression analysis showed that <span class="elsevierStyleItalic">TM6SF2</span> rs58542926 was still associated with NAFLD after adjusting for potential confounding factors &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; odds ratio &#91;OR&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;379&#44; 95&#37; confidence interval &#91;CI&#93;&#58; 1&#46;500&#8211;7&#46;612&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; Indeed&#44; NAFLD was also associated with age &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;033&#44; 95&#37; CI&#58; 1&#46;010&#8211;1&#46;057&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; BMI &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;428&#44; 95&#37; CI&#58; 1&#46;299&#8211;1&#46;569&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and <span class="elsevierStyleItalic">PNPLA3</span> genotype &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;862&#44; 95&#37; CI&#58; 1&#46;250&#8211;2&#46;773&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that the <span class="elsevierStyleItalic">TM6SF2</span> genotype was associated with the severity of steatosis in the dominant model &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In addition&#44; the association remained after adjusting for potential confounding factors&#44; such as age&#44; sex&#44; BMI and <span class="elsevierStyleItalic">PNPLA3</span> genotype &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0075">Association of <span class="elsevierStyleItalic">TM6SF2</span> E167K variant with clinical characteristics</span><p id="par0060" class="elsevierStylePara elsevierViewall">The associations between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and the hepatic enzyme&#44; lipid&#44; and FBG levels are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; In summary&#44; the E167K variant was associated with an increased ALT level &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41;&#59; however&#44; we did not find an association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and other hepatic enzymes&#44; lipids or FBG&#46; The association was still significant after adjusting for age&#44; sex&#44; BMI&#44; and <span class="elsevierStyleItalic">PNPLA3</span> genotype &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; adjusted <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0080">Interaction between the <span class="elsevierStyleItalic">PNPLA3</span> I148M and <span class="elsevierStyleItalic">TM6SF2</span> E167K variants in NAFLD</span><p id="par0065" class="elsevierStylePara elsevierViewall">As <span class="elsevierStyleItalic">PNPLA3</span> I148M variant was associated with NAFLD&#44; we tried to investigate whether there was an interaction between the <span class="elsevierStyleItalic">PNPLA3</span> I148M and <span class="elsevierStyleItalic">TM6SF2</span> E167K variants in NAFLD&#46; In the model&#44; we set the group without either variant as the reference group&#46; We found that compared to the reference group&#44; all other groups were associated with NAFLD&#46; In addition&#44; the group with only the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant had a higher OR than the group with the <span class="elsevierStyleItalic">PNPLA3</span> I148M variant&#46; In particular&#44; the group with both variants had the highest OR of 5&#46;133 after adjusting for potential confounding factors &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0085">Interaction between obesity and the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant in NAFLD</span><p id="par0070" class="elsevierStylePara elsevierViewall">In a binary logistic regression model&#44; we found that BMI was also a risk factor for NAFLD&#46; To investigate whether there was an interaction between BMI and the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant in NAFLD&#44; the group without obesity or the T risk allele was set as the reference group&#46; As shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#44; except for the non-obese group with the T allele&#44; all of the other groups were associated with NAFLD&#44; and the obese group with the T allele had the highest OR for NAFLD &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#46;19&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">TM6SF2</span> E167K variant has been reported to be associated with NAFLD as well as increased liver enzymes and decreased serum lipids in different ethnic groups <a class="elsevierStyleCrossRefs" href="#bib0200">&#91;9&#44;12&#44;13&#93;</a>&#46; We found that although the frequency of the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant was low&#44; the <span class="elsevierStyleItalic">TM6SF2</span> genotype was associated with the prevalence of NAFLD and the degree of steatosis in northeast China&#46; Notably&#44; we also discovered that there was an additive effect of the <span class="elsevierStyleItalic">PNPLA3</span> I148M and <span class="elsevierStyleItalic">TM6SF2</span> E167K variants in NAFLD&#46; In addition&#44; when performing subgroup analysis based on obesity&#44; we did not find an association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD in the non-obese group&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD has been proven in multiple ethnic groups <a class="elsevierStyleCrossRefs" href="#bib0200">&#91;9&#44;12&#44;13&#93;</a>&#44; but studies based on Chinese populations are rare&#44; with different results <a class="elsevierStyleCrossRefs" href="#bib0220">&#91;13&#44;15&#93;</a>&#46; The results of our study were similar to those of Wang&#39;s study&#44; indicating that despite a low risk allele frequency in the population of northeast China&#44; a significant association exists between the <span class="elsevierStyleItalic">TM6SF2</span> genotype and NAFLD&#46; The association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD may be attributed to the following two reasons&#58; &#40;1&#41; TM6SF2 is associated with very-low-density lipoprotein &#40;VLDL&#41; secretion&#44; whereas with the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant decreases VLDL secretion and results in a higher liver fat content <a class="elsevierStyleCrossRef" href="#bib0200">&#91;9&#93;</a>&#46; A subsequent study showed that TM6SF2 is mainly involved in mobilizing neutral lipids in VLDL assembly <a class="elsevierStyleCrossRef" href="#bib0250">&#91;19&#93;</a>&#46; &#40;2&#41; <span class="elsevierStyleItalic">TM6SF2</span> is involved in cholesterol synthesis <a class="elsevierStyleCrossRef" href="#bib0255">&#91;20&#93;</a> through the EXPERA domain of the TM6SF2 protein <a class="elsevierStyleCrossRef" href="#bib0260">&#91;21&#93;</a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and steatosis severity has been proven in other ethnic groups <a class="elsevierStyleCrossRef" href="#bib0265">&#91;22&#93;</a> but not in Chinese populations&#46; In this study&#44; we found that the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant was associated with steatosis grade independent from potential confounding factors&#44; and these findings are in line with those reported by Silvia Sookoian et al&#46; <a class="elsevierStyleCrossRef" href="#bib0265">&#91;22&#93;</a>&#46; They found that the E167K variant was associated with biopsy-proven steatosis severity after adjusting for age&#44; sex&#44; BMI and the <span class="elsevierStyleItalic">PNPLA3</span> rs738409 genotype&#44; indicating that the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant may be associated with the progression of NAFLD because the degree of steatosis is positively correlated with steatohepatitis <a class="elsevierStyleCrossRef" href="#bib0270">&#91;23&#93;</a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">TM6SF2</span> E167K variant is associated with increased liver enzyme and decreased lipid levels <a class="elsevierStyleCrossRef" href="#bib0200">&#91;9&#93;</a>&#46; Accordingly&#44; we found that the <span class="elsevierStyleItalic">TMS6F2</span> E167K variant was associated with an increased ALT level compared with other clinical indexes&#46; ALT is considered a sensitive marker of liver injury&#44; which suggests that this variant is associated with liver injury&#46; The reason why the <span class="elsevierStyleItalic">TMS6F2</span> E167K variant is associated with liver injury may be that the T allele is associated with the postprandial redistribution of lipoprotein cholesterol <a class="elsevierStyleCrossRef" href="#bib0275">&#91;24&#93;</a>&#44; which is associated with a higher level of cytokeratin &#40;CK&#41;-18&#44; a marker of liver injury&#44; after a meal <a class="elsevierStyleCrossRef" href="#bib0280">&#91;25&#93;</a>&#46; Previous studies have shown that the T allele is associated with lower serum lipid levels <a class="elsevierStyleCrossRefs" href="#bib0200">&#91;9&#44;14&#44;26&#93;</a>&#59; however&#44; we did not find an association between the <span class="elsevierStyleItalic">TMS6F2</span> E167K variant and lipid levels&#44; which may be due to selective bias and differences among races&#46; Therefore&#44; further large-sample studies are needed to confirm these results&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Given that the <span class="elsevierStyleItalic">PNPLA3</span> I148M variant is a strong modulating genetic factor of NAFLD and accounts for approximately 5&#37; of NAFLD cases <a class="elsevierStyleCrossRef" href="#bib0290">&#91;27&#93;</a>&#44; we attempted to identify whether there is a combined effect of the variants&#46; In line with the results reported by Wang <a class="elsevierStyleCrossRef" href="#bib0295">&#91;28&#93;</a>&#44; we found an additive effect for the two variants with regard to the prevalence of NAFLD&#44; which may be explained by a Bayesian analysis <a class="elsevierStyleCrossRef" href="#bib0300">&#91;29&#93;</a>&#44; i&#46;e&#46;&#44; two genes may interact each other via DNMT3L and FASN&#46; Notably&#44; the modulatory effect of the <span class="elsevierStyleItalic">PNPLA3</span> I148M variant on NAFLD was found to be lower than that of the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant in our study&#44; which differs from the results of previous meta-analyses <a class="elsevierStyleCrossRef" href="#bib0225">&#91;14&#93;</a>&#46; Carlos J&#46; Pirola confirmed that compared with the <span class="elsevierStyleItalic">PNPLA3</span> I148M variant&#44; the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant had only a moderate effect on NAFLD&#44; which may be caused by selective bias and the small sample size&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Notably&#44; in the non-obese population&#44; we did not find an association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD&#46; Considering that subjects with both the <span class="elsevierStyleItalic">PNPLA3</span> and <span class="elsevierStyleItalic">TM6SF2</span> risk alleles benefit from diet restriction and physical exercises for improving steatosis <a class="elsevierStyleCrossRef" href="#bib0305">&#91;30&#93;</a>&#44; subjects with the <span class="elsevierStyleItalic">PNPLA3</span> risk allele may benefit even more <a class="elsevierStyleCrossRef" href="#bib0310">&#91;31&#93;</a>&#46; This result emphasizes that subjects with the T risk allele may also benefit from weight loss&#59; thus&#44; it is necessary to recommend adoption of lifestyle interventions to those with the risk allele as early as possible&#46; However&#44; because the size of our study sample was small&#44; more large-sample studies are needed to confirm the result&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although biopsy is considered the gold standard for diagnosing steatosis&#44; it is an invasive examination and difficult for Chinese patients to accept&#46; In this study&#44; we used FibroScan to evaluate liver fat content&#44; which is a more inexpensive approach than 1H-MRS and is more noninvasive than CT&#46; Compared with traditional US&#44; FibroScan has a higher sensitivity and accuracy <a class="elsevierStyleCrossRef" href="#bib0240">&#91;17&#93;</a>&#46; Moreover&#44; the results are independent of the operator via quantitative evaluation of liver fat content&#46; The small sample size is another limitation of our study&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We are the first to report the association of the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant with steatosis severity in a Chinese population&#46; In addition&#44; we confirmed the interaction of the <span class="elsevierStyleItalic">PNPLA3</span> I148M and <span class="elsevierStyleItalic">TM6SF2</span> E167K variants in the prevalence of NAFLD&#46; However&#44; more large-sized studies are still needed to investigate these results in Chinese populations&#46;</p></span><span id="sec0955" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0980">Abbreviations</span><p id="par9140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDefList"><span class="elsevierStyleDefTerm">NAFLD</span><span class="elsevierStyleDefDescription"><p id="par0145" class="elsevierStylePara elsevierViewall">non-alcoholic fatty liver disease</p></span><span class="elsevierStyleDefTerm">PNPLA3</span><span class="elsevierStyleDefDescription"><p id="par0150" class="elsevierStylePara elsevierViewall">patatin-like phospholipase domain-containing protein 3</p></span><span class="elsevierStyleDefTerm">TM6SF2</span><span class="elsevierStyleDefDescription"><p id="par0155" class="elsevierStylePara elsevierViewall">transmembrane 6 superfamily member 2</p></span><span class="elsevierStyleDefTerm">ALT</span><span class="elsevierStyleDefDescription"><p id="par0160" class="elsevierStylePara elsevierViewall">alanine aminotransferase</p></span><span class="elsevierStyleDefTerm">AST</span><span class="elsevierStyleDefDescription"><p id="par0165" class="elsevierStylePara elsevierViewall">aspartate aminotransferase</p></span><span class="elsevierStyleDefTerm">ALP</span><span class="elsevierStyleDefDescription"><p id="par0170" class="elsevierStylePara elsevierViewall">alkaline phosphatase</p></span><span class="elsevierStyleDefTerm">GGT</span><span class="elsevierStyleDefDescription"><p id="par0175" class="elsevierStylePara elsevierViewall">gamma-glutamyl transpeptidase</p></span><span class="elsevierStyleDefTerm">TC</span><span class="elsevierStyleDefDescription"><p id="par0180" class="elsevierStylePara elsevierViewall">total cholesterol</p></span><span class="elsevierStyleDefTerm">HDL-C</span><span class="elsevierStyleDefDescription"><p id="par0185" class="elsevierStylePara elsevierViewall">high-density lipoprotein cholesterol</p></span><span class="elsevierStyleDefTerm">LDL-C</span><span class="elsevierStyleDefDescription"><p id="par0190" class="elsevierStylePara elsevierViewall">low-density lipoprotein cholesterol</p></span><span class="elsevierStyleDefTerm">TG</span><span class="elsevierStyleDefDescription"><p id="par0195" class="elsevierStylePara elsevierViewall">triglycerides</p></span><span class="elsevierStyleDefTerm">FBG</span><span class="elsevierStyleDefDescription"><p id="par6190" class="elsevierStylePara elsevierViewall">fasting blood glucose</p></span><span class="elsevierStyleDefTerm">HWE</span><span class="elsevierStyleDefDescription"><p id="par9190" class="elsevierStylePara elsevierViewall">Hardy-Weinberg equilibrium</p></span></span></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors&#8217; contributions</span><p id="par9180" class="elsevierStylePara elsevierViewall">YL carried out clinical studies&#59; MX&#44; SZ&#44; XW&#44; JS and SZ carried out data collection and data analysis&#59; MX and XY were in charge of manuscript writing&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par5185" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interests&#46;</p></span></span>"
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              "identificador" => "abst0005"
              "titulo" => "Introduction and aim"
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          "titulo" => "Materials and methods"
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              "titulo" => "Genotyping"
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          "titulo" => "Results"
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              "identificador" => "sec0040"
              "titulo" => "Association of TMS6F2 rs58542926 variant with NAFLD and degree of steatosis"
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              "titulo" => "Association of TM6SF2 E167K variant with clinical characteristics"
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              "titulo" => "Interaction between the PNPLA3 I148M and TM6SF2 E167K variants in NAFLD"
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              "titulo" => "Interaction between obesity and the TM6SF2 E167K variant in NAFLD"
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          "titulo" => "Discussion"
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          "titulo" => "Abbreviations"
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    "fechaAceptado" => "2018-10-04"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to confirm the association of the transmembrane 6 superfamily member 2 &#40;<span class="elsevierStyleItalic">TM6SF2</span>&#41; E167K variant with non-alcoholic fatty liver disease &#40;NAFLD&#41; and the degree of steatosis&#44; as well as the additive effect of body mass index &#40;BMI&#41; or the patatin-like phospholipase domain-containing protein 3 &#40;<span class="elsevierStyleItalic">PNPLA3</span>&#41; I148M and <span class="elsevierStyleItalic">TM6SF2</span> E167K variants in NAFLD&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 158 NAFLD patients and 158 matched controls were recruited&#46; Steatosis was classified as mild&#44; moderate and severe by FibroScan&#46; Associations between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD as well as clinical parameters were evaluated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Although the frequency of the T allele was low in the Chinese population &#40;MAF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;4&#37;&#41;&#44; there was still a significant association between the E167K variant and NAFLD &#40;odds ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;379&#44; 95&#37; confidence interval&#58; 1&#46;500&#8211;7&#46;612&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; In particular&#44; the <span class="elsevierStyleItalic">TM6SF2</span> genotype was also associated with the degree of steatosis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#46; The <span class="elsevierStyleItalic">TM6SF2</span> variant was associated with increased alanine aminotransferase &#40;ALT&#41; but no other clinical parameters&#44; such as aspartate aminotransferase &#40;AST&#41;&#44; alkaline phosphatase &#40;ALP&#41; and lipids&#46; Notably&#44; we also found that an additive effect of the <span class="elsevierStyleItalic">TM6SF2</span> E167K and <span class="elsevierStyleItalic">PNPLA3</span> I148M variants in NAFLD&#46; Furthermore&#44; we did not identify an association between the <span class="elsevierStyleItalic">TM6SF2</span> E167K variant and NAFLD in the non-obese population&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The <span class="elsevierStyleItalic">TM6SF2</span> E167K variant was associated with NAFLD in northeast China&#44; and there was an interaction between the <span class="elsevierStyleItalic">PNPLA3</span> I148M and <span class="elsevierStyleItalic">TMS6F2</span> E167K variants in NAFLD&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and aim"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "NotaPie" => array:3 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">This work was supported by the <span class="elsevierStyleGrantSponsor" id="gs0005">National Natural Science Foundation of China</span> &#40;No&#46; <span class="elsevierStyleGrantNumber" refid="gs0005">81570519</span>&#41;&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0040">The first author&#46;</p>"
        "identificador" => "fn0005"
      ]
      2 => array:3 [
        "etiqueta" => "2"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">These authors contributed equally to this work&#46;</p>"
        "identificador" => "fn0010"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; GGT&#44; gamma-glutamyl transpeptidase&#59; ALP&#44; alkaline phosphatase&#59; TG&#44; triglycerides&#59; TC&#44; total cholesterol&#59; LDL-C&#44; low-density lipoprotein cholesterol&#59; HDL-C&#44; high-density lipoprotein cholesterol&#59; FBG&#44; fasting blood glucose&#59; CC&#44; subjects with CC genotype&#59; CT&#44; subjects with CT genotype&#59; TT&#44; subjects with TT genotype&#59; MAF&#44; minor allele frequency&#59; HWB&#44; Hardy&#8211;Weinberg equilibrium&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleSup">&#8224;</span>&#58; comparison between control group and NAFLD group&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleSup">&#8225;</span>&#58; comparison of subjects with mild&#44; moderate and severe steatosis&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleSup">&#8224;</span> were calculated using independent <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney for continuous variables or chi-square test for categorical variables&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleSup">&#8225;</span> were calculated using Kruskal&#8211;Wallis <span class="elsevierStyleItalic">H</span> test for continuous variables or chi-square test for categorical variables&#46;</p>"
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            0 => array:2 [
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                  \t\t\t\t">42&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ALT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#40;12&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#40;17&#46;8&#8211;34&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#40;23&#8211;63&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#40;32&#8211;112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;023<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;016<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="char" valign="middle">0&#46;036<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="center" valign="middle"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2047852.png"
              ]
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            0 => array:3 [
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            ]
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        ]
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical data of the subjects&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at2"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CC&#44; subjects with CC genotype&#59; CT&#44; subjects with CT genotype&#59; TT&#44; subjects with TT genotype&#59; <span class="elsevierStyleItalic">PNPLA3</span>&#44; patatin-like phospholipase domain-containing protein 3&#59; OR&#58; odds ratio&#44; CI&#58; confidence interval&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value was calculated using binary logistic regression model after adjusting for age&#44; gender&#44; BMI and <span class="elsevierStyleItalic">PNPLA3</span> genotype&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multiple binary regression</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;033&#40;1&#46;010&#8211;1&#46;057&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;297&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;375&#40;0&#46;756&#8211;2&#46;500&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;428&#40;1&#46;299&#8211;1&#46;569&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNPLA3 genotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;862&#40;1&#46;250&#8211;2&#46;773&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TM6SF2 CC vs TT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;379&#40;1&#46;500&#8211;7&#46;612&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2047850.png"
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            0 => array:3 [
              "identificador" => "tblfn0010"
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            ]
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        ]
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Factors associated with NAFLD&#46;</p>"
        ]
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      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CC&#44; subjects with CC genotype&#59; CT&#44; subjects with CT genotype&#59; TT&#44; subjects with TT genotype&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value was calculated using ordinal logistic regression model after adjusting for age&#44; gender&#44; BMI and <span class="elsevierStyleItalic">PNPLA3</span> genotype&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multiple ordinal regression</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;619&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;993&#40;0&#46;966&#8211;1&#46;021&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;547&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;262&#40;0&#46;591&#8211;2&#46;697&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;168&#40;1&#46;056&#8211;1&#46;290&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PNPLA3</span> genotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;289&#40;1&#46;441&#8211;3&#46;640&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TM6SF2</span> CC vs TT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;023<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;646&#40;1&#46;147&#8211;6&#46;104&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2047851.png"
              ]
            ]
          ]
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            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Statistically significant&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Factors associated with steatosis grade&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; GGT&#44; gamma-glutamyl transpeptidase&#59; ALP&#44; alkaline phosphatase&#59; TG&#44; triglycerides&#59; TC&#44; total cholesterol&#59; LDL-C&#44; low-density lipoprotein cholesterol&#59; HDL-C&#44; high-density lipoprotein cholesterol&#59; FBG&#44; fasting blood glucose&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value was calculated using independent <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Adjusted <span class="elsevierStyleItalic">P</span> value was calculated using lineal regression model after adjusting for age&#44; gender&#44; BMI and <span class="elsevierStyleItalic">PNPLA3</span> genotype&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted <span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#40;14&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#40;15&#44;56&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;045<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AST &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#40;17&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#40;18&#44;30&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;067&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#40;17&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#40;18&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALP &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TG &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&#40;0&#46;9&#44;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&#40;0&#46;7&#44;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;568&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HDL-C &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&#40;1&#46;1&#44;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4&#40;1&#46;1&#44;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;839&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FBG &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&#40;5&#46;2&#44;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&#40;5&#46;1&#44;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2047853.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Statistically significant&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Effect of T allele on liver function and lipids&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">T&#43;&#58; <span class="elsevierStyleItalic">TM6SF2</span> risk allele carrier&#59; T&#8722;&#58; subjects without <span class="elsevierStyleItalic">TM6SF2</span> risk allele&#59; P&#43;&#58; <span class="elsevierStyleItalic">PNPLA3</span> risk allele carrier&#59; P&#8722;&#58; subjects without <span class="elsevierStyleItalic">PNPLA3</span> risk allele&#59; OR&#58; odds ratio&#59; CI&#58; confidence interval&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> value was calculated using binary logistic regression after adjusting for age&#44; gender and BMI&#59; subjects without neither of variants were considered to be the reference group&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                          "etal" => false
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                      "titulo" => "Human fatty liver disease&#58; old questions and new insights"
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                  "host" => array:1 [
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                      "titulo" => "Fatty liver in non-alcoholic non-overweight Japanese adults&#58; incidence and clinical characteristics"
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                        0 => array:2 [
                          "etal" => true
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Article information
ISSN: 16652681
Original language: English
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