Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality - PubMed (original) (raw)

Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality

Altan Onat et al. World J Gastroenterol. 2015.

Abstract

Aim: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.

Methods: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality.

Results: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.

Conclusion: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.

Keywords: All-cause death; Coronary heart disease; Hepatic steatosis; Metabolic syndrome; Turkish adult risk factor study.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Diagram depicts Kaplan-Meier plots in the whole sample for survival and (exclusive of those with diabetes/coronary heart disease) survival free of diabetes/coronary heart disease. Significantly (Log-rank < 0.001) lower survival free of diabetes and of incident CHD are noted for participants with FLD at baseline. Subjects categorized as probable FLD separated from those with no FLD in regard to CHD. However, no significant difference was elicited (Log-rank 0.53) with respect to mortality. Log-rank values were similar in the sexes. BP: Blood pressure; CHD: Coronary heart disease; FLD: Fatty liver disease.

Figure 2

Figure 2

Diagram of multivariable adjusted hazard ratios are depicted for death of fatty liver disease in the 3 glucose categories. Though significant findings were not obtained, the risk of overall mortality among normoglycemic (N) individuals with fatty liver disease was lower than in subjects with no fatty liver disease. Risk increased in prediabetes (P) and tended so in diabetic (D) women, while declining in men with diabetes. NAFLD: Non-alcoholic fatty liver disease.

References

    1. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10:330–344. - PubMed
    1. Kotronen A, Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28:27–38. - PubMed
    1. Shibata M, Kihara Y, Taguchi M, Tashiro M, Otsuki M. Nonalcoholic fatty liver disease is a risk factor for type 2 diabetes in middle-aged Japanese men. Diabetes Care. 2007;30:2940–2944. - PubMed
    1. Yamada T, Fukatsu M, Suzuki S, Wada T, Yoshida T, Joh T. Fatty liver predicts impaired fasting glucose and type 2 diabetes mellitus in Japanese undergoing a health checkup. J Gastroenterol Hepatol. 2010;25:352–356. - PubMed
    1. Sung KC, Jeong WS, Wild SH, Byrne CD. Combined influence of insulin resistance, overweight/obesity, and fatty liver as risk factors for type 2 diabetes. Diabetes Care. 2012;35:717–722. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources