A Meta-analysis on Associated Risk of Mortality in Nonalcoholic Fatty Liver Disease

Fu, Clarissa Elysia; Ng, Cheng Han; Yong, Jie Ning; Chan, Kai En; Xiao, Jieling; Nah, Benjamin; Bong, Shirley Huey Shin; Win, Khin Maung; Bwa, Aung Hlaing; Lim, Wen Hui; Tan, Darren Jun Hao; Zeng, Rebecca Wenling; Chew, Nicholas; Teng, Margaret; Siddiqui, Mohammad Shadab; Oben, Jude A.; Sanyal, Arun J.; Wong, Vincent Wai‐Sun; Noureddin, Mazen; Muthiah, Mark

doi:10.1016/j.eprac.2022.10.007

Cited by 15 publications

(8 citation statements)

References 62 publications

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“…The greatest cardiometabolic concern for participants was the chance of getting a stroke, with the least concern shown for NAFLD. We postulate that the lack of concern for NAFLD is a result of the following factors; first, there is an underdiagnosis of NAFLD by physicians across the globe ( 64 – 67 ), possibly contributed by the knowledge gap in the identification and diagnosis of NAFLD, as well as the limited treatment options in NAFLD ( 63 , 68 , 69 ). Second, less media portrayal and patient education on NAFLD, relative to that of stroke and coronary artery disease, may have been contributing factors ( 70 , 71 ).…”

Section: Discussionmentioning

confidence: 99%

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

et al. 2023

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BackgroundHealth literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs).MethodsFrom 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases – diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.ResultsA total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772–4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236–0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009).ConclusionThis study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.

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Section: Discussionmentioning

confidence: 99%

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

et al. 2023

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“…Interest in understanding the NAFLD and CVD interface has grown in recent years, but most studies have only described the increased incidence in cardiovascular diseases, 2,8 metabolic burden 12,13 and cardiovascular mortality 6,14 in the general population with hepatic steatosis. However, the prognostic significance of hepatic steatosis and advanced hepatic fibrosis following AMI has not been established.…”

Section: Introductionmentioning

confidence: 99%

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Chin

Lim

Kong

et al. 2023

Diabetes Obesity Metabolism

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Aim To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P < .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P < .001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P = .001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P = .002). Conclusions Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.

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“…5 NAFLD similarly increases the risk of end-organ complications including cardiovascular diseases, malignancy and mortality. [6][7][8] Despite evidence supporting the association, the traditional definition of MetS does not account for the presence of NAFLD. Apart from being a precursor to metabolic syndrome, NAFLD is an early marker of CVD, due to the shared inflammatory pathway in atherosclerosis and hepatic steatosis.…”

Section: Introductionmentioning

confidence: 99%

“…While closely associated with type 2 diabetes (T2DM), NAFLD can also exist outside the presence of diabetes and found to longitudinally increase the risk of T2DM by 33% 5 . NAFLD similarly increases the risk of end‐organ complications including cardiovascular diseases, malignancy and mortality 6–8 . Despite evidence supporting the association, the traditional definition of MetS does not account for the presence of NAFLD.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of including non‐alcoholic fatty liver disease in the definition of metabolic syndrome

Yong

et al. 2023

Aliment Pharmacol Ther

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Summary Background/Aims Metabolic syndrome (MetS) affects over one third of the US adult population. Despite its close association with non‐alcoholic fatty liver disease (NAFLD), the traditional definition of MetS does not account for the presence of NAFLD. The present study thus aims to evaluate the inclusion of NAFLD in the diagnostic criteria of metabolic syndrome on its accuracy of capturing individuals with metabolic dysregulation and its prediction of adverse events. Methods Data collected from NHANES between 1999 and 2018 was analysed. Clinical characteristics and outcomes between individuals with metabolic syndrome from both the American Heart Association/National Heart, Lung, and Blood Institute (MetS) and the study's proposed diagnostic criteria (MetS2) were evaluated. Outcomes in both groups were evaluated with multivariate analyses, and further subgroup analysis on individuals matched with Coarsened Exact Matching was performed. Results Of 46,184 individuals included, 32.54% and 40.54% fulfilled MetS and MetS2 criteria respectively. Considering NAFLD in the definition of metabolic syndrome, a further 8.00% (n = 3694) were included. MetS was significantly associated with all‐cause (HR: 1.184, 95% CI: 1.110–1.263, p < 0.001) and cardiovascular disease (CVD) mortality (SHR: 1.288, 95% CI: 1.233–1.347, p < 0.001), and major adverse cardiovascular events (MACE). MetS2 was similarly associated with all‐cause (HR: 1.175, 95% CI: 1.088–1.269, p < 0.001), CVD mortality (SHR: 1.283, 95% CI: 1.245–1.323, p < 0.001) and MACE. Conclusion Inclusion of NAFLD allows for identification a greater proportion of the population with metabolic risk. This allows for early intervention and potential to lift some burden off the global healthcare system.

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A Meta-analysis on Associated Risk of Mortality in Nonalcoholic Fatty Liver Disease

Cited by 15 publications

References 62 publications

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

The prognostic value of including non‐alcoholic fatty liver disease in the definition of metabolic syndrome

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