Association of fatty liver disease with mortality outcomes in an Eastern Finland male cohort

Abstract

ObjectiveFatty liver disease (FLD) has been associated with extrahepatic morbidity outcomes. However, reports on the association of FLD, assessed using fatty liver index (FLI), with mortality outcomes have been inconsistent. Our objective was to examine the effect of metabolic factors (blood pressure, insulin, fasting glucose, lipoproteins) on the associations of FLI with mortality outcomes among middle-aged men.Study designProspective cohort study.MethodsOur subjects were 1893 men at baseline from 1984 to 1989 in the Kuopio Ischaemic Heart Disease Risk Factor Study cohort. Multivariable Cox regression models were used to analyse the association of baseline FLI, with the HRs for all-cause, disease, cardiovascular, non-cardiovascular and cancer mortality outcomes.ResultsThe mean FLI in the FLI categories were 16.2 in the low and reference category (FLI<30), 43.4 in the intermediate FLI category (FLI=30–<60) and 77.5 in the high FLI (FLD) category (FLI≥60). Over an average follow-up of 20 years, 848 disease deaths were recorded through Finnish national cause of death register. In models adjusted for constitutional, lifestyle and inflammatory factors, for the high (FLI≥60) vs low (FLI<30) FLI category, the HRs (95% CI) for mortality outcomes were 1.50 (1.26–1.78) for all-cause mortality; 1.56 (1.31–2.86) for disease mortality; 1.51 (1.18–1.94) for cardiovascular disease (CVD) mortality; 1.42 (1.12–1.80) for non-CVD mortality and 1.45 (1.02–2.07) for cancer mortality. With further adjustment for metabolic factors, the HRs were 1.25 (1.01–1.53) for all-cause mortality; 1.26 (1.02–1.56) for disease mortality; 1.06 (0.78–1.43) for CVD mortality; 1.46 (1.09–1.94) for non-CVD mortality and 1.49 (0.97–2.29) for cancer mortality.ConclusionHigh FLI (FLD) is associated with increased risks of mortality outcomes. The FLI-CVD mortality association can be largely explained by metabolic factors. Persons with FLD should be monitored for metabolic deterioration and extrahepatic morbidity to improve their prognoses.

Hepatic steatosis, metabolic dysfunction and risk of mortality: findings from a multinational prospective cohort study

“…Similar associations with all-cause mortality have been observed in two smaller European prospective studies [36,37]. Another prospective [38]. The study observed that individuals with NAFLD had significantly higher mortality risk than those without NAFLD [38].…”

“…Another prospective [38]. The study observed that individuals with NAFLD had significantly higher mortality risk than those without NAFLD [38]. A novel aspect of our study is our choice of a second, but arbitrary, cut-off value of FLI ≥ 80, assuming that those with a very high FLI score have more serious degrees of steatosis, needing to be validated in additional studies.…”

“…Similar associations with all-cause mortality have been observed in two smaller European prospective studies [ 36 , 37 ]. Another prospective study including data from health insurance records ( n = 14,991 deaths) assessed mortality risks in Finnish individuals with NAFLD at 4 consecutive timepoints between 2009 and 2013 [ 38 ]. The study observed that individuals with NAFLD had significantly higher mortality risk than those without NAFLD [ 38 ].…”

“…Another prospective study including data from health insurance records ( n = 14,991 deaths) assessed mortality risks in Finnish individuals with NAFLD at 4 consecutive timepoints between 2009 and 2013 [ 38 ]. The study observed that individuals with NAFLD had significantly higher mortality risk than those without NAFLD [ 38 ]. A novel aspect of our study is our choice of a second, but arbitrary, cut-off value of FLI ≥ 80, assuming that those with a very high FLI score have more serious degrees of steatosis, needing to be validated in additional studies.…”

Circulating PCSK7 Level is Independently Associated with Obesity, Triglycerides Level and Fatty Liver Index in a General Population without Medication

“…FLI is a noninvasive and simple biomarker for diagnosis of NAFLD and is calculated by using BMI, WC and levels of GTP and triglycerides 25) . It has been reported that FLI can predict not only NAFLD but also other metabolicrelated diseases including diabetes mellitus [40][41][42][43] , hypertension [44][45][46][47] and chronic kidney disease [48][49][50][51] . Dysregulation of iron metabolism represents another typical feature of NAFLD associated with more severe hepatic and cardio-metabolic damage 52) .…”