Non-Alcoholic Fatty Liver Disease Defined by Fatty Liver Index and Incidence of Heart Failure in the Korean Population: A Nationwide Cohort Study

Abstract

Fatty liver index (FLI) is a simple and useful index that evaluates non-alcoholic fatty liver disease (NAFLD), particularly in large epidemiologic studies. Heart failure (HF) is becoming a burden to public health as the global trend toward an aging society continues. Thus, we investigated the effect of FLI on the incidence of HF using large cohort data from the Korean National Health Insurance health database. Methods and Results: A total of 7,958,538 subjects aged over 19 years without baseline HF (men = 4,142,264 and women = 3,816,274) were included. Anthropometric and biochemical measurements were evaluated. FLI scores were calculated and FLI ≥ 60 was considered as having NAFLD. Hazard ratios (HRs) and 95% confidence intervals (CIs) for HF incidence were analysed using multivariable time-dependent Cox proportional hazard models. During a mean follow up of 8.26 years, 17,104 participants developed HF. The FLI components associated with the incidence of HF and FLI showed a causal relationship with HF; the FLI ≥ 60 group had a higher HR for HF (HR 1.493; 95% CIs 1.41–1.581) than the FLI < 30 group. Subgroup analysis showed that fatty liver (FLI ≥ 60) with age ≥ 65 years or women displayed higher HR for HF than fatty liver with age < 65 or men, respectively. An increase in FLI score significantly increased the HR for HF except for those with a FLI score change from <30 to 30–60. Conclusion: NAFLD defined by FLI and increase in FLI score were associated with the incidence of HF. Further detailed prospective studies are needed.

Long-Term Cumulative Exposure to High γ-Glutamyl Transferase Levels and the Risk of Cardiovascular Disease: A Nationwide Population-Based Cohort Study

“…Estimated glomerular filtration rate (eGFR) was calculated using the equation from the Modification of Diet in Renal Disease study: eGFR=175×serum creatinine -1.154 ×age -0.0203 , and was further multiplied by 0.742 for women [ 19 ]. The fatty liver index (FLI) was used to access the degree of fatty liver and was calculated as reported in a previous study [ 20 ]. Participants were defined as having fatty liver if their FLI was ≥60.…”

Weight loss breaks the bond between nonalcoholic fatty liver disease and cardiovascular diseases: A clinical and epidemiological perspective

“…The study found that patients with the highest fatty liver index (FLI) score independently (HR between Q4 and Q1 2.709, 95% CI 2.380–3.085) suffered from a higher risk of new‐onset heart failure, compared with patients with the lowest FLI 33 . Likewise, during a mean follow‐up of 8.26 years in a Korean nationwide cohort study with 7,958,538 participants aged over 19 years without baseline heart failure, researchers unveiled that FLI ≥ 60 increased HR for incident heart failure (HR 1.493, 95% CI 1.41–1.581), compared with the FLI < 30 41 …”

Association between Alcohol Consumption and Metabolic Dysfunction-Associated Steatotic Liver Disease Based on Alcohol Flushing Response in Men: The Korea National Health and Nutrition Examination Survey 2019–2021

“…The purpose of this study was to examine the association between alcohol consumption and MASLD in Korean men using the lipid accumulation product (LAP) score as a noninvasive marker of MASLD risk while considering their facial flushing response [ 10 , 11 , 12 , 13 ]. We hypothesized that the alcohol flushing response, influenced by genetic variations in alcohol-metabolizing enzymes, may modify the relationship between alcohol consumption and MASLD risk, leading to different outcomes in individuals with and without flushing [ 14 ].…”