Suspected Nonalcoholic Fatty Liver Disease and Mortality Risk in a Population-Based Cohort Study

Abstract

Objective Case series suggest that Nonalcoholic Fatty Liver Disease (NAFLD) is associated with increased all-cause and cardiovascular mortality. The current study compared the survival of subjects with and without suspected NAFLD in a population-based cohort, and placed the finding in the context of previously published case series. Methods Primary analysis assessed mortality for NHANES-III participants with and without suspected NAFLD using the National Death Index. Suspected NAFLD was based upon unexplained ALT elevation. The Olmsted County and Cleveland Clinic case series were also used for comparison. Survivals were compared using Proportional Hazards Model and direct age standardization. Results The NHANES cohort included 980 with and 6594 subjects without suspected NAFLD. Over a mean of 8.7 years, suspected NAFLD had a hazards ratio of 1.37 (95%CI 0.98–1.91) for all-cause mortality. In the 45–54 age group, suspected NAFLD had significantly higher all-cause (4.40 95%CI 1.27–13.23) and cardiovascular mortality (8.15 , 95%CI 2.00–33.20) after adjusting for conventional cardiovascular risk factors. The age-standardized rate per 10,000 per year was 129 (95%CI 118–140) for the NHANES non-NAFLD cohort, 154 (95%CI 116–198) for the NHANES suspected NAFLD cohort, 214 (95%CI 157–279) for the Olmsted County series, and 426 (95%CI 298–573) for the Cleveland Clinic series. Conclusion The magnitude of mortality risk in NAFLD depends on the setting and method of ascertainment. Suspected NAFLD in the 45–54 age group is a strong independent risk factor for cardiovascular death and warrants further cardiovascular risk management guidelines.

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…4,7 The long term outcomes of patients with NAFLD and NASH have been reported in several studies. 31,[38][39][40][41][42][43][44][45] Their detailed discussion is beyond the scope of this guideline, but their findings can be summarized as follows; (a) patients with NAFLD have increased overall mortality compared to matched control populations, (b) the most common cause of death in patients with NAFLD, NAFL and NASH is cardiovascular disease, and (c) patients with NASH (but not NAFL) have an increased liver-related mortality rate.…”

Non‐alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population‐based study

“…[1][2][3] Over 33% of the current US population is obese, and a large proportion has associated co-morbidities which can likely affect their life expectancy. 2 These morbidities include abnormalities of fat and glucose metabolism, insulin resistance and DM.…”

Withholding Statins in Patients with Underlying Liver Disease: Wise or Unwise?

“…As this is rapidly becoming the most common form of chronic liver disease in the US population and statins are used so frequently, the clinical convergence of the need for lipid-lowering therapy and fatty liver disease is quite common. Population-based studies have taught us that obese patients with fatty liver and elevated serum ALT levels may have an 8-fold increased risk of cardiovascular mortality (9). These statistics have recently led the National Lipid Association Task Force to conclude that chronic liver disease, including compensated cirrhosis, is not a contraindication to statin therapy and statins can be safely prescribed to patients with nonalcoholic fatty liver (8).…”