The Repeatedly Elevated Fatty Liver Index Is Associated With Increased Mortality: A Population-Based Cohort Study

Abstract

AimsNon-alcoholic fatty liver disease (NAFLD) has a dynamic disease course, therefore repeated measurements of NAFLD status could have benefits rather than single one. The aim of this study was to investigate the effects of persistent NAFLD on the incidence of myocardial infarction (MI) and stroke and all-cause mortality by using repeated measurement of fatty liver index (FLI).MethodsAbout 3 million subjects who had undergone the health screening four times from 2009 until 2013 were included. NAFLD was defined as an FLI ≥60. FLI points were defined as the number of times participants meeting the criteria of NAFLD (0–4). Outcomes included all-cause mortality, MI, and stroke.ResultsThe higher the FLI points, the higher the risk of all-cause mortality, MI, and stroke (P for trend <0.001, all). Subjects with four FLI points had a higher risk of all-cause mortality (aHR, 1.86; 95% CI, 1.75–1.98; P < 0.001), incidence of MI (aHR, 1.3; 95% CI, 1.21–1.40; P < 0.001), and stroke (aHR, 1.27; 95% CI, 1.19–1.37; P < 0.001) after adjustment for age, sex, smoking, alcohol consumption, income, hypertension, dyslipidemia, diabetes, body mass index, and physical activity. When the 1st and the last FLI were compared, the “incident NAFLD” group had a higher risk for death compared to the “no NAFLD” group (aHR, 1.46; 95% CI, 1.37–1.55), and the “regression of NAFLD” group had a decreased risk for death compared to the “persistent NAFLD” group (aHR, 0.83; 95% CI, 0.77–0.89).ConclusionRepeated evaluations of NAFLD status based on FLI measurements could help physicians identify higher-risk groups in terms of mortality, MI, and stroke. The association between FLI worsening or improvement and outcomes also suggests clinical benefits of the prevention and treatment of NAFLD.

The Fatty liver Index (FLI) 15 years later: a reappraisal

“…Based on a median 29-year follow-up of a cohort of 1552 middle-aged men from the Kuopio Ischemic Disease Risk Factor Study, Setti et al [79] found that those men who had both renal hyperfiltration (RHF)which was associated with smoking -and fatty liver evaluated with FLI scores -which was associated with obesity -had the highest risk of mortality owing to all causes (HR = 1.96, 95%CI: 1.27-3.01). Conversely, having fatty liver associated with normal estimated glomerular filtration rate modestly increased the risk of all-cause mortality (HR = 1.35, 95%CI: 1.09-1.66).…”

Association between the fatty liver index and the risk of severe complications in COVID-19 patients: a nationwide retrospective cohort study

“…Patients who either had incomplete or no data for the variables used in the analysis were excluded. Additionally, 809 patients who either conducted heavy alcohol consumption (alcohol drinking ≥ 2 days per week or alcohol intake of > 30 g/day), or had a previous history of liver cirrhosis (International Classification of Diseases 10th Revision (ICD)-10 codes: K70.2, K70.3, K70.4, and K74.6), alcoholic hepatitis (K70.1), chronic viral hepatitis B with delta-agent (B18.0), chronic viral hepatitis B without delta-agent (B18.1), and chronic viral hepatitis C (B18.2), liver and intrahepatic bile duct (C22) were excluded [ 22 , 23 ]. Finally, 3122 patients were included in this study (Fig.…”

Association Between Non-alcoholic Fatty Liver Disease and Risk of Stroke: A Systematic Review and Meta-Analysis

“…These studies came from various countries across four continents. Seven studies (13,16,18,20,22,24,30) were conducted in North America (United States), seven (12,15,19,(27)(28)(29)31) in Asia (Japanese, Iran, Korea, China), five (17,21,23,25,26) in Europe (Italy, UK, Spain, Netherlands, Sweden, Germany), one (14) in Africa (Egypt). The sample size of included studies ranged widely, from 220 participants in an Iran case-control study to a study based on Korea nationwide health screening database of 95,84,399 participants.…”

“…The mean age ranged between 48 and 67 years old, with years of follow up between 2.1 and 18.6 for cohort studies. With regard to the diagnosis of NAFLD, seven studies (12,14,15,17,19,25,31) used ultrasonography, four (18,(27)(28)(29) used fatty liver index, two studies (13, 23) used liver biopsy, two studies (16,20) used computed tomography, while remaining three studies (21,22,26) used international classification of diseases (ICD) code to detect NAFLD. Three studies (24,25,30) used NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4) to diagnose NAFLD-fibrosis.…”

“…In recent years, a large number of observational studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) have explored the relationship between NAFLD and stroke, but the results remain controversial and inconsistent. Therefore, we conducted a systematic review and meta-analysis of observational studies in order to precisely gauge the nature and magnitude of the association between NAFLD and risk of stroke.…”