Front Endocrinol (Lausanne). 2021;12:638615.

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

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제1저자 이창훈, 한경도 · 교신저자 곽민선

PMID 33776934 PMC7996574 DOI 10.3389/fendo.2021.638615 IF 5.7 호흡기내과

소속 (4)

Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
Department of Biostatistics, Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea.

Abstract

AIMS Non-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).

METHODS About 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.

RESULTS The 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 1^st 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).

CONCLUSION Repeated 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.

Keywords

cardiovascular diseasefatty liverhepatic steatosismortalitynon-invasive test

Figures

**Figure 1** Definition of the fatty liver index (FLI) points and study design. The participants get one point if FLI is 60 or higher at each exam. The FLI points were defined as sum of points for four examinations.

**Figure 2** Impact of FLI points on all-cause mortality according to the subgroup analysis as follows; **(A)** age, **(B)** sex, **(C)** obesity (body mass index), **(D)** metabolic syndrome, **(E)** abdominal obesity and **(F)** diabetes mellitus. FLI points had more impacts on all-cause mortality in women, body mass index less than 25, those without metabolic syndrome, those without abdominal obesity, and those with diabetes mellitus.

**Figure 3** Impacts of changes in FLI between the 1^st exam and the last exam on outcomes. The “No NAFLD” group included those with FLI < 60 at both the 1^st exam and the last exam, and the “persistent NAFLD” group included those with FLI ≥ 60 at both the 1^st exam and the last exam. The “Incident NAFLD” group included those with FLI < 60 at the 1^st exam and FLI ≥ 60 at the last exam, and the “Regression of NAFLD” group included those with FLI ≥ 60 at the 1^st exam and FLI < 60 at the last exam. Participants with incident NAFLD had a 1.47-fold increased risk for mortality compared to those without NAFLD, and participants with regression of NAFLD had a 0.83-fold decreased risk for mortality compared to those with persistent NAFLD.

그림 출처: PubMed Central 공개 논문 (PMC7996574)

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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