Association between advanced fibrosis in fatty liver disease and overall mortality based on body fat distribution

Research output: Contribution to journalArticle

Abstract

Background: Studies on association between fatty liver disease and overall mortality have yielded conflicting results. We evaluated the impact of fatty liver disease and advanced fibrosis on overall morality with a focus on body size and abdominal fat distribution measured by computed tomography. Methods: We performed a prospective cohort study including 34 080 subjects (mean age, 51.4 years; 58.6% men) who underwent abdominal ultrasonography and fat computed tomography, from 2007 to 2015. Fatty liver was diagnosed by ultrasonography, and advanced fibrosis was defined as high probability of advanced fibrosis based on three noninvasive methods, aspartate aminotransferase-to-platelet ratio index, non-alcoholic fatty liver disease fibrosis score, and fibrosis-4 score. Body size was categorized by body mass index into obese (≥ 25 kg/m2) or nonobese (< 25 kg/m2). Multivariate proportional Cox hazard regression analyses were performed. Results: The prevalence of fatty liver disease was 37.5%, while the prevalence of advanced fibrosis in fatty liver disease was 1.8%. During a median follow-up of 87 months (interquartile range, 62–110), 296 deaths occurred. Fatty liver disease was not associated with higher overall mortality (multivariate-adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.77–1.34), while increased subcutaneous adiposity was associated with decreased mortality (HR 0.72, 95% CI 0.60–0.88). Advanced fibrosis resulted in a 3.5-fold increase in overall mortality (adjusted HR 3.52, 95% CI 1.86–6.65), which was more pronounced in the nonobese. Conclusions: While fatty liver disease did not impact overall mortality, subcutaneous adiposity was associated with reduced overall mortality. Advanced fibrosis was an independent predictor of increase in overall mortality.

Original languageEnglish
Pages (from-to)90-96
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume35
Issue number1
DOIs
StatePublished - 1 Jan 2020

Fingerprint

Body Fat Distribution
Fatty Liver
Liver Diseases
Fibrosis
Mortality
Abdominal Fat
Adiposity
Body Size
Confidence Intervals
Ultrasonography
Tomography
Aspartate Aminotransferases
Liver Cirrhosis
Body Mass Index
Cohort Studies
Blood Platelets
Regression Analysis
Prospective Studies

Keywords

  • Fibrosis
  • Hepatic steatosis
  • Mortality
  • Nonobese

Cite this

@article{7b0c34754cb24a67b460059281eff399,
title = "Association between advanced fibrosis in fatty liver disease and overall mortality based on body fat distribution",
abstract = "Background: Studies on association between fatty liver disease and overall mortality have yielded conflicting results. We evaluated the impact of fatty liver disease and advanced fibrosis on overall morality with a focus on body size and abdominal fat distribution measured by computed tomography. Methods: We performed a prospective cohort study including 34 080 subjects (mean age, 51.4 years; 58.6{\%} men) who underwent abdominal ultrasonography and fat computed tomography, from 2007 to 2015. Fatty liver was diagnosed by ultrasonography, and advanced fibrosis was defined as high probability of advanced fibrosis based on three noninvasive methods, aspartate aminotransferase-to-platelet ratio index, non-alcoholic fatty liver disease fibrosis score, and fibrosis-4 score. Body size was categorized by body mass index into obese (≥ 25 kg/m2) or nonobese (< 25 kg/m2). Multivariate proportional Cox hazard regression analyses were performed. Results: The prevalence of fatty liver disease was 37.5{\%}, while the prevalence of advanced fibrosis in fatty liver disease was 1.8{\%}. During a median follow-up of 87 months (interquartile range, 62–110), 296 deaths occurred. Fatty liver disease was not associated with higher overall mortality (multivariate-adjusted hazard ratio [HR] 1.02, 95{\%} confidence interval [CI] 0.77–1.34), while increased subcutaneous adiposity was associated with decreased mortality (HR 0.72, 95{\%} CI 0.60–0.88). Advanced fibrosis resulted in a 3.5-fold increase in overall mortality (adjusted HR 3.52, 95{\%} CI 1.86–6.65), which was more pronounced in the nonobese. Conclusions: While fatty liver disease did not impact overall mortality, subcutaneous adiposity was associated with reduced overall mortality. Advanced fibrosis was an independent predictor of increase in overall mortality.",
keywords = "Fibrosis, Hepatic steatosis, Mortality, Nonobese",
author = "Chung, {Goh Eun} and Heo, {Nam Ju} and Donghee Kim and Kwak, {Min Sun} and Yim, {Jeong Yoon} and Kim, {Joo Sung} and Aijaz Ahmed",
year = "2020",
month = "1",
day = "1",
doi = "10.1111/jgh.14778",
language = "English",
volume = "35",
pages = "90--96",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "1",

}

TY - JOUR

T1 - Association between advanced fibrosis in fatty liver disease and overall mortality based on body fat distribution

AU - Chung, Goh Eun

AU - Heo, Nam Ju

AU - Kim, Donghee

AU - Kwak, Min Sun

AU - Yim, Jeong Yoon

AU - Kim, Joo Sung

AU - Ahmed, Aijaz

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Studies on association between fatty liver disease and overall mortality have yielded conflicting results. We evaluated the impact of fatty liver disease and advanced fibrosis on overall morality with a focus on body size and abdominal fat distribution measured by computed tomography. Methods: We performed a prospective cohort study including 34 080 subjects (mean age, 51.4 years; 58.6% men) who underwent abdominal ultrasonography and fat computed tomography, from 2007 to 2015. Fatty liver was diagnosed by ultrasonography, and advanced fibrosis was defined as high probability of advanced fibrosis based on three noninvasive methods, aspartate aminotransferase-to-platelet ratio index, non-alcoholic fatty liver disease fibrosis score, and fibrosis-4 score. Body size was categorized by body mass index into obese (≥ 25 kg/m2) or nonobese (< 25 kg/m2). Multivariate proportional Cox hazard regression analyses were performed. Results: The prevalence of fatty liver disease was 37.5%, while the prevalence of advanced fibrosis in fatty liver disease was 1.8%. During a median follow-up of 87 months (interquartile range, 62–110), 296 deaths occurred. Fatty liver disease was not associated with higher overall mortality (multivariate-adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.77–1.34), while increased subcutaneous adiposity was associated with decreased mortality (HR 0.72, 95% CI 0.60–0.88). Advanced fibrosis resulted in a 3.5-fold increase in overall mortality (adjusted HR 3.52, 95% CI 1.86–6.65), which was more pronounced in the nonobese. Conclusions: While fatty liver disease did not impact overall mortality, subcutaneous adiposity was associated with reduced overall mortality. Advanced fibrosis was an independent predictor of increase in overall mortality.

AB - Background: Studies on association between fatty liver disease and overall mortality have yielded conflicting results. We evaluated the impact of fatty liver disease and advanced fibrosis on overall morality with a focus on body size and abdominal fat distribution measured by computed tomography. Methods: We performed a prospective cohort study including 34 080 subjects (mean age, 51.4 years; 58.6% men) who underwent abdominal ultrasonography and fat computed tomography, from 2007 to 2015. Fatty liver was diagnosed by ultrasonography, and advanced fibrosis was defined as high probability of advanced fibrosis based on three noninvasive methods, aspartate aminotransferase-to-platelet ratio index, non-alcoholic fatty liver disease fibrosis score, and fibrosis-4 score. Body size was categorized by body mass index into obese (≥ 25 kg/m2) or nonobese (< 25 kg/m2). Multivariate proportional Cox hazard regression analyses were performed. Results: The prevalence of fatty liver disease was 37.5%, while the prevalence of advanced fibrosis in fatty liver disease was 1.8%. During a median follow-up of 87 months (interquartile range, 62–110), 296 deaths occurred. Fatty liver disease was not associated with higher overall mortality (multivariate-adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.77–1.34), while increased subcutaneous adiposity was associated with decreased mortality (HR 0.72, 95% CI 0.60–0.88). Advanced fibrosis resulted in a 3.5-fold increase in overall mortality (adjusted HR 3.52, 95% CI 1.86–6.65), which was more pronounced in the nonobese. Conclusions: While fatty liver disease did not impact overall mortality, subcutaneous adiposity was associated with reduced overall mortality. Advanced fibrosis was an independent predictor of increase in overall mortality.

KW - Fibrosis

KW - Hepatic steatosis

KW - Mortality

KW - Nonobese

UR - http://www.scopus.com/inward/record.url?scp=85071227496&partnerID=8YFLogxK

U2 - 10.1111/jgh.14778

DO - 10.1111/jgh.14778

M3 - Article

C2 - 31272131

AN - SCOPUS:85071227496

VL - 35

SP - 90

EP - 96

JO - Journal of Gastroenterology and Hepatology (Australia)

JF - Journal of Gastroenterology and Hepatology (Australia)

SN - 0815-9319

IS - 1

ER -