Elevated Fatty Liver Index Is Independently Associated With New Onset of Hypertension During a 10‐Year Period in Both Male and Female Subjects

Abstract

Background Fatty liver index (FLI), a predictor of nonalcoholic fatty liver disease, has been reported to be associated with several metabolic disorders. Because of a sex difference in FLI level, we hypothesized that FLI is associated with development of hypertension to a greater extent in men or women. Methods and Results We investigated the relationship between FLI and development of hypertension during a 10‐year period in a general population of subjects who received annual health examinations (n=28 990). After exclusion (44.9%) of subjects with missing data and those with hypertension at baseline, a total of 15 965 subjects (men/women: 9466/6499) were included. FLI level was significantly higher in men than in women. During the 10‐year period, 2304 men (24.3%) and 745 women (11.5%) had new onset of hypertension. Multivariable Cox proportional hazard models with a restricted cubic spline showed that the hazard ratios (HRs) for development of hypertension after adjustment of age, systolic blood pressure, estimated glomerular filtration rate, habits of smoking and alcohol drinking, family history of hypertension, and diagnosis of diabetes mellitus and dyslipidemia increased gradually with increase in FLI in men and increased rapidly and then slowly with increase in FLI in women. There was a significant interaction between FLI and sex for the risk of hypertension in all of the subjects ( P =0.049). The addition of FLI to traditional risk factors significantly improved the discriminatory capability. Conclusions A high level of FLI predicts the development of hypertension in both men and women, although distribution patterns of HRs were different between sexes.

Circulating level of fatty acid‐binding protein 4 is an independent predictor of metabolic dysfunction‐associated fatty liver disease in middle‐aged and elderly individuals

“…In the original report about MAFLD, the use of FLI was recommended for detection of hepatic steatosis as a reliable biomarker 4 . Furthermore, there have been several studies showing that FLI is associated with the development of hypertension 54 , diabetes mellitus 55 , chronic kidney disease 56 and heart failure 57 . Third, since the recruited participants were all Japanese, the results obtained in the present study might not be applicable to other races.…”

High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population

“… 11 , 40 The fatty liver index (FLI) is a non-invasive marker calculated using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, and it has a high concordance with the histological criteria for NAFLD. 41 , 42 There have been several studies showing that the FLI is associated with the development of hypertension, 43 diabetes mellitus, 44 chronic kidney disease, 45 heart failure 46 and IHD 47 as well as fibroblast growth factor 21 (FGF21), a hepatokine, 48 and fatty acid binding-protein 4 (FABP4), 49 an atherogenic adipokine with possible therapeutic relevance. 50 , 51 On the contrary, NAFLD fibrosis score (NFS) is widely used to identify individuals with high probability of having advanced liver fibrosis and it is calculated by age, body mass index, presence of impaired fasting glucose or diabetes mellitus, and levels of AST, ALT, platelet count, and albumin.…”

High fatty liver index is an independent predictor of ischemic heart disease during a 10‐year period in a Japanese population

“…However, when subjects were divided by sex, the adjusted HR in the T3 group of FLI was significantly higher than the adjusted HR in the T1 group of FLI in men but not in women (See Table S4). A possible reason for the absence of significance in women was the lower incidence of IHD during a 10-year period in women (n = 123, 1.7%) than in men (n = 450, 3.9% There have been several studies showing that FLI is associated with cardiometabolic diseases including type 2 diabetes mellitus, 21,22 hypertension, 23,24 CKD, 25,26 heart failure 27 and cardiovascular disease, [28][29][30][31][32] suggesting that FLI, which is easily determined by using circulating factors and obesity indices, can predict not only NAFLD/MAFLD but also the risk of cardiometabolic disease. In the previous cohort studies, cardiovascular disease included not only IHD but also hypertension, heart failure, arrythmia, stroke and other diseases.…”

“…There have been several studies showing that FLI is associated with cardiometabolic diseases including type 2 diabetes mellitus, 21,22 hypertension, 23,24 CKD, 25,26 heart failure 27 and cardiovascular disease, 28–32 suggesting that FLI, which is easily determined by using circulating factors and obesity indices, can predict not only NAFLD/MAFLD but also the risk of cardiometabolic disease. In the previous cohort studies, cardiovascular disease included not only IHD but also hypertension, heart failure, arrythmia, stroke and other diseases 28–32 .…”

“…Furthermore, FLI has been recommended as a biomarker to detect hepatosteatosis in patients with MAFLD. 13 There have been several studies showing that FLI is associated with the development of diabetes mellitus, 21,22 hypertension, 23,24 chronic kidney disease (CKD) 25,26 and heart failure. 27 Determination of FLI will make it easier to find several NAFLD/MAFLDassociated diseases.…”