Hypertension is prevalent in non-alcoholic fatty liver disease and increases all-cause and cardiovascular mortality

Ng, Cheng Han; Wong, Zhen Yu; Chew, Nicholas; Chan, Kai En; Xiao, Jieling; Sayed, Nilofer; Lim, Wen Hui; Tan, Darren Jun Hao; Loke, Ryan Wai Keong; Tay, Phoebe Wen Lin; Yong, Jie Ning; Kong, Gywneth; Huang, Daniel Q.; Wang, Jiong‐Wei; Chan, Mark Y; Dalakoti, Mayank; Tamaki, Nobuharu; Noureddin, Mazen; Siddiqui, Mohammad Shadab; Sanyal, Arun J.; Muthiah, Mark

doi:10.3389/fcvm.2022.942753

Cited by 38 publications

(29 citation statements)

References 56 publications

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“…NAFLD cases with HTN are associated with an increased NAFLD progression risk compared to NAFLD cases without hypertension [19]. In another study (NHANES III), HTN was related to cardiovascular and all-cause mortality in NAFLD cases [5].…”

Section: Discussionmentioning

confidence: 93%

Association Between Hypertension and the Prevalence of Liver Steatosis and Fibrosis

Zhao

et al. 2023

Preprint

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Background Hypertension (HTN) and non-alcoholic fatty liver disease (NAFLD) usually occur together and have some common pathophysiological symptoms. In this study, we determined the relationship between HTN status and the rates of liver steatosis and fibrosis based on the liver stiffness measurement and controlled attenuation parameter obtained by performing liver transient ultrasound elastography (TUE). Methods To perform this cross-sectional study, data were obtained from the National Health and Nutrition Examination Survey for 2017-March 2020 Pre-pandemic cycle. The relationship between HTN and the rates of liver steatosis and fibrosis was analyzed by constructing a multivariate logistic regression model. We also conducted subgroup analyses based on the age, gender, ethnicity, and body mass index (BMI) of the patients. Results In total, 4,837 participants were recruited, including 2,375 participants with HTN and 2,462 participants without HTN. After adjusting possible confounders, HTN was positively related to the liver steatosis rate (OR = 1.4, 95% CI: 1.1–1.8). Such HTN-associated incidences were higher among males (OR = 1.6, 95% CI: 1.1–2.3), non-Hispanic African American individuals (OR = 1.9, 95% CI: 1.1–3.5), and participants with BMI ≥ 25 < 30 kg/m2 (OR = 1.7, 95% CI: 1.1–2.5). Additionally, HTN was positively associated with the fibrosis rate (OR = 2.0, 95% CI: 1.3–3.0), especially among females (OR = 2.6, 95% CI: 1.3–5.1), among individuals who were 40–59 years old (OR = 2.3, 95% CI: 1.1–4.6), 60–80 years old (OR = 2.2, 95% CI: 1.2–4.1), non-Hispanic Caucasian (OR = 3.0, 95% CI: 1.6–5.9), among those with BMI ≥ 25 < 30 kg/m2 (OR = 3.0, 95% CI: 1.1–8.1), and those with BMI ≥ 30 kg/m2 (OR = 2.0, 95% CI: 1.2–3.3). Conclusions The results of this study showed that HTN status was positively associated with liver steatosis and fibrosis rates, especially for subjects with BMI ≥ 25 kg/m2. The relationship was also affected by the ethnicity of the participants.

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Section: Discussionmentioning

confidence: 93%

Association Between Hypertension and the Prevalence of Liver Steatosis and Fibrosis

Zhao

et al. 2023

Preprint

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“…Analytical methods were designed with reference to previously published studies ( 27 – 29 ). Statistical analysis was conducted using STATA (16.1 StataCorp, Texas, United States).…”

Section: Methodsmentioning

confidence: 99%

Depression in non-alcoholic fatty liver disease is associated with an increased risk of complications and mortality

Xiao²,

Chew³

et al. 2022

Front. Med.

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Background and aimsThe global prevalence of non-alcoholic fatty liver disease (NAFLD) is expected to rise continuously. Furthermore, emerging evidence has also shown the potential for concomitant depression in NAFLD. This study aims to examine the prevalence, risk factors, and adverse events of depression in NAFLD and evaluate whether treated depression can reverse the increased risks of adverse outcomes.Materials and methodsThis study analyses the 2000–2018 cycles of NHANES that examined liver steatosis with fatty liver index (FLI). The relationship between NAFLD and depression was assessed with a generalized linear mix model and a sensitivity analysis was conducted in the no depression, treated depression, and untreated depression groups. Survival analysis was conducted with cox regression and fine gray sub-distribution model.ResultsA total of 21,414 patients were included and 6,726 were diagnosed with NAFLD. The risk of depression in NAFLD was 12% higher compared to non-NAFLD individuals (RR: 1.12, CI: 1.00–1.26, p = 0.04). NAFLD individuals with depression were more likely to be older, females, Hispanics or Caucasians, diabetic, and have higher BMI. Individuals with depression have high risk for cardiovascular diseases (CVD) (RR: 1.40, CI: 1.25–1.58, p < 0.01), stroke (RR: 1.71, CI: 1.27–2.23, p < 0.01), all-cause mortality (HR: 1.50, CI: 1.25–1.81, p < 0.01), and cancer-related mortality (SHR: 1.43, CI: 1.14–1.80, p = 0.002) compared to NAFLD individuals without depression. The risk of CVD, stroke, all-cause mortality, and cancer-related mortality in NAFLD individuals with treated depression and depression with untreated treatment was higher compared to individuals without depression.ConclusionThis study shows that concomitant depression in NAFLD patients can increase the risk of adverse outcomes. Early screening of depression in high-risk individuals should be encouraged to improve the wellbeing of NAFLD patients.

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“…We defined NAFLD as the presence of steatosis in the absence of substantial alcohol use (≥ 3 drinks a day in men, ≥ 2 drinks a day in women). The presence of steatosis in NAFLD was quantified with either the fatty liver index (FLI) or the United States fatty liver index (US-FLI) with a cut-off of ≥ 60 [20] and ≥ 30 [21] , respectively [8,22] . Metabolic unhealthy patients were defined as individuals with fatty liver and concomitant type 2 diabetes and/or ≥ 2 metabolic risk abnormalities [23] : (1) waist circumference ≥ 102 cm in men and 88 cm in women (≥ 90/80 cm in Asian men and women);…”

Section: Methodsmentioning

confidence: 99%

The growing prevalence of nonalcoholic fatty liver disease (NAFLD), determined by fatty liver index, amongst young adults in the United States. A 20-year experience

Li¹,

Ng²,

Quek³

et al. 2022

Metab Target Organ Damage

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Aim: The Global burden of nonalcoholic fatty liver disease (NAFLD) has significantly increased recently, with its prevalence mirroring increasing obesity and diabetes. However, population-specific evidence for young adults remains limited. Herein, we provide a 20-year trend analysis of NAFLD in young adults and examine factors associated with NAFLD and major adverse cardiovascular events (MACE) prevalence. Methods: This study uses data from the United States National Health and Nutrition Examination Survey (NHANES) 1999-2018. Fatty liver was examined with the fatty liver index (FLI) and United States-FLI (US-FLI), and advanced fibrosis was examined with the fibrosis-4 index. Clustered multivariate logistic regression analysis on the year of study was applied to obtain odds ratios (OR) for the estimation of events. Results: 13.31% (95%CI: 12.71% to 13.94%) of young adults had NAFLD. The prevalence increased from 9.98% in 1999 to 19.49% in 2018, with a statistically significant trend (P < 0.001). 9.52% and 5.29% of patients have clinically significant and advanced fibrosis, respectively. In multivariate analysis, diabetes (3.48, 95%CI: 2.37 to 5.11), hypertension (2.03, 95%CI: 1.62 to 2.55), elevated body mass index (1.22, 95%CI: 1.20 to 1.23, P < 0.001) significantly increases odds of NAFLD. The largest increase in odds was related to obesity (OR: 21.61, 95%CI: 16.95 to 27.55, P < 0.001). Young adults with NAFLD had a borderline non-significant increase in the prevalence of MACE compared to individuals without NAFLD (OR: 1.603, 95%CI: 0.949 to 2.708, P = 0.078). Conclusion: The rising prevalence of NAFLD in young adults depicts the changing landscape of NAFLD and its association with a significant increase in MACE. The challenge of effective risk stratification and education of these individuals remains.

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Hypertension is prevalent in non-alcoholic fatty liver disease and increases all-cause and cardiovascular mortality

Cited by 38 publications

References 56 publications

Association Between Hypertension and the Prevalence of Liver Steatosis and Fibrosis

Association Between Hypertension and the Prevalence of Liver Steatosis and Fibrosis

Depression in non-alcoholic fatty liver disease is associated with an increased risk of complications and mortality

The growing prevalence of nonalcoholic fatty liver disease (NAFLD), determined by fatty liver index, amongst young adults in the United States. A 20-year experience

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