Metabolic syndrome, but not non‐alcoholic fatty liver disease, increases 10‐year mortality: A prospective, community‐cohort study

Abstract

BackgroundData on outcomes of non‐alcoholic fatty liver disease (NAFLD) from South Asia are lacking. We compared mortality, among those with‐ and without‐NAFLD, after 10‐years follow‐up among urban, adult Sri Lankans.MethodParticipants (aged 35‐64 years), selected by age‐stratified random sampling, were screened by structured‐interview in 2007. Anthropometric measurements, liver ultrasonography and biochemical/serological tests were done. NAFLD was diagnosed on ultrasound criteria, safe‐alcohol consumption (Asian‐standards) and absence of hepatitis B/C. Subjects without NAFLD were those without any ultrasound criteria of fatty liver, safe‐alcohol consumption and absence of hepatitis B/C. The cohort was re‐evaluated to assess mortality in 2017. Participants or their households were contacted by telephone/post, and deaths confirmed by home‐visits and death certificate review. Cox‐regression was used to determine predictors of all‐cause mortality (ACM) and cardiovascular mortality (CVM) in those with‐ and without‐NAFLD.Results2724 (91.2%) of 2985 original participants were contacted (851‐with NAFLD and 1072‐without NAFLD). Overall there were 169 (6.2%) deaths [41‐deaths among NAFLD (17‐cardiovascular; 9‐cancer‐related; 4‐liver‐specific; 11‐other) and 79‐deaths among no‐NAFLD (28‐cardiovascular; 17‐cancer‐related; 1‐liver‐specific; 33‐other)]. Metabolic syndrome (MetS), low‐education level, higher age and male‐gender independently predicted ACM. MetS, increasing age and male‐gender independently predicted CVM. NAFLD did not predict either ACM or CVM. In those with NAFLD, MetS and age >55‐years were independently associated with ACM, while MetS and male‐gender were associated with CVM.ConclusionIn this community‐based study, increasing age, male‐gender and MetS, but not NAFLD, predicted 10‐year ACM and CVM. Among those with NAFLD, only those metabolically abnormal were at a higher risk for mortality.

Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis

“…After examining the full text of these 46 potentially eligible studies, we excluded 10 studies, mainly due to unsatisfactory inclusion criteria or unsatisfactory outcome measures (see appendix p10). [49][50][51][52][53][54][55][56][57][58] As a consequence of this exclusion, we identified 36 unique, observational studies for inclusion in the meta-analysis.…”

Outcomes of NAFLD and MAFLD: Results from a community-based, prospective cohort study

“…Non-fatal CVEs were identified either by documentation in medical records or, in the absence of medical records, by the presence of an episode with clinically significant chest pain or clinically significant neurological deficit, or intervention for either [22]. Clinically significant chest pain was defined as chest pain requiring hospital admission for more than 24 hours and requiring special treatment (streptokinase, heparin, cardiology referral with or without echocardiography and/or referral for coronary intervention).…”

Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Metabolic Associated Fatty Liver Disease

“…Abdominal obesity and dyslipidemia are one of the manifestations of MetS which is related to MAFLD 33. Niriella et al34 conducted a 10-year follow-up of patients and found that MetS rather than MAFLD was the predictor of all-cause mortality and cardiovascular mortality. A systematically review found that coffee consumption could have a protective role on fibrosis accompanied with low risk of having MetS among MAFLD patient.…”