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Fatty liver acts as consequence, precursor to metabolic comorbidities

Results of a self-contained community study showed that the incidence of nonalcoholic fatty liver disease significantly increased from 1997 to 2014, especially in younger adults. Further, NAFLD was both a consequence and precursor to metabolic comorbidities, such as hypertension and diabetes.

“NAFLD is a risk factor for incident dysmetabolic conditions and cardiovascular events. NAFLD is an independent risk factor for death, but impact decreases with the increase of incident metabolic comorbidities,” Alina M. Allen, MD, from the department of gastroenterology and hepatology at the Mayo Clinic, Minn., and colleagues wrote. “The lifespan of NAFLD subjects is 4 years shorter than that of controls, and the majority of the remaining years are spent in states of metabolic comorbidities.”

The researchers identified 3,869 patients with NAFLD and 15,209 age- and sex-matched controls from Olmsted County, Minn., for a population-based epidemiological study. Median patient age was 53 years (range, 42-63 years) and 52% were women.

The incidence of NAFLD increased from 62 per 100,000 person-years in 1997 to 329 per 100,000 person-years in 2014. Individuals aged 18 years to 39 years had the highest incremental increase (20 to 140 per 100,000 person-years) compared with those aged 40 years to 59 years (70 to 407 per 100,000 person-years) and those aged over 60 years (125 to 515 per 100,000 person-years).

Compared with controls, patients with NAFLD were twice as likely (RR = 2.62; 95% CI, 2.31-2.96) to develop one to three of the following comorbidities: diabetes, hypertension and dyslipidemia. Similarly, patients with NAFLD and diabetes, hypertension or dyslipidemia had a significantly higher risk for developing additional metabolic comorbidities than controls with one comorbidity (RR = 1.67; 95% CI, 1.51-1.85).

Patients with NAFLD and no metabolic comorbidities had a twofold increased mortality risk (RR = 2.16; 95% CI, 1.41-3.31) compared with controls with no metabolic comorbidities. The mortality risk increased significantly in patients with NAFLD and one (RR = 1.99; 95% CI, 1.48-2.66) and two comorbidities (RR = 1.75; 95% CI, 1.42-2.14), but was not significant in those with three comorbidities.

Patients with NAFLD but no metabolic comorbidities had a twofold increased risk for cardiovascular events compared with controls (RR = 1.96; 95% CI, 1.35-2.86). NAFLD as a cardiovascular risk factor decreased or was no longer present as patients and controls acquired one (RR = 1.21; 95% CI, 0.96-1.53), two (RR = 1.24; 95% CI, 1.05-1.47) or three (RR = 1.02; 95% CI, 0.86-1.21) metabolic comorbidities.

“While the current understanding of these complex associations continues to evolve, general practitioners and medical subspecialists alike should be aware of the intricate relationships between NAFLD and incident metabolic diseases, as well as the dynamic impact of NAFLD on mortality which may have implications for the optimal timing for intervention,” the researchers concluded. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.