Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD)
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Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Metabolic syndrome (MS) components are highly prevalent in NAFLD. Our aim is to assess the relationship of NAFLD and MS with long-term outcome of mortality.The Third National Health and Nutrition Examination Survey (NHANES) was utilized. NAFLD was diagnosed by ultrasound in the presence of hepatic steatosis and no other causes of chronic liver disease. History of MS and its components were obtained from self-reported NHANES questionnaires. Mortality was obtained from Mortality-Linkage File, through December 31, 2011. Chi-square test was used for categorical variables and Cox proportional models estimated hazard ratios with 95% confidence interval.NAFLD cohort (n = 3613) had a median age of 43 years, 73% white, and 50% male. NAFLD group with at least one MS condition was significantly older, had higher body mass index, more likely to have insulin resistance, and heart disease compared to NAFLD group without MS. Over 19-years of follow-up, 1039 people died. Compared to NAFLD patients without MS, presence of one MS component increased the risk of mortality at 8-year (2.6% vs 4.7%) and 16-year (6% vs 11.9%) (P < .001). After adjusting for socio-demographic factors, NAFLD with all MS components was associated with overall, cardiac and liver-mortality. Increased number of MS components was associated with lower survival (P < .0001).Patients with NAFLD and MS have higher mortality risk compared to NAFLD patients without MS. These NAFLD patients should be prioritized for the development of treatment regimens.
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Having several cardiometabolic risk factors confers a greater risk of progressive liver damage and major adverse liver outcomes.
“Conversely, having several cardiometabolic risk factors confers a greater risk of progressive liver damage and major adverse liver outcomes. 17,35”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [35]
The Results section on liver-specific mortality reports that metabolic-syndrome components increased liver-specific mortality in adults with NAFLD, although it cautions that there were only 22 such deaths (page not available). The Discussion says diabetes and possibly dyslipidemia are known to increase liver-disease progression, but this study does not directly establish that several risk factors increase progressive liver damage or major adverse liver outcomes beyond liver-related death. (LLM, conf=0.86)
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- Authors
- Golabi, P., Otgonsuren, M., de Avila, L., Sayiner, M., Rafiq, N., & Younossi, Z. M.
- Affiliations
- Inova Health System (US)
- Corresponding author
- Younossi, Zobair M.
- Venue
- Medicine
- Published
- 2018-03
- Volume
- 97
- Issue
- 13
- Pages
- e0214
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC5895395
- OpenAlex
- W2794816422
- Cited by
- 221
- References
- 46
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 32 · 2023: 25 · 2022: 33 · 2021: 36 · 2020: 24 · 2019: 24 · 2018: 9
- FWCI
- 18.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-sa
- Locations
- Medicine (publishedVersion, cc-by-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-sa)
- PubMed Central (publishedVersion, cc-by-sa)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, metabolic syndrome, mortality risk, hepatic steatosis, insulin resistance, cardiovascular mortality, liver-related mortality, body mass index, long-term survival
- MeSH terms
- Adult, Cardiovascular Diseases, Female, Humans, Insulin Resistance, Male, Middle Aged, Nutrition Surveys, Risk Factors, United States, Comorbidity, Body Mass Index, Proportional Hazards Models, Age Distribution, Sex Distribution, Metabolic Syndrome, Non-alcoholic Fatty Liver Disease
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