Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
National Center for Global Health and Medicine, Toyama, Tokyo, Japan.
Liver Int. 2020 Jan;40(1):101-106. doi: 10.1111/liv.14237. Epub 2019 Sep 25.
Data 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.
Participants (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.
2724 (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.
In 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.
南亚地区有关非酒精性脂肪性肝病（NAFLD）结局的数据较为缺乏。我们比较了在斯里兰卡城市成年人中，经过 10 年随访后，伴有和不伴有 NAFLD 患者的死亡率。
通过分层随机抽样选择参与者（年龄 35-64 岁），于 2007 年进行了结构化访谈筛查。进行了人体测量、肝脏超声和生化/血清学检查。根据超声标准、安全饮酒（亚洲标准）和无乙型肝炎/丙型肝炎来诊断 NAFLD。无 NAFLD 的患者是指没有任何超声脂肪肝标准、安全饮酒和无乙型肝炎/丙型肝炎的患者。在 2017 年对队列进行了重新评估以评估死亡率。通过电话/邮件联系参与者或其家属，并通过家访和死亡证明审查来确认死亡。使用 Cox 回归来确定伴有和不伴有 NAFLD 患者全因死亡率（ACM）和心血管死亡率（CVM）的预测因素。
2985 名原始参与者中有 2724 名（91.2%）被联系（851 名伴有 NAFLD，1072 名不伴有 NAFLD）。总体有 169 例（6.2%）死亡[41 例死于 NAFLD（17 例心血管；9 例癌症相关；4 例肝脏特异性；11 例其他）和 79 例死于非 NAFLD（28 例心血管；17 例癌症相关；1 例肝脏特异性；33 例其他）]。代谢综合征（MetS）、低教育水平、较高年龄和男性性别独立预测 ACM。MetS、年龄增长和男性性别独立预测 CVM。NAFLD 与 ACM 或 CVM 均无相关性。在伴有 NAFLD 的患者中，MetS 和年龄＞55 岁与 ACM 独立相关，而 MetS 和男性性别与 CVM 相关。
在这项基于社区的研究中，年龄增长、男性性别和 MetS，但不是 NAFLD，预测了 10 年 ACM 和 CVM。在伴有 NAFLD 的患者中，只有代谢异常的患者死亡风险更高。
