Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
Front Endocrinol (Lausanne). 2021 Mar 12;12:638615. doi: 10.3389/fendo.2021.638615. eCollection 2021.
Non-alcoholic fatty liver disease (NAFLD) has a dynamic disease course, therefore repeated measurements of NAFLD status could have benefits rather than single one. The aim of this study was to investigate the effects of persistent NAFLD on the incidence of myocardial infarction (MI) and stroke and all-cause mortality by using repeated measurement of fatty liver index (FLI).
About 3 million subjects who had undergone the health screening four times from 2009 until 2013 were included. NAFLD was defined as an FLI ≥60. FLI points were defined as the number of times participants meeting the criteria of NAFLD (0-4). Outcomes included all-cause mortality, MI, and stroke.
The higher the FLI points, the higher the risk of all-cause mortality, MI, and stroke ( for trend <0.001, all). Subjects with four FLI points had a higher risk of all-cause mortality (aHR, 1.86; 95% CI, 1.75-1.98; < 0.001), incidence of MI (aHR, 1.3; 95% CI, 1.21-1.40; < 0.001), and stroke (aHR, 1.27; 95% CI, 1.19-1.37; < 0.001) after adjustment for age, sex, smoking, alcohol consumption, income, hypertension, dyslipidemia, diabetes, body mass index, and physical activity. When the 1 and the last FLI were compared, the "incident NAFLD" group had a higher risk for death compared to the "no NAFLD" group (aHR, 1.46; 95% CI, 1.37-1.55), and the "regression of NAFLD" group had a decreased risk for death compared to the "persistent NAFLD" group (aHR, 0.83; 95% CI, 0.77-0.89).
Repeated evaluations of NAFLD status based on FLI measurements could help physicians identify higher-risk groups in terms of mortality, MI, and stroke. The association between FLI worsening or improvement and outcomes also suggests clinical benefits of the prevention and treatment of NAFLD.
非酒精性脂肪性肝病（NAFLD）具有动态的疾病进程，因此重复测量 NAFLD 状态可能会带来益处而非单一测量。本研究的目的是通过重复测量脂肪肝指数（FLI）来探讨持续性 NAFLD 对心肌梗死（MI）和中风以及全因死亡率的影响。
本研究纳入了 2009 年至 2013 年期间进行了四次健康筛查的约 300 万名受试者。NAFLD 定义为 FLI≥60。FLI 分数定义为符合 NAFLD 标准的次数（0-4）。结局包括全因死亡率、MI 和中风。
FLI 分数越高，全因死亡率、MI 和中风的风险越高（趋势<0.001，均）。具有四个 FLI 分数的受试者全因死亡率较高（aHR，1.86；95%CI，1.75-1.98；<0.001），MI 发生率（aHR，1.3；95%CI，1.21-1.40；<0.001）和中风（aHR，1.27；95%CI，1.19-1.37；<0.001），经年龄、性别、吸烟、饮酒、收入、高血压、血脂异常、糖尿病、体重指数和体力活动调整后。当比较第 1 次和最后 1 次 FLI 时，与“无 NAFLD”组相比，“新发 NAFLD”组的死亡风险更高（aHR，1.46；95%CI，1.37-1.55），而“NAFLD 消退”组的死亡风险较“持续性 NAFLD”组降低（aHR，0.83；95%CI，0.77-0.89）。
基于 FLI 测量的 NAFLD 状态的重复评估可以帮助医生识别死亡率、MI 和中风风险较高的人群。FLI 恶化或改善与结局之间的关联也表明预防和治疗 NAFLD 的临床获益。
