School of Public Health, Xiamen University.
Department of Public Health, Zhongshan Hospital, Fudan University (Xiamen Branch).
Eur J Gastroenterol Hepatol. 2024 Dec 1;36(12):1453-1463. doi: 10.1097/MEG.0000000000002865. Epub 2024 Oct 30.
This study aims to assess the prognostic value of the fatty liver index (FLI), a noninvasive tool for hepatic steatosis assessment, in predicting all-cause and disease-specific mortality.
We linked data from the National Health and Nutrition Examination Survey III (1988-1994) with Public-Use Mortality Files, forming a cohort of 11 297 participants with a median follow-up period of 26.25 years. Cox proportional hazards models were used to evaluate the association between FLI and all-cause mortality, while Fine and Gray's models assessed the relationship between FLI and disease-specific mortality.
The FLI ≥ 60 was independently associated with an increased risk of all-cause mortality (hazard ratio = 1.24, P < 0.001), as well as mortality from malignant neoplasms (hazard ratio = 1.18, P = 0.048), diabetes (hazard ratio = 2.62, P = 0.001), and cardiovascular diseases (CVDs) (hazard ratio = 1.18, P = 0.018), compared to FLI < 30. No significant associations were found with Alzheimer's disease, influenza and pneumonia, chronic lower respiratory diseases, or renal disorders. Subgroup analyses indicated that individuals who were females aged 40-60 (hazard ratio = 1.67, P = 0.003), non-overweight (hazard ratio = 1.75, P = 0.007), or without abdominal obesity (hazard ratio = 1.75, P = 0.007) exhibited a stronger association between FLI ≥ 60 and all-cause mortality.
These findings support the prognostic value of the FLI for predicting mortality from all causes, malignant neoplasms, diabetes, and CVDs. Targeted attention is needed in postmenopausal women, non-overweight, and non-abdominally obese populations.
本研究旨在评估脂肪肝指数（FLI）作为一种评估肝脂肪变性的非侵入性工具，其在预测全因和疾病特异性死亡率方面的预后价值。
我们将国家健康和营养检查调查 III 期（1988-1994 年）的数据与公共使用死亡率文件相链接，形成了一个由 11297 名参与者组成的队列，中位随访期为 26.25 年。Cox 比例风险模型用于评估 FLI 与全因死亡率之间的关联，而 Fine 和 Gray 的模型评估了 FLI 与疾病特异性死亡率之间的关系。
FLI≥60 与全因死亡率增加独立相关（风险比=1.24，P<0.001），与恶性肿瘤（风险比=1.18，P=0.048）、糖尿病（风险比=2.62，P=0.001）和心血管疾病（CVDs）（风险比=1.18，P=0.018）死亡率也相关，而与阿尔茨海默病、流感和肺炎、慢性下呼吸道疾病或肾脏疾病无关。亚组分析表明，女性（年龄 40-60 岁）（风险比=1.67，P=0.003）、非超重（风险比=1.75，P=0.007）或无腹部肥胖（风险比=1.75，P=0.007）的个体中，FLI≥60 与全因死亡率之间的相关性更强。
这些发现支持 FLI 对预测全因、恶性肿瘤、糖尿病和 CVDs 死亡率的预后价值。需要在绝经后妇女、非超重和非腹部肥胖人群中引起关注。
