Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13555-13565
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13555
Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality
Altan Onat, Günay Can, Ayşem Kaya, Tuğba Akbaş, Fatma Özpamuk-Karadeniz, Barış Şimşek, Hakan Çakır, Hüsniye Yüksel
Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey
Günay Can, Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey
Ayşem Kaya, Section of Biochemistry, Institute of Cardiology, all Istanbul University, 34096 Istanbul, Turkey
Tuğba Akbaş, Bağcılar Educational Hospital, 34500 Istanbul, Turkey
Fatma Özpamuk-Karadeniz, Balıklıgol State Hospital, 63050 Şanlıurfa, Turkey
Barış Şimşek, Department of Cardiology, S. Ersek Center for Cardiovascular Surgery, 34668 Istanbul, Turkey
Hakan Çakır, Darıca Farabi State Hospital, 41700 Kocaeli, Turkey
Author contributions: Onat A conceived and designed the study and analyzed and interpreted data; Can G performed the statistical analyses and critically revised the manuscript; Kaya A performed the biochemical analyses and critically revised the manuscript; Akbaş T, Özpamuk-Karadeniz F, Şimşek B and Çakır H collected data and critically revised the manuscript; and Yüksel H drafted the manuscript and obtained funding.
Supported by Automotive company TOFAŞ, Istanbul, Turkey.
Institutional review board statement: Istanbul Medical Faculty, Istanbul University, Turkey.
Clinical trial registration statement: Not applicable.
Informed consent statement: All individuals gave written consent to participation.
Conflict-of-interest statement: The authors declare no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Altan Onat, Professor, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Nisbetiye cad. 59/24, Etiler 34335, Istanbul, Turkey. alt_onat@yahoo.com.tr
Telephone: +90-212-3516217 Fax: +90-212-2211754
Received: April 22, 2015
Peer-review started: April 24, 2015
First decision: July 10, 2015
Revised: July 23, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 28, 2015
Processing time: 245 Days and 15.5 Hours
Abstract

AIM: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.

METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality.

RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.

CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.

Keywords: All-cause death; Coronary heart disease; Hepatic steatosis; Metabolic syndrome; Turkish adult risk factor study

Core tip: We prospectively assessed in 1822 adults the association between a validated surrogate of fatty liver disease (FLD) and the incidence of type-2 diabetes, coronary heart disease (CHD), and all-cause mortality by stratifying to gender and using adjusted Cox regression models. At a mean 8 year follow-up, FLD was the major determinant of developing diabetes and was a significant predictor of CHD. Similarly-adjusted models for all-cause mortality did not confer risk, except for slightly in prediabetics and diabetic women. Involvement of circulating lipoprotein(a) in autoimmune activation may be an underlying mechanism. Such a FLD surrogate may be used in epidemiologic studies.