Metabolic syndrome, but not non-alcoholic fatty liver disease, increases 10-year mortality: A prospective, community-cohort study

Madunil A Niriella; Anuradhani Kasturiratne; Thulani U Beddage; Shanthi A Withanage; Dilith C Goonatilleke; Chathurika P Abeysinghe; Ruvini T De Mel; Thilini L Balapitiya; Shamila T De Silva; Anuradha S Dassanayake; Arjuna P De Silva; Arunasalam Pathmeswaran; Ananda R Wickramasinghe; Nirihiro Kato; Hithanadura J de Silva

doi:10.1111/liv.14237

Metabolic syndrome, but not non-alcoholic fatty liver disease, increases 10-year mortality: A prospective, community-cohort study

Liver Int. 2020 Jan;40(1):101-106. doi: 10.1111/liv.14237. Epub 2019 Sep 25.

Authors

Madunil A Niriella¹, Anuradhani Kasturiratne¹, Thulani U Beddage¹, Shanthi A Withanage¹, Dilith C Goonatilleke¹, Chathurika P Abeysinghe¹, Ruvini T De Mel¹, Thilini L Balapitiya¹, Shamila T De Silva¹, Anuradha S Dassanayake¹, Arjuna P De Silva¹, Arunasalam Pathmeswaran¹, Ananda R Wickramasinghe¹, Nirihiro Kato², Hithanadura J de Silva¹

Affiliations

¹ Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
² National Center for Global Health and Medicine, Toyama, Tokyo, Japan.

PMID: 31472085
DOI: 10.1111/liv.14237

Abstract

Background: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Keywords: NAFLD; fatty liver; metabolic syndrome; mortality; non-alcoholic fatty liver disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cause of Death
Female
Humans
Liver / pathology*
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / mortality*
Proportional Hazards Models
Prospective Studies
Risk Factors
Sri Lanka / epidemiology
Time Factors
Ultrasonography