Abstract
Aim
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and may be associated with increased mortality. Our aim was to determine whether anthropometric measures are independently associated with mortality in NAFLD.
Methods
The third National Health and Nutrition Examination Surveys (1988–1994) data was used. Extensive radiologic, serologic and clinical data were available. NAFLD was defined as moderate-to-severe hepatic steatosis on the hepatic ultrasound in the absence of any cause of chronic liver disease (e.g. hepatitis C virus RNA negative, hepatitis B-surface antigen negative, normal transferrin saturation and alcohol consumption <20 gram/day). Anthropometric measures [body mass index (kg/m2), waist, hip, arm, and thigh circumferences (cm), waist-to-hip ratio, percentage of body fat, and sum of skinfolds (mm)], laboratory measures and clinico-demographic data were analyzed. Statistical analyses were conducted with SUDAAN 10.0.
Results
A total of 10,565 adult participants were included [2,510 (weighted 21 %) with NAFLD and 8,055 non-NAFLD controls]. In multivariate analysis, NAFLD was independently associated with being Mexican-American (including Hispanic or other ethnicity), larger waist circumference (cm), type-2 diabetes, insulin resistance and hypertension. After about 14 years (median) of follow up, liver-specific mortality was independently associated with NAFLD and being White.
Conclusions
Components of metabolic syndrome, and Mexican-American ethnicity are independently associated with NAFLD. Furthermore, NAFLD is an independent predictors of liver-specific mortality in men and Whites.
Similar content being viewed by others
References
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Non-alcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–1419.
Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–285.
Stepanova M, Rafiq N, Younossi ZM. Components of metabolic syndrome are independent predictors of mortality in patients with liver disease: a population-based study. Gut. 2010;59(10):1410–1415.
Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–140.
Rafiq N, Bai CH, Fang Y, et al. Long-term follow-up of patients with non-alcoholic fatty liver. Clin Gastro Hepatol. 2009;7:234–238.
Zelber-Sagi S, Ratziu V, Oren R. Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence. World J Gastroenterol. 2011;17(29):3377–3389.
Flegal KM, Graubard BI. Estimates of excess deaths associated with body mass index and other anthropometric variables. Am J Clin Nutr. 2009; 89(4):1213–1219.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298:2028–2037.
Chang SH, Beason TS, Hunleth JM, Colditz GA. A systematic review of body fat distribution and mortality in older people. Maturitas. 2012;72(3):175-191.
Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L. Body configuration as a predictor of mortality: comparison of five anthropometric measures in a 12 year follow-up of the Norwegian HUNT 2 study. PLoS One. 2011;6(10):e26621.
Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y, Hollenbeck A, Schatzkin A. Waist circumference as compared with body-mass index in predicting mortality from specific causes. PLoS One. 2011;6(4):e18582.
CDC/National Cancer for Health Statistics. National Health and Nutritional Examination Survey: analytic guidelines. Hyattsville (MD): US Department of Health and Human Services, Centers for Disease Control and Prevention; [cited 1996 October]. Source available: http://www.cdc.gov/nchs/nhanes/nh3data.html.
Chumlea WC, Guo SS, Kuczmarski RJ, et al. Body composition estimates from NHANES III bioelectrical impedance data. Int J Obes Relat Metab Disord. 2002;26(12):1596–1609.
CDC/National Cancer for Health Statistics. National Health and Nutritional Examination Survey: gallbladder ultrasonography procedure manual. Rockville (MD): Westat, Inc; [cited 1988 September]. Source available: http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/nchs/manuals/gallblad.pdf.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419.
Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):155–161.
Bellentani S, Dalle Grave R, Suppini A, Marchesini G. Fatty liver Italian network. Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology. 2008;47(2):746–754.
Koebnick C, Getahun D, Reynolds K, et al. Trends in nonalcoholic fatty liver disease-related hospitalizations in US children, adolescents, and young adults. J Pediatr Gastroenterol Nutr. 2009;48(5):597–603.
Lazo M, Solga SF, Horska A, et al. Fatty Liver Subgroup of the Look AHEAD Research Group. Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes. Diabetes Care. 2010;33(10):2156–2163.
Younossi ZM, Venkatesan C. A 2012 clinical update for internists in adult nonalcoholic fatty liver disease. Panminerva Med. 2012;54(1):29–37. Review.
Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–2219. Erratum in: N Engl J Med. 2011;365(9):869.
Melonie Heron: Deaths: Leading Causes for 2007. National vital statistics reports, vol. 59, No. 8. Hyattsville, MD: NCHS, 2007. Source available: http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_08.pdf.
Acknowledgments
This study was partly supported by the Beatty Liver and Obesity Research Fund and Liver Outcomes Research Fund of Inova Health System, Falls Church, Virginia.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Otgonsuren, M., Stepanova, M., Gerber, L. et al. Anthropometric and Clinical Factors Associated with Mortality in Subjects with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 58, 1132–1140 (2013). https://doi.org/10.1007/s10620-012-2446-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2446-3