Skip to main content

Advertisement

SpringerLink
Log in

Anthropometric and Clinical Factors Associated with Mortality in Subjects with Nonalcoholic Fatty Liver Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. 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.

    Article  PubMed  CAS  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Google Scholar 

  8. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298:2028–2037.

    Article  PubMed  CAS  Google Scholar 

  9. 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.

    Google Scholar 

  10. 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.

    Google Scholar 

  11. 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.

    Google Scholar 

  12. 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.

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):155–161.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Younossi ZM, Venkatesan C. A 2012 clinical update for internists in adult nonalcoholic fatty liver disease. Panminerva Med. 2012;54(1):29–37. Review.

    Google Scholar 

  21. 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.

    Google Scholar 

  22. 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.

Download references

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

  1. Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA

    Munkhzul Otgonsuren, Maria Stepanova, Lynn Gerber & Zobair M. Younossi

  2. Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA

    Lynn Gerber & Zobair M. Younossi

  3. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Lynn Gerber & Zobair M. Younossi

Authors
  1. Munkhzul Otgonsuren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Stepanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lynn Gerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zobair M. Younossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zobair M. Younossi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 135 kb)

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-012-2446-3

Keywords

Search

Navigation