Alcoholic and Nonalcoholic Fatty Liver Disease and Liver-Related Mortality: A Cohort Study
- Authors
- Chang, Y[Chang, Yoosoo]; Cho, YK[Cho, Yong Kyun]; Cho, J[Cho, Juhee]; Jung, HS[Jung, Hyun-Suk]; Yun, KE[Yun, Kyung Eun]; Ahn, J[Ahn, Jiin]; Sohn, CI[Sohn, Chong Il]; Shin, H[Shin, Hocheol]; Ryu, S[Ryu, Seungho]
- Issue Date
- Apr-2019
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Citation
- AMERICAN JOURNAL OF GASTROENTEROLOGY, v.114, no.4, pp.620 - 629
- Indexed
- SCIE
SCOPUS
- Journal Title
- AMERICAN JOURNAL OF GASTROENTEROLOGY
- Volume
- 114
- Number
- 4
- Start Page
- 620
- End Page
- 629
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/10216
- DOI
- 10.14309/ajg.0000000000000074
- ISSN
- 0002-9270
- Abstract
- OBJECTIVES: We compared liver-related mortality by fibrosis severity between 2 types of fatty liver disease (FLD), nonalcoholic FLD (NAFLD) and alcoholic FLD (AFLD), in a large cohort of nonobese and obese individuals. METHODS: A cohort study was performed with 437,828 Korean adults who were followed up for up to 14 years. Steatosis was diagnosed based on ultrasonography; fibrosis severity was determined by the fibrosis 4 (FIB-4) score. Vital status and liver-related deaths were ascertained through linkage to national death records. RESULTS: The prevalence of NAFLD and AFLD was 20.9% and 4.0%, respectively. During 3,145,541.1 person-years of follow-up, 109 liver-related deaths were identified (incidence rate of 3.5 per 105 person-years). When changes in fatty liver status, FIB-4 scores, and confounders during follow-up were updated as time-varying covariates, compared with the reference (absence of both excessive alcohol use and FLD), the multivariable-adjusted hazard ratios with 95% confidence intervals for liver-related mortality among those with low, intermediate, and high FIB-4 scores were 0.43 (0.19-0.94), 2.74 (1.23-6.06), and 84.66 (39.05-183.54), respectively, among patients with NAFLD, whereas among patients with AFLD, the corresponding hazard ratios (95% confidence intervals) were 0.67 (0.20-2.25), 5.44 (2.19-13.49), and 59.73 (27.99-127.46), respectively. The associations were more evident in nonobese individuals than in obese individuals (P for interaction 5 0.004). DISCUSSION: In this large cohort of young and middle-aged individuals, NAFLD and AFLD with intermediate to high fibrosis scores were associated with an increased risk of liver-related mortality in a dose-dependent manner, especially among nonobese individuals.
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