Steatohepatitis/Metabolic Liver Disease

Fatty liver index and mortality: The cremona study in the 15th year of follow-up

Calori, Giliola1; Lattuada, Guido1,4; Ragogna, Francesca1; Garancini, Maria Paola2; Crosignani, Paolo5; Villa, Marco6; Bosi, Emanuele1; Ruotolo, Giacomo1,7; Piemonti, Lorenzo3; Perseghin, Gianluca1,4

Author Information

1Division of Metabolic and Cardiovascular Sciences, H. San Raffaele Scientific Institute, Milan, Italy

2Medical Direction, H. San Raffaele Scientific Institute, Milan, Italy

3Diabetes Research Institute, H. San Raffaele Scientific Institute, Milan, Italy

4Department of Sport, Nutrition, and Health Sciences, University of Milan, Milan, Italy

5National Cancer Institute, Milan, Italy

6Epidemiology Service, Local Health Authority of the Province of Cremona, Cremona, Italy

7AstraZeneca R&D, Molndal, Sweden

Division of Metabolic and Cardiovascular Sciences, H. San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy 20132 E-mail:[email protected];fax:0039–02–26432771

Potential conflict of interest: Nothing to report.

This work was supported by a liberal donation from the family of Angela Musazzi and Mario Stellato

Giliola Calori contributed to the study concept and design, the acquisition of the data, the analysis and interpretation of the data, the critical revision of the article for important intellectual content, and the statistical analysis. Guido Lattuada and Francesca Ragogna contributed to the analysis and interpretation of the data and the critical revision of the article for important intellectual content. Maria Paola Garancini contributed to the study concept and design, the acquisition of the data, and the analysis and interpretation of the data. Paolo Crosignani and Marco Villa contributed to the acquisition of the data and the critical revision of the article for important intellectual content. Emanuele Bosi contributed to the critical revision of the manuscript for important intellectual content. Giacomo Ruotolo and Lorenzo Piemonti contributed to the study concept and design, the analysis and interpretation of the data, and the critical revision of the article for important intellectual content. Gianluca Perseghin contributed to the study concept and design, the acquisition of the data, the analysis and interpretation of the data, the drafting of the article, and the acquisition of funding.

See Editorial on Page 6

Hepatology 54(1):p 145-152, July 2011. | DOI: 10.1002/hep.24356

Abstract

 

A fatty liver, which is a common feature in insulin-resistant states, can lead to chronic liver disease. It has been hypothesized that a fatty liver can also increase the rates of non–hepatic-related morbidity and mortality. Therefore, we wanted to determine whether the fatty liver index (FLI), a surrogate marker and a validated algorithm derived from the serum triglyceride level, body mass index, waist circumference, and γ-glutamyltransferase level, was associated with the prognosis in a population study. The 15-year all-cause, hepatic-related, cardiovascular disease (CVD), and cancer mortality rates were obtained through the Regional Health Registry in 2011 for 2074 Caucasian middle-aged individuals in the Cremona study, a population study examining the prevalence of diabetes mellitus in Italy. During the 15-year observation period, 495 deaths were registered: 34 were hepatic-related, 221 were CVD-related, 180 were cancer-related, and 60 were attributed to other causes. FLI was independently associated with the hepatic-related deaths (hazard ratio = 1.04, 95% confidence interval = 1.02–1.05, P < 0.0001). Age, sex, FLI, cigarette smoking, and diabetes were independently associated with all-cause mortality. Age, sex, FLI, systolic blood pressure, and fibrinogen were independently associated with CVD mortality; meanwhile, age, sex, FLI, and smoking were independently associated with cancer mortality. FLI correlated with the homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance (Spearman's ρ = 0.57, P < 0.0001), and when HOMA-IR was included in the multivariate analyses, FLI retained its association with hepatic-related mortality but not with all-cause, CVD, and cancer-related mortality. Conclusion: FLI is independently associated with hepatic-related mortality. It is also associated with all-cause, CVD, and cancer mortality rates, but these associations appear to be tightly interconnected with the risk conferred by the correlated insulin-resistant state. (HEPATOLOGY 2011;)

Copyright © 2011 American Association for the Study of Liver Diseases.

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