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Alcoholic and Nonalcoholic Fatty Liver Disease and Liver-Related Mortality

A Cohort Study

Chang, Yoosoo, MD, PhD1–3; Cho, Yong Kyun, MD, PhD4; Cho, Juhee, PhD1,3,5; Jung, Hyun-Suk, MD1; Yun, Kyung Eun, MD, PhD1; Ahn, Jiin, MSPH1; Sohn, Chong Il, MD, PhD4; Shin, Hocheol, MD, PhD1,6; Ryu, Seungho, MD, PhD1–3

American Journal of Gastroenterology: April 2019 - Volume 114 - Issue 4 - p 620–629
doi: 10.14309/ajg.0000000000000074
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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 = 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.

1Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea;

2Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea;

3Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea;

4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;

5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;

6Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Correspondence: Seungho Ryu, MD, PhD. E-mail: sh703.yoo@gmail.com. Yong Kyun Cho, MD, PhD. E-mail: choyk2004.cho@samsung.com.

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A11, http://links.lww.com/AJG/A12, http://links.lww.com/AJG/A13, http://links.lww.com/AJG/A14, and http://links.lww.com/AJG/A15

Received June 14, 2018

Accepted November 15, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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