Author information
1Sorbonne University, Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), AP-HP, Saint-Antoine Hospital, Paris, France.
2Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
3HepatoGastroenterology Department, Anger University Hospital, Angers, France.
4HIFIH Laboratory, UPRES EA3859, SFR 4208, Angers University, Angers, France.
5Hepatology Unit, Haut-Lévêque Hospital, Bordeaux University Hospital Branch, Bordeaux, France.
6Versailles-Saint Quentin University, UMS 11 Inserm, Versailles, France.
7Paris-Saclay University, Paris, France.
8Hepatogastroenterology Service, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
9Sorbonne University, Inserm UMR_S938, Paris, France.
10Infectious Diseases Department, Saint-Antoine Hospital, APHP, Paris, France.
Abstract
Background: The impact of non-alcoholic fatty liver disease (NAFLD) on morbidity and mortality has yet to be documented at the general population level. This study aimed to assess whether NAFLD was associated with morbidities and mortality and to estimate its impact on health status and mortality.
Methods: The study population consisted of 137 206 participants from Constances cohort. Non-invasive diagnosis of NAFLD and advanced fibrosis was performed using the fatty liver index and Forns index, respectively. Constances data were linked to health care and hospitalization data to identify liver-related events, cardiovascular diseases (CVD), extrahepatic cancers (EHC), chronic kidney disease (CKD) and all-cause mortality.
Results: The prevalence of NAFLD was 18.3% in subjects without other chronic liver diseases, among whom 2.7% had fibrosis. NAFLD after IPTW-weighted remained associated with an increased risk of death (HR 1.26, 95% CI 1.01-1.57), hepatic-related complications (HR 2.48, 95% CI 1.99-3.29), CVD (HR 1.42, 95% CI 1.30-1.55), EHC (HR 1.11, 95% CI 1.01-1.28) and CKD (HR 1.81, 95% CI 1.53-2.07) compared to those without chronic liver diseases risk factors (Non-NAFLD). In the trend analysis over the study period of inclusion and compared to Non-NAFLD, NAFLD has shown a fastest growing cause of hepatic events (HR 1.38, 95% CI 1.07-1.76 per year), CVD (HR 1.08, 95% CI 1.03-1.12), CKD (HR 1.16, 95% CI 1.07-1.25), and death (HR 1.39, 95% CI 1.39-1.50).
Conclusion: This large community-based cohort showed that NAFLD was associated with excess morbidity and mortality and demonstrated a fastest-growing trend.