Cardiovascular Health Metrics in the Development and Regression of Nonalcoholic Fatty Liver Disease: A Cohort Study.

Eun-Hee Jang,Sarah H Wild,Christopher D Byrne,Seolhye Kim,Soo-Jin Lee,Hocheol Shin,Yong Kyun Cho,Ki-Chul Sung,Yoosoo Chang,Seungho Ryu,Young Hwan Kim

doi:10.3390/jcm8050610

Abstract

Cardiovascular Health (CVH) metrics scores are associated with cardiovascular disease but whether CVH scores are associated with nonalcoholic fatty liver disease (NAFLD) is uncertain. Our aim was to investigate associations between CVH scores and development or regression of NAFLD. A cohort study was performed in Korean adults who underwent a comprehensive health examination. The CVH metrics were defined according to the American Heart Association Life’s Simple 7 metrics, ranging from 0 (all metrics considered unhealthy) to 7 (all metrics considered healthy). Fatty liver was diagnosed by ultrasound, and liver fibrosis assessed using NAFLD fibrosis score (NFS). Among 93,500 participants without NAFLD or fibrosis at baseline, 15,899 developed NAFLD, and 998 developed NAFLD plus intermediate/high NFS. Healthy CVH metrics were inversely associated with NAFLD and also NAFLD with fibrosis. In time-dependent models after updating the CVH score and confounders as time-varying covariate, the multivariable-adjusted hazard ratio (95% confidence intervals) for incident NAFLD plus intermediate/high NFS participants with CVH metrics score 2, 3, 4, 5, or 6–7 to those with score 0–1 were 0.86 (0.59–1.25), 0.51 (0.36–0.73), 0.44 (0.31–0.62), 0.20 (0.14–0.29) and 0.09 (0.05–0.14), respectively. Regression of NAFLD occurred in 9742/37,517 participants who had NAFLD at baseline with positive association with CVH metrics. Higher CVH scores were significantly associated with both (a) decreased incidence of NAFLD, and (b) regression of existing NAFLD. Promoting adherence to ideal CVH metrics can be expected to reduce the burden of NAFLD as well as cardiovascular disease.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and includes a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) with varying degrees of fibrosis and cirrhosis [1]
In the cohort without NAFLD at baseline, there was an inverse independent association between the number of ideal cardiovascular health (CVH) metrics and development of: (a) overall NAFLD and (b) NAFLD with fibrosis based on non-invasive measures of liver fibrosis indices
These associations were pronounced when changes in ideal CVH metrics and confounders during follow-up were treated as time-varying covariates

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and includes a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) with varying degrees of fibrosis and cirrhosis [1]. The Life’s Simple 7 has been introduced with the definition of ideal CVH metrics and an emphasis on the importance of primordial prevention of CVD through achievement and maintenance of ideal CVH metrics [5,7]. Previous studies, including a meta-analysis of prospective studies on ideal CVH metrics, have demonstrated a strong inverse association between ideal CVH metrics and both CVD and non-CVD outcomes, including diabetes mellitus, cancer, and all-cause mortality [8,9,10,11]. Previous studies have shown associations between NAFLD and individual behavioral factors, such as diet and physical activity [12], to date it remains uncertain whether ideal CVH metrics are associated with development or regression of NAFLD

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