Abstract
Background: Nonalcoholic fatty liver disease is considered to be the hepatic component of metabolic syndrome (MetS). However, the association between changes in MetS status and the risk of liver cirrhosis (LC) has not been investigated to date. This study assessed the association between changes in MetS and subsequent nonviral LC development. Methods: Data were obtained from the Korean National Health Insurance Service. Individuals who participated in health screenings from both 2009 to 2010 and 2011 to 2012 were included. The primary outcome was LC development according to the static and dynamic MetS status. Subjects were stratified into four groups according to the change in MetS status observed from the two-year interval screening (2009–2011). Cox regression analysis was used to examine the hazard ratios of LC. Results: During a median of 7.3 years of follow-up, 24,923 incident LC cases developed among 5,975,308 individuals. After adjusting for age, sex, smoking, alcohol, regular exercise, and body mass index, the adjusted hazard ratios (95% confidence intervals) for LC development were 1.39 (1.33–1.44) for the MetS-Developed group, 1.32 (1.26–1.37) for the MetS-Recovered group, and 1.51 (1.45–1.56) for the MetS-Sustained group, relative to the MetS-Free group. Stratified analyses according to age, sex, smoking, alcohol intake, exercise, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease showed similar results. Conclusions: Both static and dynamic MetS status are independent risk factors for LC development. The risk of LC was the highest in people with sustained MetS and was lower in the MetS-Recovered group than in the MetS-Sustained group. These results suggest that improving a person’s MetS status may be helpful in preventing LC.
Highlights
Liver cirrhosis (LC) is the end-stage of various chronic liver diseases and is characterized by the pathological features of necro-inflammation and fibrosis with regenerative nodules [1]
The etiologies of cirrhosis vary according to geographic region, with alcohol and nonalcoholic fatty liver disease (NAFLD) more common in Western and industrialized countries, while viral hepatitis is often found in China and other Asian countries [6]
After adjustment for age, sex, smoking, alcohol, regular physical activity, and Body mass index (BMI), waist circumference (WC), fasting glucose, low high-density lipoprotein (HDL), and the presence of hypertension were the significant risk factors for developing liver cirrhosis (LC)
Summary
Liver cirrhosis (LC) is the end-stage of various chronic liver diseases and is characterized by the pathological features of necro-inflammation and fibrosis with regenerative nodules [1] It is a significant global health burden, triggering high morbidity and mortality rates; more than one million people die from LC [2,3], and patients with compensated cirrhosis and decompensated cirrhosis have a fivefold and tenfold increased risk of mortality, respectively, relative to the general population [4]. One study that included biopsy-proven NAFLD patients showed that the presence of MetS was associated with a high risk of severe fibrosis with an odds ratio of 3.5, but this study was limited by its small number of participants [10].
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