Incidence of liver‐related morbidity and mortality in a population cohort of non‐alcoholic fatty liver disease. (14th July 2021)

• Record Type: Journal Article
• Authors: Männistö, Ville T.; Salomaa, Veikko; Färkkilä, Martti; Jula, Antti; Männistö, Satu; Erlund, Iris; Sundvall, Jouko; Lundqvist, Annamari; Perola, Markus; Åberg, Fredrik
• Is Part Of: Liver international. Volume 41:Number 11(2021)
• Page Start: 2590
• Page End: 2600
• Publication Date: 2021-07-14
• Subjects: advanced liver disease -- cirrhosis -- non‐alcoholic fatty liver disease; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.15004
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: Non‐alcoholic fatty liver disease (NAFLD) increases morbidity and mortality. However, patients in biopsy‐based cohorts are highly selected and the absolute risks of liver‐ and non‐liver outcomes in NAFLD in population remains undefined. We analysed both liver‐related and non‐liver‐related outcomes in Finnish population cohorts of NAFLD. Methods: We included 10 993 individuals (6707 men, mean age 53.3 ± 12.6 years) with NAFLD (fatty liver index ≥60) from the Finnish population‐based FINRISK and Health 2000 studies. Liver fibrosis was assessed by the dAAR score, and genetic risk by a recent polygenic risk score (PRS‐5). Incident liver‐related outcomes, cardiovascular disease (CVD), cancer and chronic kidney disease (CKD) were identified through linkage with national registries. Results: Mean follow‐up was 12.1 years (1128 069 person‐years). The crude incidence rate of liver‐related outcomes in NAFLD was 0.97/1000 person‐years. The cumulative incidence increased with age, being respectively 2.4% and 1.5% at 20 years in men and women aged 60 years at baseline, while the relative risks for CVD and cancer were 9‐16 times higher. The risk of CKD exceeded that of liver outcomes at a baseline age around 50 years. 20‐year cumulative incidence of liver‐related outcomes was 4.3% in the high, and 1.5% in the low PRS‐5 group. The dAAR score associated with liver outcomes, but not with extra‐hepatic outcomes. Conclusion: The absolute risk of liver‐related outcomes in NAFLD is low, with much higher risk of CVD and cancer, emphasizing the need for more individualized and holistic risk‐stratification in NAFLD.