title: Fatty liver index and mortality: the Cremona study in the 15th year of follow-up.
abstract: A fatty liver, which is a common feature in insulin-resistant states, can lead to chronic liver disease. It has been hypothesized that a fatty liver can also increase the rates of non-hepatic-related morbidity and mortality. Therefore, we wanted to determine whether the fatty liver index (FLI), a surrogate marker and a validated algorithm derived from the serum triglyceride level, body mass index, waist circumference, and γ-glutamyltransferase level, was associated with the prognosis in a population study. The 15-year all-cause, hepatic-related, cardiovascular disease (CVD), and cancer mortality rates were obtained through the Regional Health Registry in 2011 for 2074 Caucasian middle-aged individuals in the Cremona study, a population study examining the prevalence of diabetes mellitus in Italy. During the 15-year observation period, 495 deaths were registered: 34 were hepatic-related, 221 were CVD-related, 180 were cancer-related, and 60 were attributed to other causes. FLI was independently associated with the hepatic-related deaths (hazard ratio = 1.04, 95% confidence interval = 1.02-1.05, P < 0.0001). Age, sex, FLI, cigarette smoking, and diabetes were independently associated with all-cause mortality. Age, sex, FLI, systolic blood pressure, and fibrinogen were independently associated with CVD mortality; meanwhile, age, sex, FLI, and smoking were independently associated with cancer mortality. FLI correlated with the homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance (Spearman's ρ = 0.57, P < 0.0001), and when HOMA-IR was included in the multivariate analyses, FLI retained its association with hepatic-related mortality but not with all-cause, CVD, and cancer-related mortality.
  
  
  CONCLUSIONS
  FLI is independently associated with hepatic-related mortality. It is also associated with all-cause, CVD, and cancer mortality rates, but these associations appear to be tightly interconnected with the risk conferred by the correlated insulin-resistant state.
authors.affiliation: Division of Metabolic and Cardiovascular Sciences, H. San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Guido
authors.initials: G
authors.lastname: Lattuada
authors.forename: Francesca
authors.initials: F
authors.lastname: Ragogna
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Garancini
authors.forename: Paolo
authors.initials: P
authors.lastname: Crosignani
authors.forename: Marco
authors.initials: M
authors.lastname: Villa
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bosi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruotolo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Piemonti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Perseghin
mesh_terms: D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005234:Fatty Liver / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D007558:Italy; D008107:Liver Diseases / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D014280:Triglycerides / Q000097:blood*; D055105:Waist Circumference; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D014280:Triglycerides; D005723:gamma-Glutamyltransferase