title: Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study.
abstract: OBJECTIVE
  To evaluate the association between non-alcoholic fatty liver disease and all cause and cause specific mortality in a representative sample of the US general population.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  US Third National Health and Nutrition Examination Survey (NHANES III: 1988-94) with follow-up of mortality to 2006.
  
  
  METHODS
  11,371 adults aged 20-74 participating in the Third National Health and Nutrition Examination Survey, with assessment of hepatic steatosis.
  
  
  METHODS
  Mortality from all causes, cardiovascular disease, cancer, and liver disease (up to 18 years of follow-up).
  
  
  RESULTS
  The prevalence of non-alcoholic fatty liver disease with and without increased levels of liver enzymes in the population was 3.1% and 16.4%, respectively. Compared with participants without steatosis, those with non-alcoholic fatty liver disease but normal liver enzyme levels had multivariate adjusted hazard ratios for deaths from all causes of 0.92 (95% confidence interval 0.78 to 1.09), from cardiovascular disease of 0.86 (0.67 to 1.12), from cancer of 0.92 (0.67 to 1.27), and from liver disease of 0.64 (0.12 to 3.59). Compared with participants without steatosis, those with non-alcoholic fatty liver disease and increased liver enzyme levels had adjusted hazard ratios for deaths from all causes of 0.80 (0.52 to 1.22), from cardiovascular disease of 0.59 (0.29 to 1.20), from cancer of 0.53 (0.26 to 1.10), and from liver disease of 1.17 (0.15 to 8.93).
  
  
  CONCLUSIONS
  Non-alcoholic fatty liver disease was not associated with an increased risk of death from all causes, cardiovascular disease, cancer, or liver disease.
authors.affiliation: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. mlazo@jhsph.edu
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.forename: Susanne
authors.initials: S
authors.lastname: Bonekamp
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016001:Confidence Intervals; D005234:Fatty Liver / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D014481:United States / Q000453:epidemiology
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