title: The fatty liver index is associated with increased mortality in subjects referred to coronary angiography.
abstract: OBJECTIVE
  Fatty liver index (FLI), a surrogate parameter for nonalcoholic fatty liver disease, is an emerging risk factor for cardiovascular diseases and mortality. We aimed to evaluate whether FLI is associated with all-cause, cardiovascular, and non-cardiovascular mortality as well as fatal cancer in a cohort of subjects routinely referred to coronary angiography.
  
  
  RESULTS
  FLI was calculated using BMI (body mass index), waist circumference (WC), triglycerides (TG) and gamma-glutamyl transferase (GGT) in 3270 subjects who were referred to coronary angiography (1997-2000). The main outcome measures were Cox proportional hazard ratios (HRs) for mortality from all causes, cardiovascular causes, non-cardiovascular causes, and fatal cancer. After a median follow-up time of 7.7 years, 740 subjects (22.6%) had died. There were 437 deaths due to cardiovascular disease and 303 deaths due to non-cardiovascular disease. Age-, sex-, and BMI-adjusted HRs (with 95% confidence intervals) for all-cause, cardiovascular, and non-cardiovascular mortality in the highest compared to the lowest FLI quartile were 2.56 (1.90-3.43; p < 0.001), 2.17 (1.47-3.22; p < 0.001), and 3.49 (2.16-5.66; p < 0.001), respectively. In age-, sex-, and BMI-adjusted analyzes, we found no significant association of FLI with fatal cancer. Multivariate adjusted HRs for all-cause, cardiovascular, non-cardiovascular mortality, and fatal cancer in the highest compared to the lowest FLI quartile were 2.17 (1.58-2.99; p < 0.001), 1.64 (1.07-2.51; p = 0.023), 3.72 (2.22-6.24; p < 0.001), and 2.33 (1.01-5.41; p = 0.048) respectively.
  
  
  CONCLUSIONS
  In subjects referred to coronary angiography, high FLI levels are independently associated with increased all-cause, cardiovascular, and non-cardiovascular mortality as well as fatal cancer.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: elisabeth.lerchbaum@medunigraz.at.
authors.forename: E
authors.initials: E
authors.lastname: Lerchbaum
authors.forename: S
authors.initials: S
authors.lastname: Pilz
authors.forename: T B
authors.initials: TB
authors.lastname: Grammer
authors.forename: B O
authors.initials: BO
authors.lastname: Boehm
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.forename: B
authors.initials: B
authors.lastname: Obermayer-Pietsch
authors.forename: W
authors.initials: W
authors.lastname: März
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000097:blood / Q000150:complications / Q000401:mortality*; D017023:Coronary Angiography; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D014280:Triglycerides; D005723:gamma-Glutamyltransferase
keywords: ALT; AP; AST; All-cause mortality; BMI; C-reactive protein; CRP; Cardiovascular disease; FLI; GGT; HOMA-IR; HR; Hepatic steatosis; MS; NAFLD; Non-cardiovascular mortality; Nonalcoholic fatty liver disease; OR; TG; WC; WHR; alanine aminotransferase; alkaline phosphatase; aspartate aminotransferase; body mass index; fatty liver index; gamma-glutamyl transferase; hazard ratio; homeostatic model assessment-insulin resistance; metabolic syndrome; nonalcoholic fatty liver disease; odds ratio; triglycerides; waist circumference; waist-to-hip ratio