title: Nonalcoholic Fatty Liver Disease Is Associated With QT Prolongation in the General Population.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is independently associated with QT prolongation among patients with diabetes. It has not yet been determined whether this association remains valid in the general population. We designed an observational study to explore this association.
  
  
  RESULTS
  We conducted a cross-sectional analysis of 31 116 consecutive participants in our health management program. Heart rate-corrected QT (QTc) interval was derived from 12-lead electrocardiography and by Bazett's formula. NAFLD was diagnosed by abdominal ultrasonography and classified as none, mild, moderate, or severe, according to the ultrasonographic criteria. A multivariable linear regression model was fitted for the association between QTc interval and potential predictors (including demographic, anthropometric, biochemical factors, and comorbidities). Multivariable logistic regression analyses were fitted to assess the association between the severity of NAFLD and QTc prolongation, with the adjustment of significant predictors derived from multivariable linear regression. The mean QTc interval was 421.3 ms (SD 45.4 ms). In the multivariable linear regression analyses, mild, moderate, and severe NAFLD were associated with increases of 2.55, 6.59, and 12.13 ms, respectively, in QTc interval compared with no NAFLD (all P<0.001). In the multivariable logistic regression analyses, mild, moderate, and severe NAFLD were associated with an increased risk for QTc prolongation, with odds ratios of 1.11 (95% CI: 1.01 to 1.21, P<0.05), 1.61 (95% CI: 1.36 to 1.9, P<0.001), and 1.31 (95% CI: 1.16 to 2.24, P<0.01), respectively, in women, and 1.11 (95% CI: 1.01 to 1.21, P<0.05), 1.39 (95% CI: 1.22 to 1.59, P<0.001), and 1.87 (95% CI: 1.16 to 2.24, P<0.001), respectively, in men, after adjusting for predictors known to be associated with the QTc interval. The association remained significant among subgroups with or without diabetes.
  
  
  CONCLUSIONS
  The severity of NAFLD was associated with a higher risk for QTc prolongation in the general population with and without diabetes.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.) Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., W.S.Y.).
authors.forename: Chi-Sheng
authors.initials: CS
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.) Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., W.S.Y.).
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.) Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., W.S.Y.).
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Tu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Chien-Chuan
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Hung-Ju
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Yi-Lwun
authors.initials: YL
authors.lastname: Ho
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.) Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., W.S.Y.).
authors.forename: Wei-Shiung
authors.initials: WS
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., Y.L.H., W.S.Y., M.S.W., M.F.C.).
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000200:Action Potentials; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008133:Long QT Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography
keywords: QT prolongation; diabetes; general population; nonalcoholic fatty liver disease