title: Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality.
abstract: OBJECTIVE
  To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.
  
  
  METHODS
  In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality.
  
  
  RESULTS
  At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.
  
  
  CONCLUSIONS
  A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Altan
authors.initials: A
authors.lastname: Onat
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Günay
authors.initials: G
authors.lastname: Can
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Ayşem
authors.initials: A
authors.lastname: Kaya
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Tuğba
authors.initials: T
authors.lastname: Akbaş
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Özpamuk-Karadeniz
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Şimşek
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Çakır
authors.affiliation: Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
authors.forename: Hüsniye
authors.initials: H
authors.lastname: Yüksel
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002423:Cause of Death; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology
keywords: All-cause death; Coronary heart disease; Hepatic steatosis; Metabolic syndrome; Turkish adult risk factor study