title: Associations of the fatty liver and hepatic steatosis indices with risk of cardiovascular disease: Interrelationship with age.
abstract: BACKGROUND
  The fatty liver index (FLI) and the hepatic steatosis index (HSI), are biomarker-based algorithms developed as proxies for non-alcoholic fatty liver disease (NAFLD). We assessed associations of FLI and HSI with cardiovascular disease (CVD) risk.
  
  
  METHODS
  The FLI and HSI were estimated at baseline in the PREVEND cohort involving 6340 participants aged 28-75years without pre-existing CVD.
  
  
  RESULTS
  During a median follow-up of 10.5years, 631 CVD events occurred. In age-and sex-adjusted analysis, the hazard ratio (HR) (95% CI) for CVD comparing FLI≥60 versus FLI<30 was 1.53 (1.25-1.88); which was attenuated to 0.89 (0.70-1.13) on adjustment for conventional cardiovascular risk factors. The association remained absent after additional adjustment for potential confounders 0.85 (0.65-1.11). Comparing HSI>36 versus HSI<30, the corresponding adjusted HRs were 1.29 (1.02-1.65), 0.84 (0.65-1.09) and 0.79 (0.55-1.13) respectively. Subgroup analyses suggested a positive association in younger participants (<50years) for FLI and inverse associations in older participants (≥50years) for both indices (P for interaction for all=0.001).
  
  
  CONCLUSIONS
  Current data suggest age interactions in the association of NAFLD (as assessed by FLI or HSI) with CVD risk in a general Caucasian population.
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK. Electronic address: skk31@cantab.net.
authors.forename: Setor K
authors.initials: SK
authors.lastname: Kunutsor
authors.affiliation: Department of Nephrology Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands.
authors.forename: Stephan J L
authors.initials: SJL
authors.lastname: Bakker
authors.affiliation: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center, Groningen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Blokzijl
authors.affiliation: Department of Endocrinology, University of Groningen and University Medical Center, Groningen, The Netherlands.
authors.forename: Robin P F
authors.initials: RPF
authors.lastname: Dullaart
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D044465:White People
keywords: Cardiovascular disease; Fatty liver index; Hepatic steatosis index; Non-alcoholic fatty liver disease; Risk factor