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. 2020 Dec 21;17(24):9568.
doi: 10.3390/ijerph17249568.

The Association between Nonalcoholic Fatty Liver Disease and Stroke: Results from the Korean Genome and Epidemiology Study (KoGES)

Yun-Jung Yang  1 , Mi-Hyang Jung  2 , Seok-Hoo Jeong  3 , Yeon-Pyo Hong  4 , Yeong In Kim  5 , Sang Joon An  5
Affiliations

The Association between Nonalcoholic Fatty Liver Disease and Stroke: Results from the Korean Genome and Epidemiology Study (KoGES)

Yun-Jung Yang et al. Int J Environ Res Public Health. .

Abstract

(1) Background: Non-alcoholic fatty liver disease (NAFLD) is associated with various cardiometabolic diseases. However, the association between NAFLD and stroke is not well known. The purpose of our study is to reveal the relationship between NAFLD and Stroke incidence. (2) Methods: Using data from a Korean prospective cohort study, we excluded participants with heavy alcohol consumption and a history of stroke; hence, 7964 adults aged 40-69 years were included in this study. According to their fatty liver index (FLI), participants were divided into three groups: <30 (n = 4550, non-NAFLD), 30-59.9 (n = 2229, intermediate), and ≥60 (n = 1185, NAFLD). The incidence of stroke according to the degree of FLI was evaluated using the Cox proportional hazard model. (3) Results: During the 12-year follow-up period, 168 strokes occurred. A graded association between NAFLD and stroke incidence was observed, i.e., 1.7% (n = 76), 2.5% (n = 56), and 3.0% (n = 36) for non-NAFLD, intermediate, and NAFLD FLI groups, respectively. After adjusting for confounding variables and compared to the risk of stroke in the non-NAFLD group, the risk of stroke in the NAFLD group was the highest (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.17-3.34), followed by the risk of stroke in the intermediate group (HR: 1.41, 95% CI: 0.94-2.21) (p for trend < 0.001). However, the level of aspartate aminotransferase, alanine aminotransferase, or gamma-glutamyltransferase alone did not show any significant association with stroke. (4) Conclusions: This study demonstrated that the risk of stroke incidence gradually increased with the degree of FLI. Individuals with NAFLD should be properly counseled and monitored for risk for stroke.

Keywords: cohort studies; incidence; liver; non-alcoholic fatty liver disease; risk factors; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The study population in the present study was obtained from the Ansung–Ansan cohort study.
Figure 2
Figure 2
Adjusted cumulative hazard curves for the incidence of cerebrovascular diseases according to the FLI group. Adjusted for age, sex, hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, smoking and alcohol status, body mass index (BMI), metabolic equivalent of task (MET), cancer, hyperlipidemia drug, antihypertension drug, aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GTP). Estimated by Cox’s proportional hazard regression.
Figure 3
Figure 3
Hazard ratio (95% confidence interval) for the incident of cerebrovascular diseases according to the (A) AST, (B) ALT, and (C) gamma-glutamyltransferase (GGT). Model 1: sex, age. Model 2: model 1 + hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, smoking and alcohol status, and body mass index. Model 3: model 2 + metabolic equivalent of task, cancer, hyperlipidemia drug, antihypertension drug, and the metabolic equivalent of task. Estimated from Cox’s proportional hazard regression model.
See this image and copyright information in PMC

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