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Severity of fatty liver is highly correlated with the risk of hypertension and diabetes: a cross-sectional and longitudinal cohort study

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Abstract

Background and aims

Fatty liver disease (FLD) is associated with several metabolic derangements. We conducted a retrospective cross-sectional and longitudinal study to evaluate the role of FL severity in the risk of new-onset and co-existing hypertension (HTN) and diabetes mellitus (DM).

Methods

The cross-sectional cohort consisted of 41,888 adults who received health checkups in a tertiary hospital of Taiwan from 1999 to 2013. Of them, 34,865 without HTN and/or DM at baseline and within 1 year after enrollment were included as a longitudinal cohort (mean, 6.45 years for HTN; 6.75 years for DM). FL severity based on the degree of hepatic steatosis was assessed by ultrasound sonography.

Results

In cross-sectional cohort, 22,852 (54.6%) subjects had FL (18,203 [43.46%] mild FL and 4,649 [11.10%] moderate/severe FL); 13.5% (n = 5668) had HTN; and 3.4% (n = 1411) had DM. Moderate/severe FL and mild FL had significantly higher risks of existing HTN (adjusted odds ratio/95% confidence interval [CI] 1.59/1.43–1.77 and 1.22/1.13–1.32, respectively). In longitudinal cohort, 3,209 and 822 subjects developed new-onset HTN and DM, respectively (annual incidence, 14.3 and 3.5 per 1000 person-years; 10-year cumulative incidence, 14.35% and 3.89%, respectively). Moderate/severe and mild FL had significantly higher risks of new-onset HTN (adjusted hazard ratio [aHR]/CI 1.54/1.34–1.77 and 1.26/1.16–1.37, respectively) and DM (aHR/CI 5.88/4.44–7.81 and 3.22/2.56–4.07, respectively). Resolved FL during follow-up decreased the risk of HTN and/or DM.

Conclusions

Patients with FL are at high risk of prevalent and incident HTN and/or DM. The risk increases with the severity of FL.

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Data availability

The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.

Abbreviations

aHR:

Adjusted hazard ratio

ALT:

Alanine aminotransferase

aOR:

Adjusted odds ratio

AST:

Aspartate aminotransferase

BS:

Blood sugar

cHR:

Crude HR

CLR:

Cumulative lifetime risk

DBP:

Diastolic blood pressure

DM:

Diabetes

FL:

Fatty liver

FLD:

Fatty liver disease

HDL-C:

High-density lipoprotein cholesterol

HTN:

Hypertension

IFG:

Impaired fasting glucose

LDL-C:

Low-density lipoprotein cholesterol

NAFLD:

Non-alcoholic fatty liver disease

SBP:

Systolic blood pressure

USG:

Ultrasound sonography

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Acknowledgements

This study was supported by the Ministry of Health and Welfare, Pingtung Hospital, Kaohsiung Medical University Hospital, Taiwan Liver Research Foundation, and " Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University " and “ Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University” from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan.. The authors thank the secretaries of the Hepatobiliary Division of Kaohsiung Medical University Hospital.

Funding

This work was supported in part by a grant from 1. Kaohsiung Medical University (MOHW112-TDU-B-221-124007, MOST111-2314-B-037-069-MY2) 2. Kaohsiung Medical University Hospital (KMUH111-1R04, KMUH110-0M03).

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Author notes

  1. Chin-I. Shih and Kuan-Ta Wu have equally contributed to this work.

Authors and Affiliations

  1. Department of Medical Education and Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Chin-I. Shih

  2. School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan

    Chin-I. Shih, Wei-Lun Tsai, Wen-Chi Chen & Ming-Lung Yu

  3. Department of Preventive Medicine, and Health Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Kuan-Ta Wu, Meng-Hsuan Hsieh, Jeng-Fu Yang, Yi-Yu Chen & Chi-Kung Ho

  4. Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Wei-Lun Tsai & Wen-Chi Chen

  5. Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung City, 807, Taiwan

    Meng-Hsuan Hsieh, Po-Cheng Liang, Yu-Ju Wei, Pei-Chien Tsai, Po-Yao Hsu, Ming-Yen Hsieh, Yi-Hung Lin, Tyng-Yuan Jang, Chih-Wen Wang, Ming-Lun Yeh, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Wan-Long Chuang & Ming-Lung Yu

  6. School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan

    Meng-Hsuan Hsieh, Chih-Wen Wang, Ming-Lun Yeh, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Wan-Long Chuang & Ming-Lung Yu

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  1. Chin-I. Shih
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Contributions

All authors contributed to the study conception and design, material preparation, and data collection. The first draft of the manuscript was written by Chin-I Shih. Ming-Lung Yu critically reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ming-Lung Yu.

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Conflict of interest

Ming-Lung Yu has received research support from Abbvie, Abbott, BMS, Gilead, Merck, and Roche diagnostics; served as a consultant of Abbvie, Abbott, BMS, Gilead, Merck, Novartis, Roche, and Roche diagnostics; and served as a speaker of Abbvie, Abbott, BMS, Gilead, Merck, Roche, and Roche diagnostics. Chin-I Shih, Kuan-Ta Wu, Meng-Hsuan Hsieh, Jeng-Fu Yang, Yi-Yu Chen, Wei-Lun Tsai, Wen-Chi Chen, Po-Cheng Liang, Yu-Ju Wei, Pei-Chien Tsai, Po-Yao Hsu, Ming-Yen Hsieh, Yi-Hung Lin, Tyng-Yuan Jang, Chih-Wen Wang, Ming-Lun Yeh, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Chi-Kung Ho, Wan-Long Chuang declare that they have no conflict of interest.

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Shih, CI., Wu, KT., Hsieh, MH. et al. Severity of fatty liver is highly correlated with the risk of hypertension and diabetes: a cross-sectional and longitudinal cohort study. Hepatol Int 18, 138–154 (2024). https://doi.org/10.1007/s12072-023-10576-z

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