Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease

J Hepatol. 2008 Oct;49(4):608-12. doi: 10.1016/j.jhep.2008.06.018. Epub 2008 Jul 9.


Background/aims: The natural history of non-alcoholic fatty liver disease (NAFLD) remains to be defined. We conducted a study to determine the overall and liver-related mortality of NAFLD in the general US population.

Methods: In this study, the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES III-Linked Mortality File were used. Adjusted hazard ratios (HR) for overall and liver-related mortality were calculated for NAFLD using persons without liver disease as reference. Causes of death were determined.

Results: After a median follow-up of 8.7 years, 80 persons with NAFLD and 1453 without liver disease died. Older age, male gender, non-Hispanic white race, lower educational level, lower income, higher BMI, presence of hypertension, diabetes mellitus, or metabolic syndrome were significantly (p<0.05) associated with overall mortality. Persons with NAFLD had higher overall mortality [HR 1.038 (95% CI 1.036-1.041), P<0.0001] and liver-related mortality [HR 9.32 (95% CI 9.21-9.43), P<0.0001]. Liver disease was the third leading cause of death among persons with NAFLD after cardiovascular disease and malignancy.

Conclusions: NAFLD is associated with higher overall and liver-related mortality in the general US population. Liver disease is a significant cause of death among persons with NAFLD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Educational Status
  • Fatty Liver / complications
  • Fatty Liver / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys*
  • Proportional Hazards Models
  • Racial Groups
  • Retrospective Studies
  • Sex Factors
  • Socioeconomic Factors
  • United States / epidemiology
  • Young Adult