Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

doi:10.3350/cmh.2021.0332

. 2022 Jul;28(3):510-521.

doi: 10.3350/cmh.2021.0332. Epub 2022 Mar 17.

Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

Seogsong Jeong^{1

2}, Yun Hwan Oh³, Seulggie Choi⁴, Jooyoung Chang¹, Sung Min Kim¹, Joung Sik Son⁵, Gyeongsil Lee^{1

6}, Joseph C Ahn⁷, Dong Hyeon Lee⁸, Bo Kyung Koo⁹, Won Kim^{8

10}, Sang Min Park^{1

11}

Affiliations

¹ Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
² Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.
³ Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
⁴ Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
⁵ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
⁶ Estherformula Medical Food R&D Center, Seoul, Korea.
⁷ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
⁹ Division of Endocrinology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁰ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
¹¹ Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.

PMID: 35299291
PMCID: PMC9293607
DOI: 10.3350/cmh.2021.0332

Free PMC article

Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

Seogsong Jeong et al. Clin Mol Hepatol. 2022 Jul.

Free PMC article

. 2022 Jul;28(3):510-521.

doi: 10.3350/cmh.2021.0332. Epub 2022 Mar 17.

Authors

Affiliations

¹ Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
² Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.
³ Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
⁴ Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
⁵ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
⁶ Estherformula Medical Food R&D Center, Seoul, Korea.
⁷ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
⁹ Division of Endocrinology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁰ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
¹¹ Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.

PMID: 35299291
PMCID: PMC9293607
DOI: 10.3350/cmh.2021.0332

Abstract

Background/aims: Accumulating evidence suggests a link between non-alcoholic fatty liver disease (NAFLD) and brain health. However, population-based evidence on the association between NAFLD and dementia remains unclear. This study was conducted to determine the association between NAFLD and incident dementia.

Methods: The study population included 608,994 adults aged ≥60 years who underwent health examinations between 2009 and 2010. Data were collected from the Korean National Health Insurance Service database. NAFLD was assessed using the fatty liver index (FLI). A Cox proportional hazards regression model was used to determine the association between NAFLD and dementia.

Results: During the 6,495,352 person-years of follow-up, 48,538 participants (8.0%) developed incident dementia. The participants were classified into low (FLI <30), intermediate (FLI ≥30 and <60), and high (FLI ≥60) groups. In the overall study population, the FLI groups were associated with a risk of dementia (P for trend <0.001). After propensity score matching, a low FLI was associated with a reduced risk of dementia (adjusted hazard ration [aHR], 0.96; 95% confidence interval [CI], 0.93-0.98; P=0.002), whereas a high FLI (NAFLD) was associated with an increased risk of dementia (aHR, 1.05; 95% CI, 1.02-1.08; P=0.001). A higher risk of dementia in the high FLI group than in the intermediate FLI group was attributed to Alzheimer's disease (aHR, 1.04; 95% CI, 1.01-1.07; P=0.004) rather than vascular dementia (aHR, 0.94; 95% CI, 0.75-1.18; P=0.602).

Conclusion: NAFLD was associated with an increased risk of dementia, which was attributed to an increased risk of Alzheimer's disease.

Keywords: Alzheimer disease; Epidemiology; Non-alcoholic fatty liver disease; Vascular dementia.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

**Figure 1.**
Flow diagram for the inclusion of study population. ALT, alanine aminotransferase; AST, aspartate aminotransferase; γ-GT, γ-glutamyltransferase; HDL, high-density lipoprotein.

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Comment in

Association of nonalcoholic fatty liver disease with incident dementia later in life among elderly adults.
Ye BS. Ye BS. Clin Mol Hepatol. 2022 Jul;28(3):481-482. doi: 10.3350/cmh.2022.0097. Epub 2022 May 16. Clin Mol Hepatol. 2022. PMID: 35570004 Free PMC article. No abstract available.

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References

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[1] Wu YT, Beiser AS, Breteler MMB, Fratiglioni L, Helmer C, Hendrie HC, et al. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13:327–339. - PubMed

[2] Wu YT, Beiser AS, Breteler MMB, Fratiglioni L, Helmer C, Hendrie HC, et al. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13:327–339. - PubMed

[3] Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: a review of the literature. J Am Acad Nurse Pract. 2008;20:423–428. - PubMed

[4] Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: a review of the literature. J Am Acad Nurse Pract. 2008;20:423–428. - PubMed

[5] GBD 2016 Dementia Collaborators Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990- 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. - PMC - PubMed

[6] GBD 2016 Dementia Collaborators Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990- 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. - PMC - PubMed

[7] Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24:908–922. - PMC - PubMed

[8] Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24:908–922. - PMC - PubMed

[9] Satizabal CL, Beiser AS, Chouraki V, Chêne G, Dufouil C, Seshadri S. Incidence of dementia over three decades in the Framingham heart study. N Engl J Med. 2016;374:523–532. - PMC - PubMed

[10] Satizabal CL, Beiser AS, Chouraki V, Chêne G, Dufouil C, Seshadri S. Incidence of dementia over three decades in the Framingham heart study. N Engl J Med. 2016;374:523–532. - PMC - PubMed

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Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

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Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

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