The 3 factors that increase your risk of death if you have fatty liver disease

Fatty liver disease is defined as the presence of more than 5% fat in this organ and already affects between 25 and 30% of the population. Also known as metabolically associated steatotic liver disease (MASLD), it is the most common chronic liver disease worldwide and can lead to other serious health problems, such as advanced liver, heart, and kidney disease. To date, little research has been conducted to examine whether certain cardiometabolic risk factors are more associated with mortality than others.

Fatty liver disease occurs when fat accumulates in the liver and is associated with one or more of five conditions: obesity, type 2 diabetes, high blood pressure, high blood sugar, and low HDL cholesterol (the "good" cholesterol). These conditions are considered cardiometabolic risk factors because they affect the heart or metabolism.

Now, a new study from Keck Medicine of USC, published in Clinical Gastroenterology and Hepatology, reveals that the three factors that carry the highest risk of death for those with fatty liver disease are high blood pressure, prediabetes or type 2 diabetes, and low HDL, which increase the odds by 40%, 25%, and 15%, respectively.

These results were independent of how many or what combination of cardiometabolic risk factors the patients had and remained stable regardless of the individuals' gender, sex, race, or ethnicity.

"MASLD is a complex disease, and this study sheds new light on where physicians should focus their efforts when treating patients. Understanding which aspects of the disease might lead to worse outcomes will help us provide patients with the best possible care," said Norah A. Terrault, M.D., a Keck Medicine hepatologist and senior author of the study.

The researchers were particularly surprised to find that high blood pressure was associated with a higher likelihood of death than diabetes, explains Matthew Dukewich, MD, PHARMA, M.D., a USC transplant hepatology fellow and senior author on the study. "Until now, it was commonly believed that diabetes was the most pressing health problem for patients with MASLD, which is a key finding," he concludes.

The study also revealed that obesity, the most common cardiometabolic risk factor for MASLD, can significantly increase mortality risk depending on the patient's body mass index (BMI) . The higher the BMI, the stronger the association with mortality.

Furthermore, the research adds to the growing number of studies indicating that patients with more cardiometabolic risk factors have worse prognoses. The risk of death in patients with MASLD increased by 15% for each additional cardiometabolic risk factor present, according to this study.

Researchers used data from the National Health and Nutrition Examination Survey (NHANES), which collected health information on children and adults in the United States between 1988 and 2018, the most recent year for which data were available. Of 134,515 participants aged 20 years and older, approximately 21,000 had MASLD. The study authors tracked all-cause mortality rates according to individual cardiometabolic risk factors to reach their conclusions.

Looking ahead, the authors hope to conduct further studies examining patients' genetic background, dietary habits, and alcohol consumption in relation to fatty liver outcomes to provide more comprehensive risk profiles. "The better we understand the triggers of the disease, the better we can identify those most in need of interventions and prioritize our resources for better outcomes," Terrault says.