Fatty liver index is an independent risk factor for all-cause mortality and major cardiovascular events in type 1 diabetes: an 11-year observational study
Authors' conclusion
This observational prospective study shows that FLI is associated with higher all-cause mortality and increased risk of incident CV events in type 1 diabetes.
Study context
- Population
- Subjects with T1D (males 52%, 30.3 ± 11.1 years old, diabetes duration 18.5 ± 11.6 years, HbA1c 7.8 ± 1.2%); Fatty Liver Index (FLI) based on BMI, waist circumference, gamma-glutamyl transferase and TG736 with incidence data
- Participants
- 774 subjects
- Exposure
- FLI 30-59 and FLI ≥ 60 vs FLI < 30
- FLI < 30n = 515reference
- FLI 30-59n = 169
- FLI ≥ 60n = 90
- Outcome
- All-cause death and first CV events
- Follow-up
- median 11-year follow-up
Methodological details11-year follow-up
- 11-year follow-up
Main finding
As reported in the abstract
All-cause mortality
FLI < 30
3.9
%
FLI 30-59
10.1
%
FLI ≥ 60
22.2%
Each group vs FLI < 30Hazard ratio (95% CI)P value
FLI 30-59unadjusted Cox
2.85(1.49–5.45)
P = 0.002FLI ≥ 60unadjusted Cox
6.07(3.27–11.29)
P < 0.0001FLI 30-59adjusted for ST1-RE
1.52(0.78–2.97)
FLI ≥ 60adjusted for ST1-RE
3.04(1.59–5.82)
P = 0.001FLI 30-59adjusted for EURO-RE
1.24(0.62–2.48)
FLI ≥ 60adjusted for EURO-RE
2.54(1.30–4.95)
P = 0.007- Mortality increased steeply with FLI (trend)
- P < 0.0001
- Overall deaths
- 57 (7.4%)
Observational data: associations, not effects.
Further findings
| Outcome | FLI < 30 | FLI 30-59 | FLI ≥ 60 | HR (CI) | P value | |
|---|---|---|---|---|---|---|
| Incident CV events · median 11-year follow-upFLI 30-59vs FLI < 30Unadjusted Cox | 3.5 % | 10.5 % | 17.2% | 3.24 (1.65–6.34) | P = 0.001 | |
| Incident CV events · median 11-year follow-upFLI ≥ 60vs FLI < 30Unadjusted Cox | 5.41 (2.70–10.83) | P < 0.0001 | ||||
| 0.050.21520Hazard ratio (log scale) |
- Incident cardiovascular (CV) events — CV events incidence increased with FLI (trend)
- p < 0.0001
- Incident CV events — Overall CV events
- 49 (6.7%)
Incident CV events · median 11-year follow-up
- After adjustment for ST1-RE or EURODIAB Risk Engine (EURO-RE), FLI ≥ 60 remained statistically associated with risk of incident CV events, with trivial modification with prior CVD inclusion
Original publication
Fatty liver index is an independent risk factor for all-cause mortality and major cardiovascular events in type 1 diabetes: an 11-year observational study. Cardiovasc Diabetol. Published 28 February 2024. doi:10.
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