Type 2 & other diabetes

Hepatic metabolic burden and all-cause mortality across glucose metabolism statuses in a cardiovascular-kidney-metabolic syndrome population: insights from the National Health and Nutrition Examination Survey (NHANES)

Cardiovasc DiabetolPublished Cohort study

Authors' conclusion

Within the CKM syndrome spectrum, elevated FLI was associated with a higher risk of all-cause mortality among individuals with diabetes, with a J-shaped association, whereas the association between FLI and all-cause mortality was not significant among individuals with normoglycemia or prediabetes. These findings suggest that the relationship between FLI and mortality in CKM populations may vary according to glycemic status and highlight the importance of considering glycemic context when interpreting liver-related metabolic markers.

Study context

Population
Adults with cardiovascular-kidney-metabolic (CKM) syndrome per AHA/ADA framework, NHANES 1999–2018weighted N = 105,007,226
Participants
19,107 adults
Exposure
Fatty liver index (FLI) and all-cause mortality across glucose metabolism statuses
Outcome
All-cause mortality
Follow-up
Median 9.42 years
Methodological detailsNHANES 1999-2018, weighted multivariable Cox proportional hazards models, restricted cubic spline analyses, joint analyses, multiple sensitivity analyses
  • NHANES 1999-2018
  • Weighted multivariable Cox proportional hazards models
  • Restricted cubic spline analyses
  • Joint analyses
  • Multiple sensitivity analyses

Main finding

As reported in the abstract

Association of FLI with all-cause mortality by glucose metabolism status

Deaths

2482

Observational data: associations, not effects.

Further findings

Joint analyses of FLI (≥60 vs <60) and glycemic categories

Elevated FLI associated with progressively higher death risk with impaired glucose metabolism; highest risk with diabetes and FLI ≥ 60

Sensitivity analyses

Multiple sensitivity analyses confirmed the main results were robust

Original publication

Hepatic metabolic burden and all-cause mortality across glucose metabolism statuses in a cardiovascular-kidney-metabolic syndrome population: insights from the National Health and Nutrition Examination Survey (NHANES). Cardiovasc Diabetol. Published 9 April 2026. doi:10.1186/s12933-026-03159-3

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