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)
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
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
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