Metabolic syndrome, but not non‐alcoholic fatty liver disease, increases 10‐year mortality: A prospective, community‐cohort study.

Background: Data on outcomes of non‐alcoholic fatty liver disease (NAFLD) from South Asia are lacking. We compared mortality, among those with‐ and without‐NAFLD, after 10‐years follow‐up among urban, adult Sri Lankans. Method: Participants (aged 35‐64 years), selected by age‐stratified random sampling, were screened by structured‐interview in 2007. Anthropometric measurements, liver ultrasonography and biochemical/serological tests were done. NAFLD was diagnosed on ultrasound criteria, safe‐alcohol consumption (Asian‐standards) and absence of hepatitis B/C. Subjects without NAFLD were those without any ultrasound criteria of fatty liver, safe‐alcohol consumption and absence of hepatitis B/C. The cohort was re‐evaluated to assess mortality in 2017. Participants or their households were contacted by telephone/post, and deaths confirmed by home‐visits and death certificate review. Cox‐regression was used to determine predictors of all‐cause mortality (ACM) and cardiovascular mortality (CVM) in those with‐ and without‐NAFLD. Results: 2724 (91.2%) of 2985 original participants were contacted (851‐with NAFLD and 1072‐without NAFLD). Overall there were 169 (6.2%) deaths [41‐deaths among NAFLD (17‐cardiovascular; 9‐cancer‐related; 4‐liver‐specific; 11‐other) and 79‐deaths among no‐NAFLD (28‐cardiovascular; 17‐cancer‐related; 1‐liver‐specific; 33‐other)]. Metabolic syndrome (MetS), low‐education level, higher age and male‐gender independently predicted ACM. MetS, increasing age and male‐gender independently predicted CVM. NAFLD did not predict either ACM or CVM. In those with NAFLD, MetS and age >55‐years were independently associated with ACM, while MetS and male‐gender were associated with CVM. Conclusion: In this community‐based study, increasing age, male‐gender and MetS, but not NAFLD, predicted 10‐year ACM and CVM. Among those with NAFLD, only those metabolically abnormal were at a higher risk for mortality. [ABSTRACT FROM AUTHOR]