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Ode to the liver enzyme

▸ Dunn W, Xu R, Wingard DL, et al. Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study. Am J Gastroenterol 2008;103:2263–71.

Cohort studies suggest that non-alcoholic fatty liver disease (NAFLD) is associated with increased all-cause and cardiovascular mortality. Mechanistic studies indicate that NAFLD itself may be an independent cardiovascular risk factor. Dunn et al compared the survival of subjects with and without suspected NAFLD in a population-based cohort. The NHANES (National Health and Nutrition Examination Survey) cohort included 980 subjects with NAFLD suspected based on unexplained elevation of alanine aminotransferase (ALT), and 6594 subjects without NAFLD. ALT was considered elevated when the levels were >30 U/l for men and >19 U/l for women. Mortality for NHANES-III participants was analysed using the National Death Index. Over a mean of 8.7 years, suspected NAFLD had a hazards ratio of 1.37 (95% CI 0.98 to 1.91) for all-cause mortality. In the 45–54 age group, suspected NAFLD had significantly higher all-cause (4.40, 95% CI 1.27 to 13.23) and cardiovascular mortality (8.15, 95% CI 2.00 to 33.20) …

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