Article Text

Download PDFPDF
Components of metabolic syndrome are independent predictors of mortality in patients with chronic liver disease: a population-based study
  1. Maria Stepanova1,
  2. Nila Rafiq2,
  3. Zobair M Younossi1,2
  1. 1Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System Falls Church, Virginia, USA
  2. 2Betty and Guy Beatty Center for Integrated Research, Inova Health System Falls Church, Virginia, USA
  1. Correspondence to Zobair M Younossi, Center for Liver Diseases at Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA; zobair.younossi{at}


Objective Chronic liver disease (CLD) is a major cause of mortality and morbidity worldwide. The aim of this study was to assess the overall and liver-related mortality and their predictors in patients with CLD using population data.

Methods The Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data were utilised. Participants from NHANES III (1988–1994) and their mortality status were updated by the Center for Disease Control (CDC) as of 31 December 2006. In this study, the aetiology of CLD was based on available serological tests and clinical data. Each diagnostic cohort was compared with a cohort without liver disease using stratum-specific χ2. The Cox proportional hazard model was used for analysis, and HRs adjusted for all major confounders; overall mortality and cause-specific mortality were calculated for each type of liver disease. All analyses were run using SAS-callable SUDAAN 10.0 functions using remote access to the CDC Research Data Center server with restricted use linked mortality data.

Results The study cohort included 15 866 NHANES III participants with complete clinical, demographic, laboratory and mortality follow-up data. Of these, 235 subjects had alcohol-related liver disease (ALD), 66 had chronic hepatitis B (CH-B), 264 had chronic hepatitis C (CH-C), 991 were presumed to have non-alcoholic fatty liver disease (NAFLD) and 505 had other liver disease. Additionally, 13 004 subjects without evidence of liver disease served as controls. The analysis shows that type II diabetes (DM) and/or insulin resistance (IR) are independent predictors of overall mortality in CH-B, NAFLD and ALD (p <0.05). Additionally, DM, IR, obesity and metabolic syndrome could be independent predictors of liver-related mortality in CH-C, NAFLD and ALD.

Conclusions Components of metabolic syndrome are associated with overall and liver-related mortality in subjects with CLD.

  • Non-alcoholic steatohepatitis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Linked articles 219907.

  • Funding This study was partly supported by the Liver Outcomes Research Fund of The Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia.

  • Competing interests None.

  • Ethics approval The study was approved by the Inova Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles