Cardiovascular Health Metrics in the Development and Regression of Nonalcoholic Fatty Liver Disease: A Cohort Study

Cardiovascular Health (CVH) metrics scores are associated with cardiovascular disease but whether CVH scores are associated with nonalcoholic fatty liver disease (NAFLD) is uncertain. Our aim was to investigate associations between CVH scores and development or regression of NAFLD. A cohort study was performed in Korean adults who underwent a comprehensive health examination. The CVH metrics were defined according to the American Heart Association Life's Simple 7 metrics, ranging from 0 (all metrics considered unhealthy) to 7 (all metrics considered healthy). Fatty liver was diagnosed by ultrasound, and liver fibrosis assessed using NAFLD fibrosis score (NFS). Among 93,500 participants without NAFLD or fibrosis at baseline, 15,899 developed NAFLD, and 998 developed NAFLD plus intermediate/high NFS. Healthy CVH metrics were inversely associated with NAFLD and also NAFLD with fibrosis. In time-dependent models after updating the CVH score and confounders as time-varying covariate, the multivariable-adjusted hazard ratio (95% confidence intervals) for incident NAFLD plus intermediate/high NFS participants with CVH metrics score 2, 3, 4, 5, or 6-7 to those with score 0-1 were 0.86 (0.59-1.25), 0.51 (0.36-0.73), 0.44 (0.31-0.62), 0.20 (0.14-0.29) and 0.09 (0.05-0.14), respectively. Regression of NAFLD occurred in 9742/37,517 participants who had NAFLD at baseline with positive association with CVH metrics. Higher CVH scores were significantly associated with both (a) decreased incidence of NAFLD, and (b) regression of existing NAFLD. Promoting adherence to ideal CVH metrics can be expected to reduce the burden of NAFLD as well as cardiovascular disease.