Abstract
Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is a chronic progressive illness with a spectrum of disease severity from steatosis to end-stage liver disease. Emerging evidence suggests total serum bilirubin levels are inversely related to the prevalence of metabolic syndrome including NAFLD. We investigated the effects of bilirubin on all-cause and cause-specific mortality stratified by NAFLD status. Methods: We used the third National Health and Nutrition Examination Survey Cohort (1988-1994) and linked mortality dataset through 2019. Cox-regression models were constructed to assess the association between bilirubin levels categorized by quartile with all-cause and cause-specific mortality. Results: During the median follow-up of 324 months (n=11,078), higher bilirubin levels were associated with a reduction in risk of all-cause mortality in the multivariable model [hazard ratio (HR): 0.83, 95% confidence interval (CI): 0.71-0.97 for quartile 4 (highest bilirubin levels) vs. quartile 1 (lowest bilirubin levels), p for trend=0.033]. Higher bilirubin levels were associated with a lower risk for all-cause mortality in individuals with NAFLD (HR=0.68, 95%CI: 0.55-0.86 for quartile 4, p for trend=0.010); however, this protective association with higher bilirubin levels was not noted in those without NAFLD. Higher bilirubin levels were associated with a lower risk for cardiovascular and cancer-related mortality in individuals with NAFLD. Conclusions: In this large national representative sample of American adults, higher bilirubin levels in NAFLD were associated with a lower risk of all-cause mortality, which may be derived from a lower risk of cardiovascular/cancer-related mortality.
Original language | English (US) |
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Pages (from-to) | 323-331 |
Number of pages | 9 |
Journal | Journal of Gastrointestinal and Liver Diseases |
Volume | 32 |
Issue number | 3 |
DOIs | |
State | Published - Sep 2023 |
Externally published | Yes |
Keywords
- NAFLD
- NHANES
- bilirubin
- death
- hepatic steatosis
ASJC Scopus subject areas
- General Medicine