Non-alcoholic fatty liver disease, liver fibrosis score and cognitive function in middle-aged adults: The Framingham Study

Galit Weinstein, Kendra Davis-Plourde, Jayandra J. Himali, Shira Zelber-Sagi, Alexa S. Beiser, Sudha Seshadri

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is common and has been recently related to brain health. We aimed to assess the relationships of NAFLD and its severity, using the NAFLD fibrosis score (NFS), with cognitive performance. Methods: Framingham study Offspring and 3rd generation participants were included if they attended exams 9 (2002-2008) and 2 (2008-2011), respectively, were free of dementia and stroke, and did not have excessive alcohol intake. Between 2008 and 2011, participants underwent Multi-detector computed tomography scans of the abdomen to determine NAFLD diagnosis and the NFS was used to categorize the severity of fibrosis. Cross-sectional relationships of NAFLD and the NFS with cognitive testing of memory, abstract reasoning, visual perception, attention and executive function were assessed, while adjusting for multiple cardiometabolic variables including visceral adipose tissue, diabetes and insulin resistance. Results: Of the 1287 participants (mean age = 61±12 years, 48% men), 378 (29%) had NAFLD. The presence of NAFLD was not associated with cognitive function. However, among those with NAFLD (mean age = 61±12 years; 58% men), high compared to low risk of advanced fibrosis was associated with poorer performance on similarities (β = −2.22 ± 0.83; P = 0.009) and trail-making B minus A (β = −0.11 ± 0.05; P = 0.028), independently of potential confounders. Conclusions: Participants with high risk of advanced fibrosis may have poorer cognitive function compared to those with low risk, particularly in executive function and abstract reasoning. Future findings are necessary to evaluate the value of the NFS as a biomarker that predicts cognitive impairment and dementia and to explore the role of hepatic fibrosis in brain health.

Original languageEnglish
Pages (from-to)1713-1721
Number of pages9
JournalLiver International
Volume39
Issue number9
DOIs
StatePublished - 1 Sep 2019

Bibliographical note

Funding Information:
The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute (contract no. N01-HC-25195 and no. HHSN268201500001I). This study was additionally supported by grants from the National Institute on Aging (R01 AG054076, R01 AG049607, R01 AG033193, U01 AG049505, U01 AG052409) and the National Institute of Neurological Disorders and Stroke (NS017950 and UH2 NS100605).

Funding Information:
The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute (contract no. N01‐HC‐25195 and no. HHSN268201500001I). This study was additionally supported by grants from the National Institute on Aging (R01 AG054076, R01 AG049607, R01 AG033193, U01 AG049505, U01 AG052409) and the National Institute of Neurological Disorders and Stroke (NS017950 and UH2 NS100605).

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Keywords

  • NAFLD fibrosis score
  • cognitive performance
  • liver fibrosis
  • non-alcoholic fatty liver disease

ASJC Scopus subject areas

  • Hepatology

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