Association between nonalcoholic fatty liver disease with advanced fibrosis and stroke

Neal S. Parikh*, Lisa B. VanWagner, Mitchell S.V. Elkind, Jose Gutierrez

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: There is an increasing appreciation of the cardiovascular implications of nonalcoholic fatty liver disease with advanced fibrosis (NAFLD-fibrosis). However, data regarding stroke risk are limited. We sought to investigate whether NAFLD-fibrosis is associated with stroke in addition to heart disease. Methods: We performed a cross-sectional study using data from the United States National Health and Nutrition Examination Survey (2005–2014). After excluding participants with competing causes of liver disease, the Fibrosis-4 score (FIB-4) and NAFLD Fibrosis Score (NFS) were calculated. First, we used a composite measure to classify participants: NAFLD-fibrosis was defined as having at least one score above its validated cut-off. Second, we also used the FIB-4 and NFS scores individually. The key outcome was prevalent stroke, and we also evaluated heart disease; both were self-reported. Multivariable logistic regression assessed the association between NAFLD-fibrosis and these outcomes while adjusting for demographic variables and cardiovascular risk factors. Results: We identified 1653 participants with NAFLD-fibrosis from a sample of 27,040 participants. In total, 753 had prior stroke. An association between NAFLD-fibrosis and stroke was seen when using the FIB-4 score (OR 1.87, 95% CI 1.00–3.50) but not the NFS (OR 1.31, 95% CI 0.92–1.87). NAFLD-fibrosis was associated with heart disease (OR 1.46, 95% CI 1.06–2.01) using the composite measure and both scores individually. Conclusions: NAFLD-fibrosis may be associated with stroke in addition to heart disease, with differences depending on the measure used to define NAFLD-fibrosis.

Original languageEnglish (US)
Article number116524
JournalJournal of the Neurological Sciences
StatePublished - Dec 15 2019


  • Cerebrovascular disease
  • Epidemiology
  • Liver disease
  • Risk factors
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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