The association of non-alcoholic fatty liver disease and cardiac structure and function-Framingham Heart Study

UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Digestive System Diseases | Hepatology | Translational Medical Research


BACKGROUND and AIMS: Non-alcoholic fatty liver disease confers increased risk for cardiovascular disease, including heart failure (HF), for reasons that remain unclear. Possible pathways could involve an association of liver fat with cardiac structural or functional abnormalities even after accounting for body size.

METHODS: We analysed N = 2356 Framingham Heart Study participants (age 52 +/- 12 years, 52% women) who underwent echocardiography and standardized computed tomography measures of liver fat.

RESULTS: In cross-sectional multivariable regression models adjusted for age, gender, cohort and cardiovascular risk factors, liver fat was positively associated with left ventricular (LV) mass (beta = 1.45; 95% confidence interval (CI): 0.01, 2.88), LV wall thickness (beta = 0.01; 95% CI: 0.00, 0.02), mass volume ratio (beta = 0.02; 95% CI 0.01, 0.03), mitral peak velocity (E) (beta = 0.83; 95% CI 0.31, 1.36) and LV filling pressure (E/e' ratio) (beta = 0.16; 95% CI 0.09, 0.23); and inversely associated with global systolic longitudinal strain (beta = 0.20, 95% CI 0.07, 0.33), diastolic annular velocity (e') (beta = -0.12; 95% CI - 0.22, -0.03), and E/A ratio (beta = -0.01; 95% CI - 0.02, -0.00). After additional adjustment for body mass index (BMI), statistical significance was attenuated for all associations except for that of greater liver fat with increased LV filling pressure, a possible precursor to HF (beta = 0.11; 95% CI 0.03, 0.18).

CONCLUSION: Increased liver fat was associated with multiple subclinical cardiac dysfunction measures, with most of associations mediated by obesity. Interestingly, the association of liver fat and LV filling pressure was only partially mediated by BMI, suggesting a possible direct effect of liver fat on LV filling pressure. Further confirmatory studies are needed.


heart failure, non-alcoholic fatty liver disease, subclinical cardiovascular disease, UMCCTS funding

DOI of Published Version



Chiu LS, Pedley A, Massaro JM, Benjamin EJ, Mitchell GF, McManus DD, Aragam J, Vasan RS, Cheng S, Long MT. The association of non-alcoholic fatty liver disease and cardiac structure and function-Framingham Heart Study. Liver Int. 2020 Oct;40(10):2445-2454. doi: 10.1111/liv.14600. Epub 2020 Jul 25. PMID: 32654390; PMCID: PMC7669676. Link to article on publisher's site

Journal/Book/Conference Title

Liver international : official journal of the International Association for the Study of the Liver

Related Resources

Link to Article in PubMed

PubMed ID