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Non-alcoholic fatty liver disease linked to increased risk of dementia

A Swedish research team has found that patients with NAFLD have an associated 44% increased risk of developing vascular dementia.

Non-alcoholic fatty liver disease (NAFLD) is a condition describing the build up of fat within the liver, not attributed to alcohol. It is the most prevalent liver disease in the world, affecting about 24% of the global population, and is frequently linked to metabolic syndrome.

According to a research study out of the Karolinska Institutet in Stockholm, researchers found a significant increased risk of dementia in patients with NAFLD when compared to the general population.

The paper’s results state, “A total of 2898 patients with NAFLD and 28357 matched controls were identified. During a median follow-up of 5.5 years, 145 (5.0%) patients with NAFLD and 1291 (4.6%) reference individuals were diagnosed with dementia. Compared to the reference individuals, patients with NAFLD had higher rates of dementia (aHR 1.38, 95% CI 1.10–1.72) and vascular dementia (aHR 1.44, 95% CI 0.96–2.23, p=0.07). Comorbid NAFLD and either heart disease (aHR 1.50 95% 1.08–2.05) or stroke (aHR 2.60 95% CI 1.95–3.47) conferred a greater risk of dementia.

The research team found that those with NAFLD had a 38% higher rate of dementia overall when compared to those without liver disease, even after controlling for cardiovascular risk factors including high blood pressure and diabetes. The team also showed that those with non-alcoholic fatty liver disease had a 44% greater risk of vascular dementia, which is brought on by insufficient blood supply to the brain. No increased prevalence of Alzheimer’s disease was found.

Ying Shang, PhD, the first author of the paper, explained in a news release, “Our study shows that non-alcoholic fatty liver disease is associated with the development of dementia, which may be driven mainly by vascular damage in the brain. These results highlight the possibility that targeted treatment of this form of liver disease and co-occuring cardiovascular disease may reduce the risk of dementia.”

The researchers concluded that despite the association, they believe that there is likely a stronger relationship than what was found, as NAFLD is widely underdiagnosed due to many patients being asymptomatic.


The study was published in Neurology on July 13th, 2022.

Abstract. Non-alcoholic fatty liver disease (NAFLD) and dementia share common risk factors including metabolic disorders. However, whether NAFLD is associated with dementia risk is unclear. We investigated the association between NAFLD and dementia risk as well as the role of cardiovascular complications including heart disease and stroke. In this population-based matched cohort study, we identified all Swedish patients aged ≥65 years with NAFLD identified from the National Patient Register (NPR) between 1987 and 2016. These were matched with up to ten reference individuals from the general population on age, sex, and municipality at the year of diagnosis. Incident dementia diagnosis was derived from the NPR or the Cause of Death Register until 2016. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were estimated with Cox regression models. A total of 2898 patients with NAFLD and 28357 matched controls were identified (median age at entry, interquartile range [IQR], 70 [8]; 55.1% female). During a median follow-up of 5.5 years (IQR: 8.5 years), 145 (5.0%) patients with NAFLD and 1291 (4.6%) reference individuals were diagnosed with dementia. Compared to the reference individuals, patients with NAFLD had higher rates of dementia (aHR 1.38, 95% CI 1.10–1.72) and vascular dementia (aHR 1.44, 95% CI 0.96–2.23, p=0.07). Comorbid NAFLD and either heart disease (aHR 1.50 95% 1.08–2.05) or stroke (aHR 2.60 95% CI 1.95–3.47) conferred a greater risk of dementia. NAFLD had a modest association with increased rates of dementia. This was stronger among patients with NAFLD diagnosed with cardiovascular comorbidities.

Nonalcoholic Fatty Liver Disease and Risk of Dementia: A Population-Based Cohort Study. Ying Shang, Linnea Widman, Hannes Hagström; Neurology Jul 2022, 10.1212/WNL.0000000000200853; DOI: 10.1212/WNL.0000000000200853

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