Life's Simple 7 and Nonalcoholic Fatty Liver Disease: The Multiethnic Study of Atherosclerosis

Ebenezer Oni, Oluseye Ogunmoroti, Norrina Allen, Mouaz H. A-Mallah, Ron Blankstein, Seth S. Martin, Irfan Zeb, Mary Cushman, Parag H. Joshi, Matthew J. Budoff, Michael J. Blaha, Roger S. Blumenthal, Emir Veledar, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: The American Heart Association (AHA) has defined Life's Simple 7 (LS7) as a measure of overall cardiovascular health. Nonalcoholic fatty liver disease (NAFLD) has been involved as a risk factor for cardiovascular disease. We evaluated the association between LS7 and NAFLD. Methods: We evaluated participants form the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cardiovascular health score was calculated from the Life's Simple 7 metrics. A score of 0-8 was considered inadequate, 9-10 average, and 11-14 optimal. NAFLD was defined using noncontrast cardiac computed tomography (CT) and a liver/spleen attenuation ratio (L/S) < 1. Multivariable regression were performed to evaluate the association. Results: Our cross-sectional analysis of 3901 participants showed 19% (n = 747) had optimal cardiovascular health, 33% (n = 1270) had average, and 48% (n = 1884) had inadequate. White participants were most likely to have an optimal score (51%, n = 378), whereas African American participants had the lowest proportion with optimal scores (16%, n = 120; P < 0.001). The overall prevalence of NAFLD was 18% with a distribution of 7%, 14%, and 25% in the optimal, average, and inadequate score categories, respectively (P < 0.001). Adjusted for risk factors, average and optimal health categories had lower odds of NAFLD compared to those with inadequate scores: odds ratio for average, 0.44 (95% confidence interval 0.36-0.54); optimal, odds ratio 0.19 (95% confidence interval 0.14-0.26). This association was similar across gender, race and age groups. Conclusion: A more favorable cardiovascular health score was associated with a lower prevalence of NAFLD. This study may suggest a potential of Life's Simple 7 in the prevention of liver disease.

Original languageEnglish (US)
Pages (from-to)519-525
Number of pages7
JournalAmerican Journal of Medicine
Issue number4
StatePublished - Apr 2021


  • Cardiovascular health
  • Life's Simple 7
  • Nonalcoholic fatty liver disease

ASJC Scopus subject areas

  • General Medicine


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