Nonalcoholic fatty liver disease is associated with benign gastrointestinal disorders

Table 1 International Classification of Diseases, 9^th Revision, Clinical Modification diagnosis codes used to identify disease

	ICD-9-CM diagnosis	Diagnosis
The “other liver disease” cohort	571	Chronic liver disease and cirrhosis
	571	Alcoholic fatty liver
	571.1	Acute alcoholic hepatitis
	571.2	Alcoholic cirrhosis of liver
	571.3	Alcoholic liver damage, unspecified
	571.4	Chronic hepatitis
	571.4	Chronic hepatitis unspecified
	571.41	Chronic persistent hepatitis
	571.42	Autoimmune hepatitis
	571.49	Other chronic hepatitis
	571.5	Cirrhosis of liver without mention of alcohol
	571.6	Biliary cirrhosis
	571.9	Other unspecified chronic liver disease without mention of alcohol
	573	Other disorders of liver
	573.1	Hepatitis in viral diseases classified elsewhere
	573.2	Hepatitis in other infectious diseases classified elsewhere
	573.3	Hepatitis, unspecified
	573.8	Other specified disorders of liver
	573.9	Unspecified disorder of liver
	70	Viral hepatitis
	70	Viral hepatitis A with hepatic coma
	70.1	Viral hepatitis A without mention of hepatic coma
	70.2	Viral hepatitis B with hepatic coma
	70.2	Viral hepatitis B with hepatic coma, acute or unspecified without hepatitis delta
	70.21	Viral hepatitis B with hepatic coma, acute or unspecified with hepatitis delta
	70.22	Chronic viral hepatitis B with hepatic coma without hepatitis delta
	70.23	Chronic viral hepatitis B with hepatic coma with hepatitis delta
	70.3	Viral hepatitis b without mention of hepatic coma
	70.3	Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta
	70.31	Viral hepatitis B without mention of hepatic coma, acute or unspecified, with hepatitis delta
	70.32	Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta
	70.33	Chronic viral hepatitis B without mention of hepatic coma with hepatitis delta
	70.4	Other specified viral hepatitis with hepatic coma
	70.41	Acute hepatitis C with hepatic coma
	70.42	Hepatitis delta without mention of active hepatitis B disease with hepatic coma
	70.43	Hepatitis E with hepatic coma
	70.44	Chronic hepatitis C with hepatic coma
	70.49	Other specified viral hepatitis with hepatic coma
	70.5	Other specified viral hepatitis without mention of hepatic coma
	70.51	Acute hepatitis C without mention of hepatic coma
	70.52	Hepatitis delta without mention of active hepatitis B disease or hepatic coma
	70.53	Hepatitis E without mention of hepatic coma
	70.54	Chronic hepatitis C without mention of hepatic coma
	70.59	Other specified viral hepatitis without mention of hepatic coma
	70.6	Unspecified viral hepatitis with hepatic coma
	70.7	Unspecified viral hepatitis c
	70.7	Unspecified viral hepatitis C without hepatic coma
	70.71	Unspecified viral hepatitis C with hepatic coma
	70.9	Unspecified viral hepatitis without mention of hepatic coma
	V02.6	Carrier or suspected carrier of viral hepatitis
	V02.60	Viral hepatitis carrier, unspecified
	V02.61	Hepatitis B carrier
	V02.62	Hepatitis C carrier
	V02.69	Other viral hepatitis carrier
	275	Disorders of iron metabolism
	275.01	Hereditary hemochromatosis
	275.02	Hemochromatosis due to repeated red blood cell transfusions
	275.03	Other hemochromatosis
	275.09	Other disorders of iron metabolism
	275.1	Disorders of copper metabolism
Alcohol abuse, dependence, and/or overdose	291	Alcohol-induced mental disorders
	291	Alcohol withdrawal delirium
	291.1	Alcohol-induced persisting amnestic disorder
	291.2	Alcohol-induced persisting dementia
	291.3	Alcohol-induced psychotic disorder with hallucinations
	291.4	Idiosyncratic alcohol intoxication
	291.5	Alcohol-induced psychotic disorder with delusions
	291.8	Other specified alcohol-induced mental disorders
	291.81	Alcohol withdrawal
	291.82	Alcohol-induced sleep disorder
	291.89	Other alcoholic psychosis
	291.9	Unspecified alcohol-induced mental disorders
	303	Alcohol dependence syndrome
	303	Acute alcoholic intoxication
	303	Acute alcoholic intoxication in alcoholism unspecified drinking behavior
	303.01	Acute alcoholic intoxication in alcoholism continuous drinking behavior
	303.02	Acute alcoholic intoxication in alcoholism episodic drinking behavior
	303.03	Acute alcoholic intoxication in alcoholism in remission
	303.9	Other and unspecified alcohol dependence
	303.9	Other and unspecified alcohol dependence unspecified drinking behavior
	303.91	Other and unspecified alcohol dependence continuous drinking behavior
	303.92	Other and unspecified alcohol dependence episodic drinking behavior
	303.93	Other and unspecified alcohol dependence in remission

ICD-9-CM: International classification of diseases, 9^th revision, clinical modification.

Table 2 Clinical classification software categories used to identify comorbidities and associated diagnoses

CCS Category	Diagnosis
98 and 99	Hypertension
49 and 50	Diabetes mellitus
138	Esophageal disorders (excluding ICD-9-CM diagnoses f.or varices)
139	Gastroduodenal ulcer
140	Gastritis and/or duodenitis
141	Other disorders of stomach and duodenum
142	Appendicitis
143	Abdmoninal and groin hernia
144	Inflammatory bowel diseases
145	Intestinal obstruction
146	Diverticular disease
147	Anal and rectal conditions
148	Peritonitis and intestinal abscess
149	Benign biliary tract disease
152	Benign pancreatic disorders excluding diabetes mellitus
153	Gastrointestinal hemorrhage
154	Noninfectious gastroenteritis

CCS: Clinical classification software categories; ICD-9-CM: International classification of diseases, 9^th revision, clinical modification.

Table 3 Disease Staging© (Thomson Reuters) classification system used to identify principal discharge diagnoses

Discharge category	Description
GIS03, GIS04, GIS18	Benign anal-rectal disorders
GIS05	Appendicitis
GIS09 or GIS37	Inflammatory bowel disease
GIS10	Diverticular disease
GIS17 or GIS84	Gastroduodenitis
GIS19	Hernia
GIS20	Esophagitis
GIS25-30, HEP11, GIS82-83	Upper gastrointestinal cancers
GIS31	Gastroduodenal ulcer
HEP01 or HEP 84	Gallstone related disorders
HEP12 or HEP85	Non-malignant pancreatitis
HEP81 or HEP82	Hepatobiliary malignancies

Table 4 Demographics and hospital outcomes of discharge records stratified by background liver disease n (%)

	NAFLD (n = 32347)	Other liver diseases (n = 271049)	P value	Missing
Average age (yr)	52.3 ± 16.5	55.3 ± 15.4	< 0.0001	0
Female gender	19027 (58.8)	112788 (41.6)	< 0.0001	78 (0.0003)
Non-elective admission	25291 (78.4)	231024 (85.4)	< 0.0001	521 (0.2)
Ethnicity			< 0.0001	29349 (9.7)
White	20536 (70.7)	152778 (62.4)
Black	2798 (9.6)	45634 (18.6)
Hispanic	4135 (14.2)	32124 (13.1)
Asian/Pacific Islander	592 (2.0)	5720 (2.3)
Native American	191 (0.7)	2075 (0.9)
Other	797 (2.7)	6667 (2.7)
Diabetes mellitus	14027 (43.4)	78011 (28.9)	< 0.0001
Hypertension	18413 (56.9)	129031 (47.6)	< 0.0001
Obesity	11920 (36.9)	21677 (8.0)	< 0.0001
Dyslipidemia	12262 (37.9)	42299 (15.6)	< 0.0001
Metabolic syndrome	9286 (28.7)	23888 (8.8)	< 0.0001
Location			< 0.0001	13512 (4.4)
Central Metropolitan	9115 (28.8)	91426 (35.4)
Fringe Metropolitan	8540 (27.0)	58794 (22.8)
Metro below one million	6003 (19.0)	48308 (18.7)
50000-250000 population	2563 (8.1)	19519 (7.6)
Micropolitan	3482 (11.0)	24641 (9.5)
Other	1948 (6.2)	15545 (6.0)
Median zip code income ($)			< 0.0001	13104 (4.3)
< 39000	8003 (25.3)	89265 (34.5)
39000-47999	8140 (25.7)	65082 (25.2)
48000-62999	8006 (25.3)	58595 (22.7)
≥ 63000	7488 (23.7)	45713 (17.7)
Primary payer			< 0.0001	870 (0.3)
Medicare	10429 (32.3)	104892 (38.8)
Medicaid	4461 (13.8)	65829 (24.4)
Private	13602 (42.1)	59410 (22.0)
Self-pay	2454 (7.6)	24729 (9.2)
No charge	244 (0.8)	2917 (1.1)
Other	1107 (3.4)	12452 (4.6)
Major operative procedure	9804 (30.3)	47187 (17.4)	< 0.0001	0
Average total hospital charges ($)	39607.3 ± 52512	51665 ± 90685	< 0.0001	0
Average length of hospital stay (d)	4.7 ± 6.0	6.6 ± 9.7	< 0.0001	0
Discharge disposition			< 0.0001	420 (0.001)
Routine	25703 (79.5)	167545 (61.9)
Acute care	660 (2.0)	9190 (3.4)
Another health facility	2273 (7.0)	39311 (14.5)
Home Health	3114 (9.6)	30276 (11.2)
AMA	269 (0.8)	7691 (2.8)
Other	10 (0.03)	479 (0.2)
Died in hospital	301 (0.9)	16154 (6.0)	< 0.0001	571 (0.2)
Aprdrg mortality risk			< 0.0001	347 (0.1)
Minor	14347 (44.4)	82849 (30.4)
Moderate	11678 (36.1)	84343 (31.1)
Major	4921 (15.2)	63614 (23.5)
Extreme	1377 (4.3)	40280 (14.9)
Aprdrg severity			< 0.0001	347 (0.1)
Minor functional loss	814 (2.5)	12242 (4.5)
Moderate functional loss	18105 (56.0)	88446 (32.6)
Major functional loss	11156 (35.0)	116365 (43.0)
Extreme functional loss	2248 (7.0)	53673 (19.8)
Associated Diagnoses
Abdominal Hernia	3459 (10.7)	12755 (4.7)	< 0.0001
Appendiceal disorders	254 (0.8)	728 (0.3)	< 0.0001
Benign anus-rectum disorders	174 (0.5)	1401 (0.5)	0.62
Benign biliary disorders	5421 (16.8)	19306 (7.1)	< 0.0001
Benign pancreatic disorders	3379 (10.5)	15898 (5.9)	< 0.0001
Diverticular disease	2845 (8.8)	8697 (3.2)	< 0.0001
Esophageal disorders (non-variceal)	9114 (28.2)	41835 (15.4)	< 0.0001
Gastritis/duodenitis	2163 (6.7)	11220 (4.1)	< 0.0001
Gastroduodenal ulcer	1011 (3.1)	7477 (2.8)	0.002
Gastrointestinal hemorrhage	1119 (3.5)	23651 (8.7)	< 0.0001
Gastrointestinal malignancies	688 (2.1)	6871 (2.5)	< 0.0001
Hepatobiliary malignancies	84 (0.3)	7903 (2.9)	< 0.0001
Inflammatory bowel disease	555 (1.7)	2659 (1.0)	< 0.0001
Intestinal infection	886 (2.7)	5904 (2.2)	< 0.0001
Intestinal obstruction	1346 (4.2)	7898 (2.9)	< 0.0001
Peritonitis-abscess	326 (1.0)	5772 (2.1)	< 0.0001
Principal discharge diagnoses
Appendicitis	217 (0.7)	554 (0.2)	< 0.0001
Benign anus-rectal disorders	163 (0.5)	1694 (0.6)	0.008
Benign pancreatitis	2224 (6.9)	7074 (2.6)	< 0.0001
Diverticular disease	898 (2.8)	1805 (0.7)	< 0.0001
Esophagitis	306 (1.0)	1762 (0.7)	< 0.0001
Gallstone disorders	2622 (8.1)	5978 (2.2)	< 0.0001
Gastroduodenal ulcer	232 (0.7)	2572 (1.0)	< 0.0001
Gastroduodenitis	713 (2.2)	3481 (1.3)	< 0.0001
Gastrointestinal malignancies	338 (1.0)	3017 (1.1)	0.27
Hepatobiliary malignancies	68 (0.2)	2837 (1.1)	< 0.0001
Hernia	204 (0.6)	1497 (0.6)	0.07
Inflammatory bowel disease	242 (0.8)	696 (0.3)	< 0.0001
Intestinal Infection	235 (0.7)	1999 (0.7)	0.83

NAFLD: Nonalcoholic fatty liver disease; AMA: American medical association.

Table 5 Multivariable logistic regression for factors associated with nonalcoholic fatty liver disease compared to other liver diseases using associated diagnoses

Variable	P value	OR (95%CI)
Age (reference ≤ 70 yr)	< 0.0001	0.79 (0.76-0.83)
Gender (reference female)	< 0.0001	0.58 (0.57-0.60)
Diabetes	< 0.0001	1.41 (1.37-1.45)
Hypertension	0.05	0.97 (0.94-1.0)
Obesity	< 0.0001	4.47 (4.34-4.61)
Dyslipidemia	< 0.0001	2.35 (2.28-2.42)
Location (reference central metropolitan)	< 0.0001
50000-250000 population		1.2 (1.1-1.3)
Fringe metropolitan		1.1 (1.1-1.2)
Metro 250000 - one million population		1.2 (1.1-1.2)
Micropolitan		1.4 (1.4-1.5)
Other		1.4 (1.3-1.4)
Income (reference ≥ $63000)	< 0.0001
$39000-$47999		0.80 (0.77-0.83)
$48000-$62999		0.86 (0.82-0.89)
< $39000		0.64 (0.62-0.67)
Payer (reference private insurance)	< 0.0001
Medicaid		0.42 (0.41-0.43)
Medicare		0.46 (0.44-0.47)
No charge		0.61 (0.53-0.70)
Other		0.55 (0.51-0.59)
Self-pay		0.65 (0.62-0.68)
Associated diagnoses
Abdominal hernia	< 0.0001	1.70 (1.63-1.79)
Appendiceal disorders	< 0.0001	2.58 (2.19-3.04)
Benign biliary disorders	< 0.0001	2.11 (2.03-2.19)
Benign pancreatic disorders	< 0.0001	1.57 (1.50-1.64)
Diverticular disease	< 0.0001	2.22 (2.11-2.34)
Esophageal disorders (non-variceal)	< 0.0001	1.52 (1.48-1.57)
Gastroduodenal ulcer	< 0.0001	1.41(1.33-1.49)
Gastrointestinal hemorrhage	< 0.0001	0.41 (0.38-0.44)
Gastrointestinal malignancies	< 0.0001	0.83 (0.76-0.91)
Hepatobiliary malignancies	< 0.0001	0.12 (0.10-0.15)
Inflammatory bowel disease	< 0.0001	1.68 (1.52-1.86)
Intestinal infection	< 0.0001	1.29 (1.19-1.40)
Intestinal obstruction	< 0.0001	1.30 (1.22-1.39)
Peritonitis-abscess	< 0.0001	0.47 (0.42-0.53)

Table 6 Multivariable logistic regression for factors associated with nonalcoholic fatty liver disease compared to other liver diseases using principal diagnoses

Variable	P value	OR (95%CI)
Age (reference ≤ 70 yr)	< 0.0001	0.84 (0.81-0.88)
Gender (reference female)	< 0.0001	0.55 (0.53-0.56)
Diabetes	< 0.0001	1.38 (1.35-1.42)
Obesity	< 0.0001	4.75 (4.61-4.89)
Dyslipidemia	< 0.0001	2.51 (2.44-2.58)
Location (reference central metropolitan)	< 0.0001
50000-250000 population		1.21 (1.14-1.27)
Fringe metropolitan		1.12 (1.09-1.17)
Metro 250000 - one million population		1.15 (1.11-1.20)
Micropolitan		1.44 (1.37-1.51)
Other		1.37 (1.29-1.45)
Income (reference > $63000)	< 0.0001
$39000-$47999		0.80 (0.77-0.83)
$48000-$63000		0.86 (0.83-0.89)
< $39000		0.64 (0.62-0.67)
Payer (reference private insurance)	< 0.0001
Medicaid		0.42 (0.40-0.43)
Medicare		0.47 (0.46-0.49)
No charge		0.60 (0.52-0.69)
Other		0.54 (0.50-0.58)
Self-pay		0.62(0.59-0.65)
Principal discharge diagnosis
Appendicitis	< 0.0001	3.53 (2.96-4.22)
Benign pancreatitis	< 0.0001	2.95 (2.79-3.12)
Diverticular disease	< 0.0001	4.26 (3.89-4.67)
Esophagitis	< 0.0001	1.69 (1.48-1.93)
Gallstone disorders	< 0.0001	3.59 (3.40-3.79)
Gastroduodenitis	< 0.0001	2.09 (1.91-2.29)
Hepatobiliary malignancies	< 0.0001	0.29 (0.22-0.37)
Hernia	0.01	1.23 (1.04-1.45)
Inflammatory bowel disease	< 0.0001	3.64 (3.10-4.28)

Table 7 Demographics and hospital outcomes of discharge records of patients with a principal discharge diagnosis of diverticular disease, gallstone disease or benign pancreatitis stratified by background liver disease n (%)

	Diverticular disease (n = 2703)			Gallstone disease (n = 8600)			Benign pancreatitis (n = 9298)
	NAFLD (n = 898)	OLD (n = 1805)	P value	NAFLD (n = 2622)	OLD (n = 5978)	P value	NAFLD (n = 2224)	OLD (n = 7074)	P value
Average age (yr)	55.1 ± 13.5	62.7 ± 14.2	< 0.0001	50.5 ± 16.7	57.7 ± 17.4	< 0.0001	47.8 ± 15.5	51.9 ± 14.0	< 0.0001
Female Gender	501 (55.8)	897 (49.7)	< 0.003	1606 (61.3)	3056 (51.2)	< 0.0001	1058 (47.6)	2796 (39.5)	< 0.0001
Non-elective admission	791 (88.3)	1612 (89.5)	0.36	2305 (88.4)	5137 (86.0)	< 0.0001	2110 (95.1)	6680 (94.5)	< 0.0001
Ethnicity			< 0.0001			< 0.0001			< 0.0001
White	610 (74.5)	1174 (72.1)		1575 (65.3)	3532 (65.5)		1376 (67.8)	3910 (60.8)
Black	48 (5.9)	236 (14.5)		166 (6.9)	633 (11.7)		196 (9.7)	1355 (21.1)
Hispanic	128 (15.7)	159 (9.8)		519 (21.5%)	882 (16.4)		339 (16.7)	854 (13.3)
Other	33 (4.0)	60 (3.7)		152 (6.3)	344 (6.4)		119 (5.9)	313 (4.9)
Diabetes mellitus	276 (30.7)	440 (24.4)	0.0004	816 (31.1)	1603 (26.8)	< 0.0001	984 (44.2)	1974 (27.9)	< 0.0001
Hypertension	490 (54.6)	1021 (56.6)	0.32	1285 (49.0)	2892 (48.4)	< 0.0001	1222 (55.0)	3524 (49.8)	< 0.0001
Obesity	252 (28.1)	200 (11.1)	< 0.0001	1010 (38.5)	770 (12.9)	< 0.0001	680 (30.6)	561 (7.9)	< 0.0001
Dyslipidemia	319 (35.5)	451 (25.0)	< 0.0001	818 (31.2)	1233 (20.6)	< 0.0001	1093 (49.2)	1359 (19.2)	< 0.0001
Metabolic syndrome	178 (19.8)	195 (10.8)	< 0.0001	567 (21.6)	638 (10.7)	< 0.0001	662 (29.8)	721 (10.2)	< 0.0001
Location			0.02			< 0.0001			< 0.0001
Central Metro	268 (30.6)	537 (30.7)		835 (32.5)	1775 (30.7)		603 (27.8)	2184 (32.6)
Fringe Metro	247 (28.2)	436 (24.9)		707 (27.5)	1379 (23.9)		600 (27.6)	1554 (23.2)
Metro below one million	185 (21.1)	322 (18.4)		505(19.7)	1132 (19.6)		406 (18.7)	1373 (20.5)
50000-250000	53 (6.1)	147 (8.4)		160 (6.2)	427 (7.4)		185 (8.5)	536 (8.0)
Micropolitan	81 (9.3)	187 (10.7)		237 (9.2)	651 (11.3)		238 (11.0)	626 (9.3)
Other	42 (4.8)	119 (6.8)		124 (4.8)	411 (7.1)		140 (6.5)	437 (6.5)
Median zip code income ($)			0.0008			< 0.0001			< 0.0001
< 39000	202 (22.8)	502 (28.5)		632 (24.6)	166 (28.9)		556 (25.6)	2334 (34.4)
39000-47999	209 (23.5)	437 (24.8)		640 (24.9)	1550 (26.9)		534 (24.6)	1734 (25.5)
48000-63000	233 (26.2)	445 (25.2)		676 (26.3)	1446 (25.1)		564 (25.9)	1527 (22.5)
> 63000	244 (27.5)	380 (21.5)		618 (24.1)	1107 (19.2)		520 (23.9)	1196 (17.6)
Primary payer			< 0.0001			< 0.0001			< 0.0001
Medicare	256 (28.5)	866 (48.1)		659 (25.2)	2461 (41.2)		523 (23.6)	2028 (28.8)
Medicaid	60 (6.7)	181 (10.1)		382 (14.6)	1016 (17.0)		320 (14.4)	1682 (23.9)
Private	469 (52.2)	562 (31.2)		1229 (46.9)	1687 (28.3)		971 (43.7)	1742 (24.7)
Self-pay	75 (8.4)	119 (6.6)		215 (8.2)	531 (8.9)		295 (13.3)	1054 (15.0)
No charge	6 (0.7)	15 (0.8)		27 (1.0)	53 (0.9)		24 (1.1)	128 (1.8)
Other	32 (3.6)	58 (3.2)		106 (4.1)	219 (3.7)		87 (3.9)	418 (5.9)
Major operative procedure	109 (12.1)	333 (18.5)	< 0.0001	2002 (76.4)	3327 (55.7)	< 0.0001	294 (13.2)	652 (9.2)	< 0.0001
Average total hospital charges ($)	26868.7 ± 26364.6	46666.9 ± 80222.8	< 0.0001	40016.5 ± 32898.6	49682.8 ± 65425.9	< 0.0001	32680.5 ± 42691.0	45115.5 ± 83193.4	< 0.0001
Average length of hospital stay (d)	4.2 ± 3.4	6.0 ± 8.3	< 0.0001	4.0 ± 3.4	5.6 ± 6.1	< 0.0001	4.9 ± 4.4	6.2 ± 8.4	< 0.0001
Discharge Disposition			< 0.0001			< 0.0001			< 0.0001
Routine	821 (91.4)	1355 (75.2)		2403 (91.8)	4492 (75.3)		2013 (90.5)	5396 (76.3)
Acute care	2 (0.2)	33 (1.8)		32 (1.2)	240 (4.0)		45 (2.0)	209 (3.0)
Another health facility	25 (2.8)	158 (8.8)		66 (2.5)	503 (8.4)		47 (2.1)	480 (6.8)
Home Health	44 (4.9)	184 (10.2)		101 (3.9)	487 (8.2)		86 (3.9)	361 (5.1)
AMA	5 (0.6)	17 (0.9)		14 (0.5)	81 (1.4)		22 (1.0)	325 (4.6)
Other	0	3 (0.2)		0	7 (0.1)		0	4 (0.1)
Died in hospital	1 (0.1)	53 (2.9)	< 0.0001	3 (0.1)	157 (2.6)	< 0.0001	11 (0.5)	296 (4.2)	< 0.0001
APRDRG Mortality risk			< 0.0001			< 0.0001			< 0.0001
Minor	530 (59.0)	783 (43.4)		1457 (55.6)	2123 (35.5)		1177 (52.9)	2658 (37.6)
Moderate	278 (31.0)	563 (31.2)		936 (35.7)	2095 (35.1)		746 (33.5)	2308 (32.6)
Major	82 (9.1)	291 (16.1)		188 (7.2)	1187 (19.9)		238 (10.7)	1318 (18.6)
Extreme	8 (0.9)	167 (9.3)		37 (1.4)	571 (9.6)		61 (2.7)	785 (11.1)
APRDRG Severity			< 0.0001			< 0.0001			< 0.0001
Minor functional loss	0	163 (9.0)		1 (0.04%)	377 (6.3)		1 (0.04)	347 (4.9)
Moderate functional loss	645 (71.8)	747 (41.4)		1828 (69.7)	2371 (39.7)		1318 (59.3)	2721 (38.5)
Major functional loss	231 (25.7)	697 (38.6)		715 (27.3)	2393 (40.0)		791 (35.6)	2855 (40.4)
Extreme functional loss	22	197 (10.9)		74	835 (14.0)		112 (5.0)	1146 (16.2)
	-2.5			-2.8

NAFLD: Nonalcoholic fatty liver disease; OLD: Other liver diseases; AMA: American medical association.