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A change in hepatic blood flow caused by the hepatic arterial buffer response (HABR) occurs as fatty liver disease progress. The aim of this longitudinal cohort study was to investigate whether fatty liver with the HABR induces metabolic disorders. In 2009 and 2010, 494 (89.5%) participants were enrolled. The median follow‐up duration was 5.0 (interquartile range, 3.9‐6.0) years. The hazard ratios of fatty liver with the HABR for incident metabolic disorders were assessed by Cox proportional hazard models. A non–fatty liver group (non‐FL group, hepatorenal echo intensity ratio <1.12), a fatty liver without portal hypertension (FL group, hepatorenal echo intensity ratio ≥1.12 and ratio of the maximal blood velocity in the right hepatic artery to maximal blood velocity in the right portal vein <3.1) group, and a fatty liver with portal hypertension (FL‐HABR group, hepatorenal echo intensity ratio ≥1.12 and ratio of the maximal blood velocity in the right hepatic artery to maximal blood velocity in the right portal vein ≥3.1) group were defined based on echo intensity and Doppler ultrasonography. Fatty liver with and without the HABR was significantly associated with the incidence of diabetes on multivariate analysis (non‐FL versus FL group, hazard ratio, 3.36; 95% confidence interval, 1.05‐12.85; FL versus FL with the HABR group, HR, 2.68; 95% confidence interval, 1.28‐6.04). With respect to the incidence of hypertension and dyslipidemia, only FL with the HABR was a significant factor (hypertension, non‐FL versus FL,  P  = 0.874, FL versus FL‐HABR,  P  = 0.016, non‐FL versus FL‐HABR,  P  = 0.023; dyslipidemia, non‐FL versus FL,  P  = 0.311, FL versus FL‐HABR,  P  = 0.194, non‐FL versus FL‐HABR,  P  = 0.038).  Conclusion : Fatty liver with the HABR is a high‐risk condition for metabolic diseases. ( Hepatology Communications  2017;1:623–633)

Nonalcoholic fatty liver with a hepatic arterial buffer response strongly associated with future metabolic disease