People with fatty liver disease are more likely to die early if they have one of three additional medical problems, a new study says.

High blood pressure, diabetes and low levels of HDL cholesterol all increase the risk of death for people with fatty liver disease, the researchers reported in the journal Clinical Gastroenterology and Hepatology.

Importantly, high blood pressure was associated with the highest risk of death in people with fatty liver disease.

Until now, diabetes was generally thought to be the most important health problem for patients with fatty liver, Dr. Matthew Djukevich, a University of Southern California Transplant Hepatology Fellow and lead researcher, said in a news release.

More than a third of the world’s population has fatty liver disease, also known as metabolic dysfunction-associated steatohepatitis.

This condition occurs when fat builds up in the liver, causing tissue damage and scarring. It is usually associated with one or more of five other health problems: obesity, type 2 diabetes, high blood pressure, high blood sugar, and low HDL cholesterol.