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Gastroenterology Podcast January 2011: Prevalence of NAFLD and NASH Utilizing Ultrasound and Liver Biopsy
An important prospective study in the January Gastroenterology sought to define define the prevalence of both nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) among a largely middle-aged group of outpatients. Dr. Kuemmerle speaks to author Dr. Stephen A. Harrison of the Brooke Army Medical Center in Fort Sam Houston, Texas, about the study’s findings; plus, a rundown of top stories from this month's issue of GI and Hepatology News.
Williams CD, Stengel J, Asike MI, et al. Prevalence of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among a Largely Middle-Aged Population Utilizing Ultrasound and Liver Biopsy: A Prospective Study. Gastroenterology 2011; Jan; 140 (1): 124-131
Abstract
Prevalence of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among a Largely Middle-Aged Population Utilizing Ultrasound and Liver Biopsy: A Prospective Study
Background & Aims
Prevalence of nonalcoholic fatty liver disease (NAFLD) has not been well established. The purpose of this study was to prospectively define the prevalence of both NAFLD and nonalcoholic steatohepatitis (NASH).
Methods
Outpatients 18 to 70 years old were recruited from Brooke Army Medical Center. All patients completed a baseline questionnaire and ultrasound. If fatty liver was identified, then laboratory data and a liver biopsy were obtained.
Results
Four hundred patients were enrolled. Three hundred and twenty-eight patients completed the questionnaire and ultrasound.
Mean age (range, 28−70 years) was 54.6 years (7.35); 62.5% Caucasian, 22% Hispanic, and 11.3% African American; 50.9% female; mean body mass index (BMI) (calculated as kg/m2) was 29.8 (5.64); and diabetes and hypertension prevalence 16.5% and 49.7%, respectively. Prevalence of NAFLD was 46%. NASH was confirmed in 40 patients (12.2% of total cohort, 29.9% of ultrasound positive patients).
Hispanics had the highest prevalence of NAFLD (58.3%), then Caucasians (44.4%) and African Americans (35.1%).
NAFLD patients were more likely to be male (58.9%), older (P = .004), hypertensive (P less then .00005), and diabetic (P less then .00005). They had a higher BMI (P less then .0005), ate fast food more often (P = .049), and exercised less (P = 0.02) than their non-NAFLD counterparts. Hispanics had a higher prevalence of NASH compared with Caucasians (19.4% vs 9.8%; P = .03).
Alanine aminotransferase, aspartate aminotransferase, BMI, insulin, Quantitative Insulin-Sensitivity Check Index, and cytokeratin-18 correlated with NASH. Among the 54 diabetic patients, NAFLD was found in 74% and NASH in 22.2%.
Conclusion
Prevalence of NAFLD and NASH is higher than estimated previously. Hispanics and patients with diabetes are at greatest risk for both NAFLD and NASH.
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