Gastroenterology

Gastroenterology

Volume 140, Issue 1, January 2011, Pages 124-131
Gastroenterology

Clinical Advances in Liver, Pancreas, and Biliary Tract
Prevalence of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among a Largely Middle-Aged Population Utilizing Ultrasound and Liver Biopsy: A Prospective Study

https://doi.org/10.1053/j.gastro.2010.09.038Get rights and content

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 < .00005), and diabetic (P < .00005). They had a higher BMI (P < .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.

Section snippets

Methods

Patients between the ages of 18 and 70 years who were eligible for care at Brooke Army Medical Center were considered for enrollment. Eligible patients include all active duty personnel, their dependents, and military retirees (to include spouses) who completed 20 years of active duty service or were medically retired. Patients were recruited through study handouts or posters that were located in the Primary Care Clinic waiting area. If the patient was interested in the study, the clinic

Patient Demographics

A total of 400 patients were enrolled (Figure 1) from January 2007 to March 2010. Seventy-two patients did not obtain a right upper quadrant ultrasound: 67 patients did not keep their ultrasound appointment and declined further participation in the study; 2 patients were excluded as they were discovered to have earlier fatty liver disease; 3 patients were excluded as the study questionnaire detected significant alcohol ingestion. Three hundred twenty-eight of the patients underwent a right

Discussion

The most compelling finding of this prospective study is the overall prevalence of NAFLD (46%) and NASH (12.2%) within our cohort of US middle-aged adults. The Dallas Heart Study performed in the early part of the previous decade utilized a more sensitive imaging modality and found an overall prevalence for NAFLD of 31%. Hispanics had the highest prevalence, followed by Caucasians and then African Americans.4 Our study found a higher prevalence of NAFLD using a less sensitive test and more

Acknowledgments

ClinicalTrials.gov identifier: NCT01100398.

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    This article has an accompanying continuing education activity on page e12. Learning Objective: Upon completion of reading this article, successful learners will be able to identify patients likely to be at greater risk for both NAFLD and NASH.

    Conflicts of interest The authors disclose no conflicts.

    The opinion or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the view of the US Department of the Army or the US Department of Defense.

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