BackgroundData on outcomes of non‐alcoholic fatty liver disease (NAFLD) from South Asia are lacking. We compared mortality, among those with‐ and without‐NAFLD, after 10‐years follow‐up among urban, adult Sri Lankans.MethodParticipants (aged 35‐64 years), selected by age‐stratified random sampling, were screened by structured‐interview in 2007. Anthropometric measurements, liver ultrasonography and biochemical/serological tests were done. NAFLD was diagnosed on ultrasound criteria, safe‐alcohol consumption (Asian‐standards) and absence of hepatitis B/C. Subjects without NAFLD were those without any ultrasound criteria of fatty liver, safe‐alcohol consumption and absence of hepatitis B/C. The cohort was re‐evaluated to assess mortality in 2017. Participants or their households were contacted by telephone/post, and deaths confirmed by home‐visits and death certificate review. Cox‐regression was used to determine predictors of all‐cause mortality (ACM) and cardiovascular mortality (CVM) in those with‐ and without‐NAFLD.Results2724 (91.2%) of 2985 original participants were contacted (851‐with NAFLD and 1072‐without NAFLD). Overall there were 169 (6.2%) deaths [41‐deaths among NAFLD (17‐cardiovascular; 9‐cancer‐related; 4‐liver‐specific; 11‐other) and 79‐deaths among no‐NAFLD (28‐cardiovascular; 17‐cancer‐related; 1‐liver‐specific; 33‐other)]. Metabolic syndrome (MetS), low‐education level, higher age and male‐gender independently predicted ACM. MetS, increasing age and male‐gender independently predicted CVM. NAFLD did not predict either ACM or CVM. In those with NAFLD, MetS and age >55‐years were independently associated with ACM, while MetS and male‐gender were associated with CVM.ConclusionIn this community‐based study, increasing age, male‐gender and MetS, but not NAFLD, predicted 10‐year ACM and CVM. Among those with NAFLD, only those metabolically abnormal were at a higher risk for mortality.

BackgroundThere are few studies investigating the natural course of non-alcoholic fatty liver disease (NAFLD) in the community. We assessed resolution of NAFLD in a general population cohort of urban Sri Lankans adults.MethodsParticipants were selected by age-stratified random sampling from electoral lists. They were initially screened in 2007 and re-evaluated in 2014. On both occasions structured interview, anthropometric-measurements, liver ultrasonography, and biochemical/serological tests were performed. NAFLD was diagnosed on ultrasound criteria for fatty liver, safe-alcohol consumption (<14-units/week for men, <7-units/week for women) and absence of hepatitis B/C markers. Non-NAFLD was diagnosed on absence of any ultrasound criteria for fatty liver and safe-alcohol consumption. Resolution of NAFLD was defined as absence of ultrasound criteria for fatty liver. Changes in anthropometric indices [Weight, Body-Mass-Index (BMI), waist-circumference (WC), waist-hip ratio (WHR)], clinical [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and biochemical measurements [Triglycerides (TG), High Density Lipoprotein (HDL), Total Cholesterol (TC), HbA1c%] at baseline and follow-up were compared.ResultsOf the 2985 original study participants, 2148 (71.9%) attended follow-up after 7 years. This included 705 who had NAFLD in 2007 and 834 who did not have NAFLD in 2007. Out of 705 who had NAFLD in 2007, 11(1.6%) changed their NAFLD status due to excess alcohol consumption. After controlling for baseline values, NAFLD patients showed significant reduction in BMI, weight, WHR, HDL and TC levels and increase in HbA1c levels compared to non-NAFLD people. Despite this, none of them had complete resolution of NAFLD.ConclusionWe did not find resolution of NAFLD in this general population cohort. The observed improvements in anthropometric, clinical and biochemical measurements were inadequate for resolution of NAFLD.

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BackgroundThere is limited data on prevalence and outcome of prediabetes (PDM) and incidence of type 2 diabetes mellitus (T2DM) from South Asia. We investigated this in an urban, adult population in Sri Lanka that was followed-up for seven years. Methods The study population (selected by age-stratified random sampling from the community) was initially screened in 2007 and re-evaluated in 2014. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. Results In the original cohort of 2985 recruited in 2007 [54.8% women, median age (IQR) 53 (47-59)], 737 had T2DM [baseline prevalence 24.7% (95% CI: 23.1–26.2)] and 525 (17.7%) had PDM [54.1% women, median age (IQR) 56 (50-60)]. 2148/2985 (71.6%) attended follow-up in 2014 [57.5% women; median (IQR) 60 (54–66) years], which included 1650 who did not have T2DM in 2007. By 2014, 436/1650 (27.6%) had developed new T2DM [annual incidence 3.9% (95% CI:3.0-4.9). On logistic regression, PDM, central obesity, dyslipidemia and non-alcoholic fatty liver disease (NAFLD) showed significant association with incident T2DM. Of 525 with PDM in 2007, 365 (69.5%) presented for follow up in 2014; 147 (40.3%) remained in PDM, 201 (55.1%) had progressed to T2DM and 17 (4.6%) had reverted to normal. Annual conversion rate of PDM to T2DM was 7.9%. Increase in waist circumference and decrease in HDL predicted progression to T2DM. ConclusionsPresence of components of the metabolic syndrome at baseline predicted new-onset T2DM and conversion of PDM to T2DM. Targeted lifestyle interventions are essential for individuals with metabolic risk to prevent incident T2DM.

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