Incidence and natural course of fatty liver in the general population: The Dionysos study

Abstract

Using the general population of the Dionysos Study, we followed up 144 subjects without fatty liver (FL ؊ ) and 336 with fatty liver (FL ؉ ) for a median time of 8.5 years. All subjects had suspected liver disease (SLD) defined as altered liver enzymes, high mean corpuscular volume, or low platelet count in the absence of HBV and HCV infection. Ethanol intake was assessed using a food frequency questionnaire, and FL was diagnosed using ultrasonography. The incidence and remission rates of FL were 18.5 and 55.0 per 1,000 person-years. Progression to cirrhosis or HCC was rare in both cohorts (incidence rate: 1.7 versus 1.1 and 0.8 versus 0.4 per 1,000 person-years for FL ؊ versus FL ؉ ). Multivariable Poisson regression was performed to identify predictors of FL incidence and remission among sex, age, body mass index, ethanol, and liver enzymes. Every increase of 20 g/day of ethanol intake at baseline was associated with a 17% increase in the rate of incident FL (P ‫؍‬ 0.019), a 10% decrease in the rate of remitting FL and SLD (P ‫؍‬ 0.043), a 19% decrease in the rate of remitting FL with persistent SLD (P ‫؍‬ 0.002), and a 10% increase in mortality rate (P ‫؍‬ 0.005) in the FL ؉ cohort. Conclusion: In the general population of the Dionysos Study, FL regressed in nearly 1 of every 2 cases and had a substantially benign course. Ethanol intake was the most important risk factor for FL remission and incidence and a predictor of mortality in subjects with FL. (HEPATOLOGY 2007;46:1387-1391 R ecent studies performed in representative samples of the general population have shown that fatty liver (FL) is highly prevalent and that anthropometric and metabolic indicators are better predictors of FL than ethanol intake. 1-4 Data are still lacking, however, on the incidence and natural course of FL in the general population. 5 The incidence and remission rates of nonalcoholic fatty liver disease (NAFLD) were 10% and 16%, respectively, in a convenience sample of 4,401 Japanese employees followed for a mean time of 1.1 years. 6 The survival of a community-based sample of NAFLD patients was lower than that of the general population (standardized mortality rate [SMR], 1.34; 95% CI, 1.003-1.76) and 5% of them developed cirrhosis after a mean (SD) time of 7.6 (4.0) years. 7 In the largest clinical study performed to date, 5% of a convenience sample of 129 hospitalized NAFLD patients developed end-stage liver disease after a mean follow-up time of 13.7 years. 8 Referral bias may be responsible for the relatively high incidence of cirrhosis observed in community-and hospitalbased cohorts. 5,7,9 Indeed, there is an ongoing controversy as to whether NAFLD should be considered a benign disease. 10,11 Using data from the follow-up of the Dionysos Study, we evaluated the incidence and natural course of FL in a representative sample of the general population. Patients and MethodsStudy Design. The purpose of the Dionysos Study was to assess the prevalence, incidence, and natural course of liver disease in the general population of 2 towns o...

Phosphatidylcholine functional foods and nutraceuticals: A potential approach to prevent non‐alcoholic fatty liver disease

“…In severe cases, NASH can progress to either cirrhosis or liver cancer. Estimates of NAFLD prevalence range from 22 to 33.6% in the U.S. population, and similar estimates have recently been found among adults in Western Europe [10]. Estimates of NASH prevalence range from 2 to 5.7%, but may be found in more than 25% of obese individuals [9].…”

Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

“…Over a follow up of 8.5 years, the incidence of ultrasonographically detected NAFLD was 18.5 per 1,000 person years in a sample representative of the general Italian population 36 . Data gathered in the past few years are clarifying the natural history of histologically diagnosed NAFLD.…”

“…The two major available studies, conducted on a large cohort of Italian patients with T2DM, reported NAFLD prevalence of 60-70% 33,34 ; data from the UK suggests that NAFLD, detected ultrasonographically, is present in 42.6% of patients with T2DM 35 . Prevalence of NAFLD also increases with BMI, such that in an unselected Italian population sample 91% of patients who were obese (BMI ≥30 kg/m 2 ), 67% of those who were overweight (BMI 25-30 kg/m 2 ) and 25% of individ uals at a normal weight (BMI 18-25 kg/m 2 ) had ultra sonographical evidence of NAFLD 36 . The prevalence of NAFLD among patients matching at least one of the Adult Treatment Panel III (ATP III) criteria for serum lipid level alterations is similarly high at 78.8% 33 .…”

Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?

“…Metabolically induced liver disease may also act as a contributing factor in the progression of liver disease of a different aetiology [5,10]. Because of the high prevalence of metabolic diseases in the adult population, there is a frequent chance association, and there is evidence that the progression of viral or genetic liver diseases may be more severe in individuals with steatosis, leading to an underestimation of the overall clinical impact of NAFLD on morbidity and mortality [5,10].…”

“…Population and cohort-based studies suggested that the regular course is relatively benign in pure steatosis [10,11], with a long-term prognosis similar to that for the general population [11]. However, a few clinical series observed that hepatic steatosis is a risk factor for NAFLD progression, mainly in the presence of obesity and type 2 diabetes [12].…”