Nonobese Population in A Developing Country Has A High Prevalence of Nonalcoholic Fatty Liver and Significant Liver Disease

Abstract

There is a paucity of community-based epidemiological data on nonalcoholic fatty liver (NAFL) among nonaffluent populations in developing countries. Available studies are radiological and/or biochemical and lack histological assessment, limiting their strength. We conducted a prospective epidemiological study comprising a 1:3 subsample of all adult (>18 years) inhabitants of a rural administrative unit of West Bengal, India. Subjects positive for hepatitis B virus and/or hepatitis C virus infection and consuming any amount of alcohol were excluded. Diagnosis of NAFL was by dual radiological screening protocol consisting of ultrasonographic and computed tomographic examination of the liver. Transient elastographic examination and liver biopsy were performed in a subset to identify significant liver disease. The risk factors of having NAFL were analyzed. A total of 1,911 individuals were analyzed, 7% of whom were overweight and 11% of whom had abdominal obesity. The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively. Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m 2 , and 54% were neither overweight nor had abdominal obesity. The subjects with the highest risk of having NAFL were those with a BMI >25 kg/m 2 (odds ratio 4.3, 95% confidence interval 1.6-11.5). Abdominal obesity, dysglycemia (fasting plasma glucose >100 mg/dL or elevated homeostatic model assessment of insulin resistance), and higher income were the other risk factors. Even having a normal BMI (18.5-24.9 kg/m 2 ) was associated with a 2-fold increased risk of NAFL versus those with a BMI <18.5 kg/m 2

Risk of nonalcoholic steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease and low visceral adiposity

“…Interestingly, a third-world NAFLD phenotype has recently been described in which subtle values of increased adiposity, not overt adiposity, predispose to NAFLD [39]. This finding could open new perspectives to understand the origin of NAFLD in lean subjects.…”

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

“…Not unexpectedly, in rural India, a region characterized by traditional diets and lifestyles, the preva lence of NAFLD is low (~9%), whereas it mimics Western prevalence trends in urban populations, with rates vary ing between 16% and 32% [56][57][58] . A similar drama tic variation in NAFLD prevalence between urban and rural regions and along racial, economic and cultural bound aries (5-30%) was observed from smaller surveys in Sri Lanka, Malaysia, Singapore and Indonesia [59][60][61][62] .…”

“…2; see Supple mentary information S1,S2 (tables)) 45,49,50,56,[67][68][69][70][71][72][73][74][75][76][77][78] . This manifestation of NAFLD deserves clinical attention as many physicians have a perception that lean NAFLD is more benign in nature than NAFLD in individuals who are obese.…”

Non-alcoholic Fatty Liver Disease: East Versus West

“…The prevalence of NAFLD, NAFLD with elevated alanine aminotransferases (ALT), and cryptogenic cirrhosis (CC) was 8.7%, 2.3%, and 0.2%, respectively. 4 The figures for the prevalence of NAFLD are higher in the urban parts of India, ranging from 16.6% in Western India to 24.5% in Eastern India to 32% in South India. [5][6][7] …”

“…53,54 Other centers from India have also reported low prevalence of DM at presentation in patients with NAFLD ranging from 4% to 10%. 4,[72][73][74] Similarly, only 15% of Chinese patients with NAFLD have diabetes at presentation. 20 Diabetes was seen in only 4.2% and 4.8% of males and 5.8% and11.6% of females with steatosis and NASH, respectively, in Korea.…”