Women in the Age Group of 20 to 50 Years Are Less Prone to Develop Nafld in Kerala, South India: A Population Based Study

Abstract

Aim To investigate frequency, gender-specific differences and impact of polymorphisms in Non alcoholic Fatty Liver Disease (NAFLD) among the population of Kerala State, South India with a high incidence of type 2 Diabetes Mellitus (Type 2 DM). Methods In a Community based study, data were collected on anthropometry, blood pressure, morbidity patterns and Ultrasound was carried out in 484 subjects. 121 subjects were excluded due to other findings on ultrasonography, hepatitis B and C. 363 subjects, 126 with NAFLD (cases) and 237 with no NAFLD (controls) were evaluated. Blood samples collected after 12 hours fasting were analysed for blood glucose, Liver Function Tests, Lipid profile and Genetic studies for MTP polymorphisms. Results A low prevalence of NAFLD was noted in women below the age of 50 years (P<0.05). Prevalence of Type 2 DM was 14% and more common in men (P=0.002). Mean BMI was 25.5 for the NAFLD group and 23.2 for controls (p< 0.001). Women with NAFLD had higher BMI (P=0.003), systolic blood pressure (SBP) (P=0.030), LDL (P=0.001), HDL (P=0.001) and alkaline phosphatase (P<0.001) than men with NAFLD. Women with NAFLD had increased total cholesterol, higher AST/ALT ratio, (P<0.001) and diastolic BP (P=0.061) compared to women controls. Microsomal triglyceride transfer protein (MTP) T-substitution at -493 was significantly more common in NAFLD than controls (P=0.003). High prevalence was noted among females as carriers (P=0.002). More than 80% of the T-allele carriers were females in the 20-50 years of age group, compared to 25% among males. Conclusion Women under 50 years of age had less NAFLD but more often had type 2 DM, metabolic syndrome, high BMI and the MTP -493 mutation.. The specific age cut-off, for differences, indicates that estrogens may play an important role.