Prevalence of and risk factors for fatty liver in the general population of Northern Italy: the Bagnacavallo Study (original) (raw)
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Hepatology, 2005
The prevalence of and the risk factors for fatty liver have not undergone a formal evaluation in a representative sample of the general population. We therefore performed a crosssectional study in the town of Campogalliano (Modena, Italy), within the context of the Dionysos Project. Of 5,780 eligible persons aged 18 to 75 years, 3,345 (58%) agreed to participate in the study. Subjects with suspected liver disease (SLD), defined on the basis of elevated serum alanine aminotransferase (ALT) and ␥-glutamyl-transferase (GGT) activity, hepatitis B surface antigen (HBsAg), or hepatitis C virus (HCV)-RNA positivity, were matched with randomly selected subjects of the same age and sex without SLD. A total of 311 subjects with and 287 without SLD underwent a detailed clinical, laboratory, and anthropometrical evaluation. Fatty liver was diagnosed by ultrasonography, and alcohol intake was assessed by using a 7-day diary. Multinomial logistic regression was used to detect risk factors for normal liver versus nonalcoholic fatty liver disease (NAFLD) and for alcoholic fatty liver (AFLD) versus NAFLD. The prevalence of NAFLD was similar in subjects with and without SLD (25 vs. 20%, P ؍ .203). At multivariable analysis, normal liver was more likely than NAFLD in older subjects and less likely in the presence of obesity, hyperglycemia, hyperinsulinemia, hypertriglyceridemia, and systolic hypertension; AFLD was more likely than NAFLD in older subjects, males, and in the presence of elevated GGT and hypertriglyceridemia, and less likely in the presence of obesity and hyperglycemia. In conclusion, NAFLD is highly prevalent in the general population, is not associated with SLD, but is associated with many features of the metabolic syndrome. (HEPATOLOGY 2005;42:44-52.) From the 1 Centro Studi
2005
Background: Non-Alcoholic Fatty Liver (NAFL) is a spectrum of liver diseases (LD) that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. Hepatic ultrasound (US) and serum alanine aminotransferase (ALT) are often used as markers of NAFL. Our aim is to describe prevalence of NAFL and associated findings on ultrasound (US) and biochemical parameters in a population of children and adolescents with obesity at the Children's Hospital of Eastern Ontario. Methods: Children with Obesity (BMI >95th percentile) ages 8-17 years presenting to the Endocrinology and Gastroenterology clinics, without underlying LD were prospectively recruited from 2009 to 2012. Fasting lipid profile, HOMA IR) and serum adiponectin levels were measured. NAFL was defined as ALT > 25 and >22 IU/mL (males and females respectively) and/or evidence of fatty infiltration by US. Logistic regression was performed to assess associations. Results: 97 children with obesity included in the study (Male 43%). Mean age was 12.9 ± 3.2 years (84% were older than 10 y). Mean BMI-Z score was 3.8 ± 1.4. NAFL was identified in 85%(82/97) of participants. ALT was elevated in 61% of patients. Median triglyceride (TG) level was higher in children with NAFL(1.5 ± 0.9 vs. 1.1 ± 0.5 mmol/L, p = 0.01). Total cholesterol, HDL, LDL and Non HDL cholesterol were similar in both groups(p = 0.63, p = 0.98, p = 0.72 and p = 0.37 respectively). HOMA IR was ≥3.16 in 53% of children(55% in those with NAFL and 40% in those without NAFL). Median serum adiponectin was 11.2 μg/ml(IQR 7.3-18.3) in children with NAFL vs. 16.1 μg/ ml(IQR 9.0-21.9) in those without NAFL(p = 0.23). Liver US was reported as normal in 30%, mild fatty infiltration in 38%, moderate in 20% and severe in 12%. TG were significantly higher(1.5 mmol/L vs. 1.0 mmol/L, p < 0.01) and HDL-C was lower(1.0 mmol/L vs. 1.1 mmol/L, p = 0.05) in children with moderate and severe NAFL by US. BMI-Z score, HOMA IR, serum adiponectin and HDL levels were not associated with NAFL, however TG were significantly associated(OR = 3.22 (95% CI: 1.01-10.25, p = 0.04)). Conclusion: NAFL is highly prevalent in obese children and youth. Elevated TG levels are associated with NAFL; these findings may serve as a noninvasive screening tool to help clinicians identify children with obesity needing liver biopsy and/or more aggressive therapeutic interventions.
Fatty liver and mortality: a cohort population study in South Italy
BMJ Open
ObjectiveAlcoholic fatty liver (AFLD) and non-alcoholic fatty liver (NAFLD) are two common conditions. However, if they can increase the risk of death is poorly explored. We therefore aimed to investigate the potential association between the presence and severity of liver steatosis and mortality in a large sample of older people.DesignProspective.SettingCommunity.ParticipantsWomen and men randomly sampled from the electoral rolls of the population of Castellana Grotte, a town in Southern Italy (Apulia region) between 2005 and 2006. Among 1942 initially contacted, 1708 (=87.9%) participated to the baseline survey (Multicentrica Colelitiasi III (MICOL III)). This specific study included 1445 older participants (mean age=65.2 years, females=44.2%).ExposureNAFLD or AFLD.Primary and secondary outcomesMortality (all-cause and specific-cause).ResultsAfter a median of 12 years, 312 participants (=21.6%) died. After adjusting for nine potential confounders, the presence of steatosis was not...
Incidence and natural course of fatty liver in the general population: The Dionysos study
Hepatology, 2007
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
External validation of biomarkers of fatty liver in the general population: the Bagnacavallo study
Qeios, 2020
Objective: We externally validated the fatty liver index (FLI), the lipid accumulation product (LAP), the hepatic steatosis index (HSI), and the Zhejiang University index (ZJU) for the diagnosis of fatty liver (FL) and non-alcoholic fatty liver disease (NAFLD) in the general population. Subjects and Methods: The validation was performed on 2159 citizens of the town of Bagnacavallo (Ravenna, Italy). Calibration was evaluated by calculating the calibration slope and intercept and by inspecting calibration plots; discrimination was evaluated using the c-statistic. Results: The average calibration slope was 1 and the average intercept was 0 for all combinations of outcomes and Qeios, CC-BY 4.0 • Article,
Revista Brasileira de Medicina do Trabalho, 2020
Health care professionals are vulnerable to several health problems, including overweight, stress and anxiety. As such, nonalcoholic fatty liver disease is a likely diagnosis in this population. Objectives: To investigate the association between non-alcoholic fatty liver disease and levels of stress and anxiety in a sample of health care workers in a community hospital in the state of Rio Grande do Sul. Methods: The sample consisted of 107 health care workers who were interviewed and screened for non-alcoholic fatty liver disease based on clinical, imaging and laboratory parameters. Occupational stress was evaluated using Lipp's Stress Symptom Inventory, and anxiety was assessed using the Hamilton Anxiety Rating Scale. Results: The mean age of the sample was 37.6 years. Most participants were female (89.1%) and the most frequent occupation was nursing technicians (83.2%). While 77.22% of participants did not report significant levels of stress, 30.7% did have mild anxiety. Statistical tests did not reveal a significant association between non-alcoholic fatty liver disease and stress (p = 0.688) or anxiety (p = 0.996). Conclusions: All participants with non-alcoholic fatty liver disease had some degree of anxiety, but only some experienced stress symptoms, according to Lipp's Inventory. Statistical tests did not confirm an association between stress, anxiety and the presence non-alcoholic fatty liver disease. Nevertheless, the potential association between these variables should continue to be investigated given the global rise in the prevalence of non-alcoholic fatty liver disease and its implications for health care workers. Keywords | anxiety; stress; professionals; health; non-alcoholic fatty liver disease. resumO | Introdução: Profissionais de saúde são suscetíveis a afecções, em um contexto de possível exposição a sobrepeso, estresse e ansiedade. Assim, a doença hepática gordurosa não alcoólica encontra-se como um provável diagnóstico. Objetivos: Investigar a relação entre presença da doença hepática gordurosa não alcoólica e níveis de estresse e ansiedade em profissionais de saúde, por meio de uma amostra de profissionais atuantes em hospital do interior do estado do Rio Grande do Sul. Métodos: Foram entrevistados e examinados 107 profissionais da área da saúde, e foi avaliada a presença de doença hepática gordurosa não alcoólica por meio de exames físico, de imagem e laboratoriais. O estresse ocupacional foi avaliado pelo Inventário de Sintomas de Estresse de Lipp para adultos e a ansiedade foi avaliada pela Escala de Avaliação de Ansiedade de Hamilton. Resultados: A média de idade foi de 37,6 anos, o sexo predominante foi o feminino (89,1%) e técnicos de enfermagem corresponderam à maior parte da amostra (83,2%). Em 77,22% dos entrevistados, não houve identificação de estresse, e 30,7% dos participantes apresentaram ansiedade de grau leve. Testes estatísticos não obtiveram associação significativa entre estresse, ansiedade e doença hepática gordurosa não alcoólica, sendo p = 0,688 e p = 0,996, respectivamente. Conclusões: Todos os portadores de doença hepática gordurosa não alcoólica do estudo relataram algum nível de ansiedade, porém nem todos apresentaram estresse, por meio da mensuração da Escala de Lipp. Testes estatísticos utilizados no estudo não demonstraram correlação entre estresse, ansiedade e presença de doença hepática gordurosa não alcoólica. Ainda assim, mostra-se importante desenvolver novos estudos, considerando o aumento global de casos da doença hepática gordurosa não alcoólica e as suas implicações nos profissionais da saúde. Palavras-chave | ansiedade; estresse; profissionais; saúde; doença hepática gordurosa não alcoólica. 449 non-alcoholic fatty liver disease and associated risk factors in health care professionals in a community hospital in brazil Avaliação da doença hepática gordurosa não alcoólica e fatores de risco associados em profissionais da área da saúde de hospital do interior do Brasil
Revista da Associação Médica Brasileira, 2016
SUMMARY Introduction: NAFLD is an heterogeneous condition that includes steatosis and non-alcoholic steatohepatitis (NASH), in the absence of significant alcohol consumption, reaching 30% of the population. The most common risk factors are: age, gender, ethnicity, diabetes mellitus (DM), obesity, predisposition, metabolic syndrome (MS), insulin resistance (IR), drugs, and polycystic ovary syndrome. Objective: To describe the profile of patients with NAFLD seen at Hospital de Base of Rio Preto, in the state of São Paulo. Method: Patients with NAFLD were assessed, with medical and epidemiological data collected after informed consent. Results: Of the 62 patients evaluated, 76% were women, 73% Caucasians, and 71% were aged between 50 and 69 years and had no symptoms. Ultrasonography results showed steatosis in 84%. NASH was diagnosed in 61% of the sample. 21 patients underwent liver biopsy, of which 36% had cirrhosis, 1 had liver cancer, and 1 pure steatosis (5% each). Risk factors wer...
Epidemiology of Non-Alcoholic Fatty Liver Disease: A Primary Health Care Based Study
Background and aim: The prevalence of Non-alcoholic fatty liver disease is markedly increasing in the past decade, in association to a linked increase in other comorbidities; mainly metabolic syndrome. As insufficient data, exist in the literature regarding the prevalence and predisposing factors among patients in Saudi Arabia. This study aimed to estimate the frequency and associated risk factors of NAFLD detected in abdominal ultrasound requested by primary care physicians in Prince Sultan military medical city, Riyadh, KSA. To properly identify high-risk groups for early detection, management, decreasing the associated morbidity and mortality. Methods: A cross sectional study with a total of 143 patients enrolled from primary health centers of PSMMC. All patients were adults who are not known to have hepatic disease, and their abdomen ultrasound requested by Primary health cares from March to September 2020. An estimation of prevalence and correlation with common risk factors was done. Whereas Electronic health records were used for data collection including demographical data, Clinical measurements, laboratory workup, medication history and indication of ultrasound request. Result: The estimated prevalence of NAFLD detection in ultrasound was 78 patients (54.5%). With a female (n=52, 67%) to male (n=26, 33%) predominance. The highest detection was among patients who are 18-35 years of age (n=49, 34.4%). As per clinical risk factors, the majority were found to be overweight (n= 34, 23.8%, p-value= 0.003), with normal systolic (n=105, 73.4%, p-value=0.339) and diastolic (n=87, 60.8%, p-value=0.819) blood pressure. The highest associated detection of NAFLD was among patients with thyroid disorders (n=16, 84%), then hypertensive (n=22, 73%), then diabetics (n= 21, 70%), then dyslipidemias (n=15, 68%), and cardiovascular (n=4, 50%). The strongest associated biochemical risk factors were suboptimal HBa1c (n=20, 74%, p-value=0.066), and elevated LDL cholesterol (n= 8, 73%, p-value=0.272). As per medication history, majority were on either hypertensive (n=23, 79%), diabetic (n=21, 70%) or dyslipidemia (n=15, 68%) therapy. Finally, the most common ultrasonographic indication was abdominal pain (n=31, 48%). Conclusions: The exact prevalence of NAFLD is underestimated. With a clear bidirectional association with metabolic syndrome parameters. Therefore, we recommend physicians to control the previously mentioned comorbidities to prevent further development of fatty liver. We recommend against the routine ultra-sonographic screening, with a tailored approach for screening only high-risk metabolic syndrome patients. Finally, emphasizing on the need for further larger scaled-census; to establish an exact population prevalence and establishing a validated clinical criterion for which patients' to be screened for fatty liver disease.
Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy
Annals of Internal Medicine, 2000
The prevalence of and the risk factors for fatty liver have not undergone a formal evaluation in a representative sample of the general population. We therefore performed a crosssectional study in the town of Campogalliano (Modena, Italy), within the context of the Dionysos Project. Of 5,780 eligible persons aged 18 to 75 years, 3,345 (58%) agreed to participate in the study. Subjects with suspected liver disease (SLD), defined on the basis of elevated serum alanine aminotransferase (ALT) and ␥-glutamyl-transferase (GGT) activity, hepatitis B surface antigen (HBsAg), or hepatitis C virus (HCV)-RNA positivity, were matched with randomly selected subjects of the same age and sex without SLD. A total of 311 subjects with and 287 without SLD underwent a detailed clinical, laboratory, and anthropometrical evaluation. Fatty liver was diagnosed by ultrasonography, and alcohol intake was assessed by using a 7-day diary. Multinomial logistic regression was used to detect risk factors for normal liver versus nonalcoholic fatty liver disease (NAFLD) and for alcoholic fatty liver (AFLD) versus NAFLD. The prevalence of NAFLD was similar in subjects with and without SLD (25 vs. 20%, P ؍ .203). At multivariable analysis, normal liver was more likely than NAFLD in older subjects and less likely in the presence of obesity, hyperglycemia, hyperinsulinemia, hypertriglyceridemia, and systolic hypertension; AFLD was more likely than NAFLD in older subjects, males, and in the presence of elevated GGT and hypertriglyceridemia, and less likely in the presence of obesity and hyperglycemia. In conclusion, NAFLD is highly prevalent in the general population, is not associated with SLD, but is associated with many features of the metabolic syndrome. (HEPATOLOGY 2005;42:44-52.) From the 1 Centro Studi