Non-alcoholic fatty liver disease patients attending two metropolitan hospitals in Melbourne, Australia: high risk status and low prevalence

BACKGROUND: Non- alcoholic fatty liver disease (NAFLD) is the commonest liver disease globally with increased rates in high risk populations including type 2 diabetes and obesity. The condition increases the risk of end stage liver disease, hepatocellular carcinoma and all-cause mortality. NAFLD is asymptomatic and often remains undiagnosed as routine screening in high risk groups is not practised. AIMS: The aim of this study was to determine the rates and characteristics of NAFLD patients attending liver clinics at two Melbourne metropolitan hospitals. METHODS: Liver clinics were prospectively screened for ten consecutive months and participants with a diagnosis of NAFLD were further evaluated using pathology and imaging results obtained from medical records. RESULTS: Of the 2050 patients screened, 148 (7%) had NAFLD predominantly diagnosed using ultrasound (81%). NAFLD patients were obese (mean BMI 30.7 ± 5.9kg/m2 ), insulin resistant (median HOMA 4.2 (3.2) mmol/L), had elevated liver enzymes (ALT median, males 47.0 (34.3), females 36.0 (28.0) U/L) and 18% of patients with liver stiffness measure >12kPa suggesting a moderate probability of cirrhosis. Patients with liver stiffness measure ≥9.6kPa had significantly higher: glucose (median 5.5 (1.2) vs. 6.2 (5.3) mmol/L, p=0.007), AST levels (median 25.5 (26.0) vs. 41.0 (62.0) u/L, p=0.0005) and HOMA (3.1 (3.0) vs. 5.4 (5.5) mmol/L, p= 0.040). CONCLUSIONS: NAFLD constituted a minority of liver clinic patients, most were obese, insulin resistant, hypertensive and many had an elevated liver stiffness measurement. NAFLD poses added adverse health outcomes to high risk patients and therefore early detection is warranted.