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

journal contribution
posted on 29.05.2018, 00:00 authored by Elena GeorgeElena George, Stuart K Roberts, Amanda J Nicoll, Anjana Reddy, Tonya Paris, Catherine Itsiopoulos, Audrey C Tierney
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.

History

Journal

Internal medicine journal

Volume

48

Issue

11

Pagination

1369 - 1376

Publisher

John Wiley & Sons

Location

Chichester, Eng.

eISSN

1445-5994

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018, Royal Australasian College of Physicians