The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort
J Hepatol. 2021 Mar 18;S0168-8278(21)00176-8. doi: 10.1016/j.jhep.2021.02.034.Online ahead of print.
Stephen A Harrison1, Samer Gawrieh2, Katharine Roberts3, Christopher J Lisanti4, Ryan B Schwope4, Katherine M Cebe5, Valerie Paradis6, Pierre Bedossa6, Jennifer M Aldridge Whitehead7, Aymeric Labourdette8, Véronique Miette8, Stefan Neubauer9, Céline Fournier10, Angelo H Paredes3, Naim Alkhouri11
Author information
1Radcliffe Department of Medicine, University of Oxford, UK. Electronic address: stephenharrison87@gmail.com.
2Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
3Department of Internal Medicine, Gastroenterology and Hepatology Service, San Antonio Military Medical Center, San Antonio, TX, USA.
4Department of Radiology, San Antonio Military Medical Center, San Antonio, TX, USA;; Department of Radiology & Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
5Department of Pathology, San Antonio Military Medical Center, San Antonio, TX, USA.
6Department of Pathology, Beaujon Hospital, Clichy, France.
7Department of Internal Medicine, Gastroenterology and Hepatology Service, San Antonio Military Medical Center, San Antonio, TX, USA; Department of Radiology, San Antonio Military Medical Center, San Antonio, TX, USA.
8Innovation, Echosens, Paris, France.
9Radcliffe Department of Medicine, University of Oxford, UK.
10Medical Affairs, Echosens, Paris, France.
11Arizona Liver Health, Chandler, AZ, USA.
Abstract
Background and aims: Large prospective studies to establish the prevalence of nonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), are lacking. We prospectively assessed the prevalence and severity of NAFLD/NASH in a cohort of asymptomatic middle-aged Americans attending a colonoscopy class at a gastroenterology clinic.
Methods: Screening for NAFLD was performed using magnetic resonance (MR)-based LiverMultiScan® proton density fat fraction (LMS-PDFF). MR exams also included corrected T1 and elastography for liver stiffness measurement (LSM). FibroScan® was also used to measure LSM. Participants with predetermined abnormal imaging parameters were proposed a liver biopsy to evaluate for NASH. Biopsies were read in a blinded fashion with consensus by two expert pathologists. The prevalence of NAFLD was determined by PDFF ≥ 5% or when PDFF and biopsy data available, by histological diagnosis of NAFLD. The prevalence of NASH was defined by biopsy.
Results: Of 835 participants, 664 subjects met the inclusion and exclusion criteria. The mean age was 56 ± 6.4 years, 50% were male, the mean body mass index was 30.48 ± 5.46 kg/m2, and 52% were obese. The prevalence of NAFLD was 38% (95% CI 34-41%) and the prevalence of NASH was 14% (95% CI 12-17%). While no patient had cirrhosis on biopsy, significant fibrosis (F ≥ 2) was present in 5.9% (95% CI: 4-8%) and bridging fibrosis in 1.6% (95% CI: 1-3%). In a multivariable analysis, factors associated with the presence of NASH were race, obesity, and diabetes.
Conclusion: Using state-of-the-art liver imaging modalities and reference biopsy, this study establishes an overall prevalence of NAFLD of 38% and NASH by biopsy of 14% in this cohort of asymptomatic middle-aged US adults. Lay summary.