Emerging Increase in the prevalence and severity of nonalcoholic fatty liver disease: epidemiological study from general Mediterranean population

Background and Aims: The worldwide spread of obesity anddiabetes is leading to a drastic increase in nonalcoholic fatty liverdisease (NAFLD) and its complications.We aimed to assess prevalenceof NAFLD and of its severity among a general Mediterraneanpopulation.Methods:We considered 886 consecutive individuals included in theABCD study (ISRCTN15840340). Hepatic ultrasound (US) was used todiagnose steatosis and FibroScan (M and XL probe) to measureliver stiffness and controlled attenuation parameter (CAP). Liverstiffness >6.9 KPa was considered suggestive of significant liverfibrosis (Petta S et al., Hepatology 2015), and CAP ≥ 310 dB wasconsidered suggestive of moderate-severe steatosis (de Ledinghen Vet al., JHEP 2014).Results: Steatosis by USwas diagnosed in 396 individuals (44.6%) andwas significantly associated with male gender, type 2 diabetes, lowHDL (<40 mg/mL in males and <50 mg/mL in females), and visceralobesity. When splitting the analysis according to gender, steatosiswas independently linked to visceral obesity (OR 2.63, 95% CI 1.62–4.27, p < 0.001) and low HDL (OR 2.06, 95% CI 1.10–3.85, p = 0.02) inmales, and to visceral obesity (OR 2.75, 95% CI 1.80–4.19, p < 0.001)and type 2 diabetes (OR 2.19, 95% CI 1.00–4.87, p = 0.05) in females.The rate of US steatosis, stiffness >6.9 kPa and CAP ≥310 progressivelyincreased from males without obesity and low HDL (35.1% steatosis;among theme 18.6% CAP ≥310, and 13.5% stiffness >6.9), to those withone risk factor (from 57.7% to 62.1% steatosis; among them 42.8% CAP≥310, and from 21.4% to 23.2% stiffness >6.9), and further to thosewith both risk factors (74.2% steatosis; among them 35% CAP ≥310,and 30% stiffness >6.9). Similarly, in females the rate of US steatosis,stiffness >6.9 kPa and CAP ≥310 progressively increased from patientswithout obesity and diabetes (23.7% steatosis; among them 6.1% CAP≥310, and 6.1% stiffness >6.9), to those with only one risk factor (from33.3% to 50.8% steatosis; among them CAP ≥310 from 30.5% to 54.5%,and stiffness >6.9 from 11.1% to 27.2%), and further to those with bothrisk factors (74.2% steatosis; among them 47.1% CAP ≥ 310, and 26.4%stiffness >6.9).Conclusions: NAFLD is present in more than 40% of generalpopulation and its prevalence, as well as the prevalence of liver