Influence of lifestyle-related diseases and age on the development and progression of non-alcoholic fatty liver disease.

Abstract

Although non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome, the clinical association between non-alcoholic steatohepatitis (NASH) and lifestyle-related diseases such as obesity, type 2 diabetes mellitus (DM), hypertension (HT) and dyslipidemia (DL) has not been clarified. We studied the influence of lifestyle-related diseases and age on the development and progression of NAFLD. We enrolled 550 patients with biopsy-proven NAFLD (284 men, 266 women; average age, 52 and 62 years, respectively). The effect of lifestyle-related diseases and age (≤49 vs ≥50 years) on the frequency of NASH and advanced fibrosis (≥stage 3) was studied. Prevalence of obesity, DM, HT and DL in male and female NASH patients was 75%/67%, 53%/54%, 66%/77% and 85/79%, respectively. DM patients had a higher frequency of NASH in the older male NAFLD group and a higher frequency of advanced fibrosis in the older female NASH group. With the increasing number of complicating lifestyle-related diseases, the rate of NASH increased in male NAFLD patients. In both sexes, aging resulted in the development of NASH and progression of liver fibrosis. Multivariate logistic regression analysis revealed that age and DM were significantly associated with the development of NASH in male NAFLD patients and progression of fibrosis in female NASH patients. Age is strongly associated with the development and progression of NASH. Type 2 DM may play the most crucial role among lifestyle-related diseases in the development and progression of NASH.