Is the Profile of Nonalcoholic Fatty Liver Disease (NAFLD) Changing Over Time?

Abstract

Purpose: In recent times, NAFLD has emerged as the major cause of liver disorders in both the developed and developing countries. With the fast socioeconomic growth and changing pattern of lifestyle, there is possibility of change in the profile of NAFLD over time. The present study was conducted to look for changes if any in profile of NAFLD patients over one decade. Methods: Retrospective comparison of anthropometric, metabolic, radiological and histological parameters was made between 100 consecutive NAFLD patients diagnosed in 2002 and another 100 NAFLD patients diagnosed in 2012. Results: Over the last decade, there was no significant change in the average age of presentation (42.75±9.6 Vs 40.33±9.9, p=0.081), and gender ratio (M: F 3.2:1 vs 2.8:1, p=0.745) and BMI (26.04±4.05 Vs 26.21±3.25, p=0.744). The steatosis grade on ultrasound increased over this period though it was statistically not significant; (15% vs 27% had moderate fatty change, p=0.098). Though the prevalence of diabetes (10% vs 8%, p=0.623) was similar, prevalence of hypertension (6% vs 35%, p=0.00) was significantly higher among the recent NAFLD population. There were significant decreases in the levels of 2 hour PGBS (p=0.010), TG (p=0.037), ratio of TC/HDL (p=0.002) and increase in HDL (p= 0.00). However, FBS (p=0.267), SGOT (p=0.910), SGPT (p=0.275) did not show any significant change. 20 patients had undergone liver biopsy in each group. Though average NAFLD activity score (2.85±1.348 Vs 3.65±1.785; p=0.118, not significant) and fibrosis (0.25±0.444 Vs 0.95±0.945, p=0.005, significant) were increased in the recently diagnosed NAFLD group, only the increase in fibrosis was statistically significant. Fibrosis was present in 55%(11/20) in 2012 patients compared to 25% (5/20) in the 2002 patients' group. Conclusion: There is a trend towards greater steatosis, necroinflammatory activity and fibrosis in newly diagnosed NAFLD patients compared to NAFLD patients diagnosed a decade ago. However, only the increase in fibrosis assumed significance. This change was seen despite a favourable lipid and glycemic profile and unchanged BMI in these patients. Factors other than metabolic status may be responsible for these alterations.