Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease, and yet the natural course remains unclear. Study population included 36,195 individuals who participated in a health-screening program and diagnosed with fatty liver by abdominal ultrasound. Participants were provided written information regarding fatty liver and advised to make lifestyle changes. Ultrasound was repeated after at least 6 months. After a mean follow up of 4.9 years (±3.4), 19.6% resolved their fatty liver. Individuals who resolved were more likely female (22.9% vs. 12.3%), thinner (body mass index [BMI], 25.2 ± 2.7 vs. 26 ± 2.7), and with lower HOMA-IR (1.4 vs. 1.7) (P .70.001). Decrease in BMI predicted resolution of fatty liver with 42% of those in the top quartile of BMI decline resolving compared with 5.7% in the lowest quartile (odds ratio [OR] (95% confidence interval [CI]) 15.65 (14.13–17.34), P < 0.001)). Baseline HOMA-IR also predicted resolution with those in the top quartile (most insulin resistant) being least likely to resolve (12%) vs. those in the lowest quartile (25%) (OR 0.36 [0.31–0.42], P < 0.001). Fatty liver disease is persistent. Individuals with higher degree of insulin resistance are also the most likely to have persistent steatosis at follow up.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide[1]
The global prevalence of NAFLD is 25%2, which is similar to the estimate in our population of South Korean adults
NAFLD reflects a spectrum of disease from steatosis alone to steatohepatitis
Summary
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide[1]. Prior studies have focused on highly selected individuals with NAFLD based on retrospective chart review[3,4,5,6]. These studies included individuals based on clinical diagnosis of fatty liver[3], elevated liver enzymes[4] or liver biopsies[5,6]. The purpose of this study is to present follow-up on 36,195 individuals with diagnosis of fatty liver by ultrasound. This is the largest known cohort of individuals with fatty liver[2]. We evaluated the effects of obesity and insulin resistance, both strong predictors of fatty liver[7,8], on resolution of steatosis
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