Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) in High-Risk Undiagnosed Adults in South Florida

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is reportedly increasing in prevalence. Purportedly, 3-5% of NAFLD patients will progress to non-alcoholic steatohepatitis (NASH). The prevalence of NAFLD and NASH among high-risk adults reportedly ranges from 20-25% and 3-12% respectively. This study aims to investigate a more precise prevalence of NAFLD and NASH among undiagnosed high-risk individuals in South Florida by utilizing FibroScan®, a non-invasive assessment of transient elastography and controlled attenuation parameter (CAP). Methods: This is a cross-sectional analysis of 51 patients who met ≥2 inclusion criteria: BMI ≥30 kg/m2, waist circumference >40” in men and >35” in women, HTN, hypertriglyceridemia and DM II. All patients who met the inclusion criteria underwent FibroScan® imaging. Two measures were obtained: CAP and kilopascals (kPa), metrics for steatosis and fibrosis respectively. Prespecified, validated cutpoints for steatosis and fibrosis were CAP >280 and kPa >8. An analysis of variant (ANOVA) was conducted to explore the impact of each patient's total risk factors on CAP score. Results: Of 51 patients, 21 males and 13 females had a CAP ≥280. 3 males had a kPa ≥8. Among this cohort, the mean CAP and kPa were 330.29 and 8.50 respectively. A t-test disclosed no significant difference in CAP score between males and females (p=0.235). The ANOVA revealed a statistical difference in CAP score in patients with 2 risk factors vs those with >2 risk factors (p=0.001) as noted in Fig. 2, demonstrating that additional risk factors may augment the development of steatosis.893_B Figure 2. Number of risk factors vs the mean CAP scoreConclusion: The diagnosis of NAFLD or NASH is often delayed in high risk patients, perhaps a consequence of the absence of an FDA approved therapeutic. FibroScan® is a screening tool with which patients can be assessed for subclinical disease. Our study demonstrates a much higher than reported prevalence of underlying NAFLD or NASH in the at-risk population. 67% of people with ≥2 risk factors for NASH and NAFLD had evidence of disease on FibroScan®. Thus, the current estimates for NASH and NAFLD may misjudge their prevalence in the US population. Moreover, a significant rise in CAP score was associated with more risk factors. Future healthcare expenditures for liver disease may therefore be higher than anticipated. Novel therapeutics for these disorders require greater attention in order to avert a potential hepatic disease ‘epidemic.'893_A Figure 1. Distribution of risk factors for NAFLD and NASH among males and females