The Demographic Features of the Prevalence of Non- Alcoholic Steatohepatitis (NASH) in a Cohort of Adult Sri Lankans, Investigated for Suspected Chronic Liver Disease in a Medical Unit – Data Form a Tertiary Care Center

Abstract

Purpose: To study the prevalence of NASH and related matters in adult Sri Lankans, who had undergone consented liver biopsies during the process of investigation for suspected chronic liver pathology since in Sri Lanka this condition is picked up on routine medical screening of asymptomatic patients and its clinical implications and long term sequele are not well studied in the general population. Methods: The clinical notes of 224 patients admitted to the principal author's unit at Sri Jayewardenepura General Hospital Kotte, Sri Lanka for liver biopsies, for elucidation of suspected liver disease from 17.4.2002 to 31.7.2007 were retrospectively analyzed, to compile data with respect to the above. Results: 122 biopsies out of 224 (54.4%) had evidence of non alcoholic fatty liver disease (NAFLD). The latter comprised 80.5%of steatosis, 15.4% of NASH and 4.1% NASH with cirrhosis. Sex distribution for NASH was male 13: female 6 (∼2:1). Age distribution 22–55 years with a population mean age of 42.7 ± 5.13 SD yrs. The same for males and females were 41.6 ± 15.3 SD and 45.0 ± 10.0 SD respectively. Associated diabetes mellitus, hyperlipidaemia, and hypertension in subgroups of steatosis, NASH, NASH with cirrhosis were as follows, steatosis –61.5%, 72.2%, 68.4%; steatohepatitis 30.7%, 22.2%, 26.3%, NASH with cirrhosis 8.8%, 5.6%, 5.5% respectively. Mean ages and body mass index (BMI) for the above subgroups were as follows. Steatosis 36.3 ± 13.5 yrs, 22.7 ± 2.4, NASH 42.7 ± 5.1 yrs, 25.6 ± 2.2, NASH with cirrhosis 47.3 ± 7.5, 24.8 ± 2.2 respectively. SGPT and SGOT had means of 78.8 ± 33.3 SD IUL/L, (range 35–152) and 65.5 ± 46.1 SD IUL/L (range 21–215) for NASH group. Social status and dietary habits had no influence while all were lacking adequate amounts of exercise. Conclusion: Prevalence of NASH in adult Sri Lankans parallel what is found elsewhere. A cluster of metabolic syndrome was seen amongst NASH patients. Males had a higher BMI with early presentation. Higher BMI values were seen during the disease progression from steatosis to NASH thus highlighting a point of active intervention by modifying lifestyle. Progression of NASH to cirrhosis in this cohort at a relatively younger age was an alarming feature.