Fatty liver on the rise among young adults
Nonalcoholic fatty liver disease (NAFLD, or steatosis) was prevalent in a substantial number of young adults, suggesting an imminent public health crisis if left undiagnosed and untreated, according to data from a large UK trial presented at ILC 2019.
Researchers of this population-based trial evaluated fibroscans (ie, transient elastography) of 4,020 individuals (mean age 24 years) from the Children of the 90s prospective birth cohort (otherwise known as Avon Longitudinal Study of Parents and Children). Of these, 3,128 scans were eligible for fibrosis analysis, while 3,283 were eligible for steatosis analysis. Participants with excessive alcohol intake or known alcohol use disorder were excluded. [ILC 2019, abstract GS-08]
The current fibroscans revealed that almost 21 percent (n=780) of participants had fatty liver deposits indicative of NAFLD, half of which were classified as severe.
“[These are higher than the] previous estimated prevalence of NAFLD within the same cohort 6 years prior,” said study investigator Dr Kushala Abeysekera from the University of Bristol Population Health Sciences in Bristol, UK, pertaining to the previous results reflecting NAFLD in only about 3 percent of participants.
NAFLD was more prevalent among females than males (p<0.001). Moreover, 2.4 percent (n=72) developed fibrosis to a certain degree, 0.3 percent of which was at stage F4.
“This is the largest study to date to analyse fibrosis and steatosis in young adults with suspected NAFLD using transient elastography,” said Abeysekera. “We were concerned to find that, at only 24 years of age, one in five had steatosis and one in 40 had evidence of fibrosis … in a group of largely asymptomatic, predominantly Caucasian young people.”
Furthermore, there were positive associations between increased liver enzymes (ALT, AST, and GGT*) and higher fibrosis score (p≤0.002) and CAP** score (p<0.001), which were all suggestive of liver damage.
Cholesterol levels, triglycerides, and low-density lipoprotein also increased with increasing steatosis grade (p<0.001), and BMI increased significantly with both fibrosis and CAP scores (p<0.001 for both).
NAFLD pertains to the accumulation of lipids in the liver unrelated to alcohol consumption, with an estimated global prevalence of 20–30 percent. [North Clin Istanb 2016;3:111-117; J Med Life 2018;11:20-23] Its rising prevalence can give rise to other serious health issues such as cardiovascular disease-related morbidities, diabetes, and liver cancer. [Nat Rev Gastroenterol Hepatol 2018;15:11-20; J Hepatol 2016;65:425-443; World J Clin Oncol 2017;8:429-436]
Nonetheless, NAFLD is a reversible condition that can be remedied through lifestyle changes – by incorporating a proper diet and exercise regimen to achieve or maintain a healthy weight, noted the researchers.
Early diagnosis, prevention, and treatment are imperative to arrest its progression into cirrhosis, they added, underscoring the importance of promoting awareness to avoid a public health crisis.
In a press release, Prof Philip Newsome, vice secretary of the European Association for the Study of the Liver, commented, “These data highlight the impact of the obesogenic environment and … its role in the development of NAFLD in a much younger sector of the population. This requires swift changes in public policy if we are to defuse the ticking time-bomb of obesity and NAFLD.”