NAFLD common among young adults in UK

Last Updated: 2020-01-29

By Marilynn Larkin

NEW YORK (Reuters Health) - Twenty percent of young people in the UK have steatosis and about 2.5% have fibrosis, portending a healthcare burden of adults with non-alcoholic fatty liver disease (NAFLD), a population-based study reveals.

"Only a small proportion of this group will go on to develop advanced liver disease (cirrhosis) from this, but NAFLD is now one of the commonest indications for liver transplant in the UK and the US, and significantly increases the risk of liver cancer," Dr. Kushala W M Abeysekera of the University of Bristol told Reuters Health by email. "Young adults remain a blind spot for clinicians...as generally they will be fit and well, so are not routinely assessed."

"Whilst obesity and being overweight were the main factors associated with steatosis, those at greatest risk were those with harmful alcohol consumption AND steatosis," he said. "The concern is we will see more people present with NAFLD and alcohol-related cirrhosis earlier, which has major implications for our healthcare service."

The study included 3,768 participants (out of more than 10,000 invited) in the Avon Longitudinal Study of Parents and Children. The mean age was 24 and 63% were women. Participants were assessed by transient elastography with FibroScan to determine the prevalence of steatosis and fibrosis.

FibroScan data were collected on histologically equivalent fibrosis stage (F0-F4) and steatosis grade (S0-S3).

As reported in The Lancet Gastroenterology and Hepatology, 780 participants had suspected steatosis (S1-S3), and 377 (10%) presented with S3 (severe) steatosis. BMI was positively associated with increasing steatosis grade, with the median BMI in the overweight range (25 to <30) for S1 and S2 and the obese range (30 or greater) for S3. As steatosis grade increased, the proportion of participants with obesity increased to 56.2% for those with S3.

After adjustment for excessive alcohol intake, smoking, and social class, participants with a BMI in the obese range had a five times greater risk of steatosis compared with those who were overweight.

Among the 3,600 participants with transient elastography results, 96 (2.7%) had values equivalent to suspected fibrosis (F2-F4), including nine with F4.

The authors conclude, "A holistic approach to the UK obesity epidemic and excessive drinking patterns is required to prevent an increasing health-care burden of adults with advanced liver disease in later life."

Dr. Abeysekera said, "I think the obesity crisis and harmful alcohol use in the UK should be tackled on multiple fronts by, for example, increasing the sugar levy on soft drinks; reducing advertising from fast food outlets and alcoholic products; inventive food labelling such as the amount of exercise required to burn off the calories; making it easier for the public to cycle round their towns and cities; and introduction of minimum-unit pricing across the UK (present in Scotland, Wales and Northern Ireland but not England)."

Further, he advised, "If you see someone with NAFLD, it is important to assess them for associated diseases such as type 2 diabetes, hypertension and dyslipidemia, whilst clarifying if they have fibrosis with either a scan or blood tests." He recommended the referral pathway guidance from the European Association for the Study of the Liver (http://bit.ly/2GB0w36).

Dr. Na Li, a gastroenterologist at The Ohio State University Wexner Medical Center in Columbus, commented by email, "Many studies have shown increased incidence and prevalence of NAFLD over the past decade or two. Therefore, it's reasonable to believe that current high prevalence is predominantly due to the nature of the disease progression rather than improved diagnostic performance."

"Fortunately, although NAFLD affects a quarter of world population, not all people have significant clinical consequences," she said by email. "This is particularly true in patients with steatosis alone in the liver."

"We have learned that the bad outcomes of NAFLD are tightly associated with liver injury, including fibrosis and steatohepatitis," she said. "Therefore, it's important for patients and clinicians to understand this, and identify the high-risk NAFLD patients for early intervention."

SOURCE: http://bit.ly/313xm6g and http://bit.ly/36I2bPj The Lancet Gastroenterology and Hepatology, online January 15, 2020.