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11/03/2011 01:15 AM


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Fatty Liver Disease on the Rise in U.S.

By Joyce Frieden, News Editor, MedPage Today

Published: October 31, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

■Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

■Note that in one study, non-alcoholic steatohepatitis was more common in American Hispanics and individuals with components of metabolic syndrome, while in another study,

Mexicans had the highest prevalence of unexplained elevated aminotransferases, which was associated with several adiposity-related factors.


The prevalence of non-alcoholic fatty liver disease (NAFLD) as measured by elevated aminotransferase levels is higher than previous estimates, researchers reported here.

Depending on whether "traditional" or "clinical" cutoffs were used, the prevalence of elevated aminotransferases was 15.4% and 39.3%, respectively, Steven Scaglione, MD, of Loyola University in Maywood, Ill., and colleagues reported in a poster presentation at the American College of Gastroenterology annual meeting.

Previous studies of NAFLD using different study designs and measurement cutoffs have found varying rates of NAFLD, the researchers noted.

To clarify the issue, the researchers examined data covering 1999-2008 from the National Health and Nutrition Examination Survey (NHANES) III.

The data included about 20,000 adults, ages 20 to 85. Levels designated "clinically" abnormal included alanine transaminase (ALT) levels of >30 IU/L in men and >19 IU/L in women, and aspartate transaminase (AST) levels of >40 IU/L for men and >31 IU for women.

Levels designated "traditionally" abnormal included ALT >40 IU/L in men and >31 IU/L for women, and AST levels of >37 IU/L in men and >31 IU/L in women.

The researchers found that Mexican-Americans had the highest prevalence of NAFLD -- 24.4% using traditional cutoffs and 49% using the clinical cutoffs. Women had 61% increased odds of having elevated aminotransferases compared to men, with white women having an increased risk compared to black or Mexican women.

If the clinical cutoffs were used, both men and women with elevated aminotransferases had statistically significantly higher body mass index (BMI), waist circumference, total cholesterol, fasting triglycerides, and insulin and glucose levels compared to those whose levels weren't elevated.

Men with elevated aminotransferases also had lower HDL cholesterol levels, while their female counterparts had a higher prevalence of diabetes and hypertension.

In a separate study using NHANES data gathered between 1988 and 1994, Maria Stepanova, PhD, of Inova Health System in Falls Church, Va., and colleagues, found a prevalence of NAFLD of 18.8%.

In that study of about 12,000 people, NAFLD was defined as the presence of moderate-severe hepatic steatosis (by ultrasound), the absence of excessive alcohol use (more than 20 g/day in men and 10 g/day in women), and the absence of hepatitis B and hepatitis C.

That study also found a prevalence rate of 2.21% for non-alcoholic steatohepatitis, defined as having moderate-severe steatosis and elevated aminotansferases in the presence of diabetes or insulin resistance.

In the study using later data, Scaglione and colleagues also looked at whether aminotransferase elevations were "explained" or "unexplained." The elevations were considered "explained" if patients:

•had tested positive for viral hepatitis,

•had transferrin saturation ≥ 50%,

•had significant alcohol consumption, or

•had taken potentially hepatotoxic medications in the previous month.

Elevations were designated "unexplained" if patients did not meet any of the above criteria.

Looking only at data from 1999 to 2002, the investigators found that people with unexplained aminotransferase elevations were more likely to be Mexican and to have a higher BMI, waist circumference, total cholesterol, fasting triglycerides, and insulin levels.

"Several factors associated with obesity" are associated with the unexplained elevations, Scaglione told MedPage Today. As well, "the [percentage of] unexplained abnormal liver function tests are going up, and the percent of explained is going down."

He noted that further analysis showed that 14% of all abnormal liver function tests are attributed to obesity alone, much more than other causes such as alcohol use, which accounts for around 1%.

The authors did not disclose any conflicts of interest.

Primary source: American College of Gastroenterology

Source reference:

Scaglione S et al "The prevalence of elevated aminotransferases in the United States: NHANES 1999-2008" ACG 2011; Abstract P169.

View Comments By: Healthcare Professionals All

jorge antonio medina - Oct 31, 2011

I have learned alot in this article, specially because the people with this disease is increasing since the past year getting worse with time.

It is very important for the primary care provider to be aware about this problem and try to prevent this unfortunate disease to develop.

This problem can be prevented with patient education, leting them know and be aware about this. Trying to change the habits to diminish the obesity

doctorsh - Nov 01, 2011

High fructose corn syrup use is a simple explanation.

tom hennessy - Nov 01, 2011

Quote: the prevalence of elevated aminotransferases was 15.4% and 39.3%

Answer: Increased iron is a marker for NAFLD. An NIH clinical trial is presently investigating the link between iron and NAFLD.

"Iron Depletion Therapy for Type 2 DM and NAFLD" Increased iron is considered to be a subcategory of erythrocytosis / too many red blood cells.

Elevated aminotransferases is related to hemoglobin / red blood cells in that higher hemoglobin parallels high ALT. Lower ALT parallels lower hemoglobin.

"Abnormal ALT started if hemoglobin >11 g/dl females or >13.5 g/dl in males"

"Higher hemoglobin level might serve as a surrogate marker for a possible overload of iron in the human body, which has been found to be associated with elevated ALT" utm_content=&utm_medium=email&utm_campaign=DailyHeadlines& utm_source=

© 2011 Everyday Health, Inc. All rights reserved.


05/29/2012 12:20 AM
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Fatty Liver Disease on Rise in Teens

By Kristina Fiore, Staff Writer, MedPage Today

Published: May 25, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Data from the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2008 showed an increase in non-alcoholic fatty liver disease among adolescents.

Note that elevated serum ALT increased substantially in obese children over this time frame.

SAN DIEGO -- The prevalence of non-alcoholic fatty liver disease (NAFLD) in adolescents has risen over the last few decades and now affects about one in 10 children, researchers said here.

From 1988 to 2008, the prevalence of NAFLD rose from 3.6% to 9.9% among children ages 12 to 18 (P<0.001), Miriam Vos, MD, of Emory University in Atlanta, and colleagues reported during a press briefing at Digestive Disease Week here.

Vos added that additional data from 2009 and 2010, however, have shown a potential flattening in that trend.

Still, she said, the data "point to the importance of continued study [of this condition in this population], particularly for prevention, because just like obesity, this disease is much easier to prevent than to treat."

NAFLD is the most common liver disease in children, and has been tied to further complications down the road, including diabetes, hypertension, and cancer.

Researchers have suspected that there's been an increase in the number of cases of NAFLD among pediatric patients in recent years, "but one of the challenges with that is, we're all looking for it more often because awareness has also been increased," Vos said.

So she and colleagues looked at data from the National Health and Nutrition Examination Survey (NHANES) 1988-2008 on 10,359 patients ages 12 to 18.

NAFLD was defined as being overweight or obese (having a body mass index [BMI] in the 85th percentile or higher) and having an elevated ALT (one that is above 25.8 for boys or above 22.1 for girls).

They found that the prevalence of NAFLD in this pediatric population rose significantly during the course of the study. Among overweight children, the prevalence of elevated ALT was 13.2% in 2008, with no significant increases over time, but in obese children, that prevalence jumped a significant 120% over the study period, from 16.7% to 36.9% (P=0.006).

Vos said the overall increase in pediatric NAFLD prevalence wasn't just determined by the prevalence of obesity or overweight in the sample. In fact, she said, NAFLD "seems to be increasing faster than the prevalence of obesity."

To understand why, they conducted further analyses and found that there's been an increase in average BMI in obese and overweight categories, and also in mean waist circumference in those categories.

"That seemed to nicely parallel the increase in NAFLD," she said. "That may be because an increase in belly fat or abdominal weight is very closely correlated with fatty liver disease."

Vos noted, however, that in additional data from 2009 and 2010, it seems that the trend may be flattening or even slightly improving. "It's not statistically significant, but I'm optimistic this is going to lead to good news in years to come," she said.

Nonetheless, she and colleagues concluded that the data strongly support recommendations to screen for NAFLD in obese adolescents.

The researchers reported no conflicts of interest.

Primary source: Digestive Disease Week

Source reference:

Vos MB, Welsh J "Prevalence of suspected NAFLD is increasing among U.S. adolescents" DDW 2012; Abstract 705.

Kristina Fiore

Staff Writer

Kristina Fiore joined MedPage Today after earning a degree in science, health, and environmental reporting from NYU. She's had bylines in newspapers and trade and consumer magazines including Newsday, ABC News, New Jersey Monthly, and Earth Magazine.

At MedPage Today, she reports with a focus on diabetes, nutrition, and addiction medicine. utm_content=&utm_medium=email&utm_campaign=DailyHeadlines& utm_source=

© 2012 Everyday Health, Inc. All rights reserved.


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