Academic journal article Iranian Journal of Public Health

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Predictors in North of Iran

Academic journal article Iranian Journal of Public Health

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Predictors in North of Iran

Article excerpt


Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent types of liver diseases in western countries. It is defined as storage of tri- glycerides in hepatocytes more than 5% of liver weight, less than 20 g/d of alcohol consumption and exclusion of any other causes of chronic liver diseases (1-3). This disease has a wide spectrum of manifestations from simple hepatic steatosis to steatohepatitis with different grades of fibrosis to cirrhosis and in rare cases hepatocellular carci- noma (4). It is usually associated with visceral obe- sity, type 2 diabetes, dyslipidemia and other com- ponents of metabolic syndrome so it is considered to be one of the aspects of metabolic syndrome (1-3, 5-8). The prevalence of NAFLD in adults is 20-30% in western countries (9-13). In eastern countries the disease did not used to be frequent but recent studies have shown an increasing rise in the prevalence of NAFLD and it has been associ- ated with the change of life style (diet, physical activity) and increasing prevalence of obesity (14- 15). The Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran reported a strikingly high prevalence of some metabolic abnormalities such as diabetes (8.7%), obesity (22.3%), hypertension (26.6%), hypertriglyceridemia (36.4%), hypercholesterole- mia (42.9%) and central obesity (53.6%) in our country, as a developing country which was com- parable, if not higher, to most developed countries (16). Since all these metabolic abnormalities are risk factors for NAFLD, these results predict a high prevalence of NAFLD in Iran.

To the best of our knowledge a few studies are available on the prevalence of NAFLD in Iran (17-19) and most of them have reported NASH prevalence in particular (not NAFLD) or has been conducted on a specific group such as diabetic patients (20). On the other hand there has been no study on the prevalence of NAFLD in North- ern provinces of Iran. In fact the distribution of type 2 diabetes, central obesity, hypertension and dyslipidemia is not the same in different regions and it affects on the prevalence of NAFLD.

The aims of this study were to determine the prevalence of NAFLD, its potential predictors and their sex distribution in an adult population based study in Amol, northern Iran.

Material and Methods

Study design

This study was conducted within the framework of Amol health cohort study. From 2008, the Gas- tro Intestinal and Liver Disease Research Center (GILDRC) has conducted a multidisciplinary study on general population of Amol and sur- rounding areas. Total 6420 subjects were involved in this study by cluster random sampling. Details of the Amol cohort protocol have been published elsewhere (21).

This population based cross-sectional study was conducted on phase 1 of Amol cohort study and included 5023 adult individuals who had full rele- vant data.

Inclusion criteria

An adult population of 18-90 year old, who gave written informed consent, participated in the study.

Exclusion criteria

The exclusion criteria were patients with chronic liver diseases, the presence of hepatitis B virus surface antigen or hepatitis C virus antibodies, known cases of autoimmune hepatitis or Wilson disease, an alcohol consumption more than 30 g/day in men and more than 20 g/day in women, patients with cognitive diseases and individuals who were incapable of communicating.


Details of the Amol cohort health study have been published elsewhere (21) but briefly, after signing a detailed informed consent, a standard- ized questionnaire was administered to determine the clinical histories, past medical histories, alco- hol consumption and the use of any drugs includ- ing hepatotoxic drugs in all the participants. Then a physical examination was performed to measure weight (kg), height (m) and waist circumference [WC (cm)] according to the standard protocol (22). …

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