title: Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease.
abstract: There is a paucity of community-based epidemiological data on nonalcoholic fatty liver (NAFL) among nonaffluent populations in developing countries. Available studies are radiological and/or biochemical and lack histological assessment, limiting their strength. We conducted a prospective epidemiological study comprising a 1:3 subsample of all adult (>18 years) inhabitants of a rural administrative unit of West Bengal, India. Subjects positive for hepatitis B virus and/or hepatitis C virus infection and consuming any amount of alcohol were excluded. Diagnosis of NAFL was by dual radiological screening protocol consisting of ultrasonographic and computed tomographic examination of the liver. Transient elastographic examination and liver biopsy were performed in a subset to identify significant liver disease. The risk factors of having NAFL were analyzed. A total of 1,911 individuals were analyzed, 7% of whom were overweight and 11% of whom had abdominal obesity. The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively. Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m(2), and 54% were neither overweight nor had abdominal obesity. The subjects with the highest risk of having NAFL were those with a BMI >25 kg/m(2) (odds ratio 4.3, 95% confidence interval 1.6-11.5). Abdominal obesity, dysglycemia (fasting plasma glucose >100 mg/dL or elevated homeostatic model assessment of insulin resistance), and higher income were the other risk factors. Even having a normal BMI (18.5-24.9 kg/m(2)) was associated with a 2-fold increased risk of NAFL versus those with a BMI <18.5 kg/m(2).
  
  
  CONCLUSIONS
  There is a significant prevalence of NAFL and potentially significant liver disease, including cryptogenic cirrhosis, in this predominantly nonobese, nonaffluent population in a developing country. NAFL will be a major determinant of future liver disease burden in countries of the developing world.
authors.affiliation: Division of Hepatology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India.
authors.forename: Kausik
authors.initials: K
authors.lastname: Das
authors.forename: Kshaunish
authors.initials: K
authors.lastname: Das
authors.forename: Partha S
authors.initials: PS
authors.lastname: Mukherjee
authors.forename: Alip
authors.initials: A
authors.lastname: Ghosh
authors.forename: Sumantra
authors.initials: S
authors.lastname: Ghosh
authors.forename: Asit R
authors.initials: AR
authors.lastname: Mridha
authors.forename: Tapan
authors.initials: T
authors.lastname: Dhibar
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Bhattacharya
authors.forename: Dilip
authors.initials: D
authors.lastname: Bhattacharya
authors.forename: Byomkesh
authors.initials: B
authors.lastname: Manna
authors.forename: Gopal K
authors.initials: GK
authors.lastname: Dhali
authors.forename: Amal
authors.initials: A
authors.lastname: Santra
authors.forename: Abhijit
authors.initials: A
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000886:Anthropometry; D044466:Asian People; D015992:Body Mass Index; D016022:Case-Control Studies; D003906:Developing Countries; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008099:Liver / Q000201:enzymology; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications; D050177:Overweight / Q000150:complications; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class
chemical_list: D000410:Alanine Transaminase