title: Non-alcoholic fatty liver disease (NAFLD) in the Western Cape: a descriptive analysis.
abstract: BACKGROUND
  Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in Western countries, but the disease profile has not yet been described in South Africa. NAFLD affects all spheres of society, especially the poorest and least educated. Aim. To investigate the demographics and clinical and biochemical features of South African patients diagnosed with non-alcoholic fatty liver and non-alcoholic steatohepatitis (NASH) in the Western Cape, South Africa.
  
  
  METHODS
  Overweight/obese subjects were screened by ultrasound and those with fatty liver/hepatomegaly were included. Liver biochemistry, insulin resistance (using the insulin resistance homeostasis model assessment method for insulin resistance, HOMA-IR) and body mass index were assessed and liver biopsies were performed on patients older than 45 years with persistently abnormal liver function and/or hepatomegaly.
  
  
  RESULTS
  We screened 233 patients: 69% coloured, 25% Caucasian, 5% black and 1% Asian. The majority (73%) were female. NAFLD was confirmed histologically in 111 patients, of whom 36% had NASH and 17% advanced liver fibrosis. No black patient had advanced fibrosis. Subjects with NASH had higher mean triglyceride (p=0.03) and cholesterol (p=0.01) levels than subjects with NAFL. All patients were insulin resistant/diabetic. HOMA-IR and not the degree of obesity was strongly associated with advanced fibrosis (p=0.09).
  
  
  CONCLUSIONS
  This study is the first to describe the clinical characteristics of NAFLD in South Africa, albeit only in the Western Cape population. Insulin resistance was the universal factor present. The degree of obesity was not associated with severity of disease. The role of genetic risk factors in disease development and severity remains to be defined.
authors.affiliation: Department of Internal Medicine, Stellenbosch University. ckruger@gastrosa.com
authors.forename: F C
authors.initials: FC
authors.lastname: Kruger
authors.forename: C
authors.initials: C
authors.lastname: Daniels
authors.forename: M
authors.initials: M
authors.lastname: Kidd
authors.forename: G
authors.initials: G
authors.lastname: Swart
authors.forename: K
authors.initials: K
authors.lastname: Brundyn
authors.forename: C
authors.initials: C
authors.lastname: Van Rensburg
authors.forename: M J
authors.initials: MJ
authors.lastname: Kotze
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids