title: Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups.
abstract: An improved understanding of non-alcoholic fatty liver disease epidemiology would lead to identification of individuals at high risk of developing chronic liver disease and extra-hepatic complications, thus contributing to more effective case finding of non-alcoholic fatty liver disease among selected groups. We aimed to illustrate the epidemiology of non-alcoholic fatty liver disease in high-risk groups, which were identified based on existing literature. To this end, PubMed was searched to retrieve original articles published until May 2015 using relevant and pertinent keywords "nonalcoholic fatty liver disease" and "diabetes", "obesity", "hyperlipidaemia", "familial heterozygous hypobetalipoproteinaemia", "hypertension", "metabolic syndrome", "ethnicity", "family history" or "genetic polymorphisms". We found that age, sex and ethnicity are major physiological modifiers of the risk of non-alcoholic fatty liver disease, along with belonging to "non-alcoholic fatty liver disease families" and carrying risk alleles for selected genetic polymorphisms. Metabolic syndrome, diabetes, obesity, mixed hyperlipidaemia and hypocholesterolaemia due to familial hypobetalipoproteinaemia are the major metabolic modifiers of non-alcoholic fatty liver disease risk. Compared with these metabolic conditions, however, arterial hypertension appears to carry a relatively more modest risk of non-alcoholic fatty liver disease. A better understanding of the epidemiology of non-alcoholic fatty liver disease may result in a more liberal policy of case finding among high-risk groups.
authors.affiliation: Internal Medicine and Outpatient Liver Clinic, NOCSAE Baggiovara, Azienda USL di Modena, Modena, Italy. Electronic address: a.lonardo@libero.it.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Lonardo
authors.affiliation: Internal Medicine and Outpatient Liver Clinic, NOCSAE Baggiovara, Azienda USL di Modena, Modena, Italy; Department of Gastroenterology and Endoscopy, NOCSE Baggiovara, Azienda USL di Modena Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellentani
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Internal Medicine Pavullo Hospital, Azienda USL di Modena, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ballestri
authors.affiliation: Nutrition and Metabolism, University of Southampton, Southampton National Institute for Health Research Biomedical Research Centre, Southampton, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.affiliation: Department of Gastroenterology, University Hospital of Santa Maria, Faculty of Medicine, Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Cortez-Pinto
authors.affiliation: Institute of Internal Medicine, Catholic University of Rome, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
authors.affiliation: Department of Gastroenterology, University Hospital of Santa Maria, Faculty of Medicine, Lisbon, Portugal.
authors.forename: Mariana V
authors.initials: MV
authors.lastname: Machado
authors.affiliation: Institute of Internal Medicine, Catholic University of Rome, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005006:Ethnicity; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications*; D006973:Hypertension / Q000150:complications; D024821:Metabolic Syndrome / Q000150:complications*; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000235:genetics; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D012737:Sex Factors
keywords: Dyslipidaemia; Metabolic syndrome; NAFLD; Obesity; Type 2 diabetes mellitus