title: Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case-Control Study.
abstract: OBJECTIVE
  NAFLD has today emerged as the leading cause of liver disorder. There is scanty data on risk factors associated with NAFLD emanating from India. The present study was conducted to identify the risk factors associated with NAFLD.
  
  
  METHODS
  464 consecutive NAFLD patients and 181 control patients were subjected to detailed questionnaire regarding their lifestyle and dietary risk factors. Anthropometric measurements were obtained and biochemical assays were done. Comparison of different variables was made between NAFLD patients and controls using principal component analysis (PCA).
  
  
  RESULTS
  NAFLD patients had higher BMI [26.25 ± 3.80 vs 21.46 ± 3.08 kg/m(2), P = 0.000], waist-hip ratio [0.96 ± 0.12 vs 0.90 ± 0.08, P = 0.000] and waist-height ratio [0.57 ± 0.09 vs 0.50 ± 0.06, P = 0.000] compared to controls. Fasting blood sugar [101.88 ± 31.57 vs 90.87 ± 10.74 mg/dl] and triglyceride levels [196.16 ± 102.66 vs 133.20 ± 58.37 mg/dl] were significantly higher in NAFLD group. HOMA-IR was also higher in NAFLD group [2.53 ± 2.57 vs 1.16 ± 0.58, P = 0.000]. Majority (90.2%) of NAFLD patients were sedentary. Family history of metabolic syndrome (MS) was positively correlated with NAFLD. Dietary risk factors associated with NAFLD were non-vegetarian diet [35% vs 23%, P = 0.002], fried food [35% vs 9%, P = 0.000], spicy foods [51% vs 15%, P = 0.001] and tea [55% vs 39%, P = 0.001]. Diabetes, hypertension, snoring and sleep apnoea syndrome were common factors in NAFLD. On multivariate PCA, waist/height ratio and BMI were significantly higher in the NAFLD patients.
  
  
  CONCLUSIONS
  The risk factors associated with NAFLD are sedentary lifestyle, obesity family history of MS, consumption of meat/fish, spicy foods, fried foods and tea. Other risk factors associated with NAFLD included snoring and MS.
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Shivaram P
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Ayaskanta
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Bijay
authors.initials: B
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Girish K
authors.initials: GK
authors.lastname: Pati
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Manas K
authors.initials: MK
authors.lastname: Panigrahi
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Sanjib K
authors.initials: SK
authors.lastname: Kar
authors.affiliation: Department of Pathology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Bhuyan
authors.affiliation: Department of Pathology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Kaumudee
authors.initials: K
authors.lastname: Pattnaik
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, Cuttack 753001, India.
authors.forename: Chudamani
authors.initials: C
authors.lastname: Meher
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, Cuttack 753001, India.
authors.forename: Omprakash
authors.initials: O
authors.lastname: Agrawal
authors.affiliation: Department of Oncopathology, A.H. Regional Cancer Center, Cuttack 753001, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Rout
authors.affiliation: Department of Biochemistry, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Manoroma
authors.initials: M
authors.lastname: Swain
authors.affiliation: National Institute of Science Education & Research (NISER), Jatni, Khurdha 752050, India.
authors.forename: Palok
authors.initials: P
authors.lastname: Aich
keywords: ALT, Alanine Transaminase; AST, Aspartate Transaminase; BMI, Body Mass Index; FBG, fasting blood glucose; HC, hip circumference; HCC, hepatocellular carcinoma; HDL, high-density lipoprotein; HOMA, Homeostatic Model Assessment; HOMA-B, beta-cell function; IR, insulin resistance; MS, Metabolic syndrome; NAFLD, Non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; PCA, Principal Component Analysis; SD, standard deviation; WC, waist circumference; anthropometry; diet; fatty liver; lifestyle; metabolic syndrome