A study from Great Britain shows that in a population-based cohort, almost every fifth person examined had a fatty liver with an average age of 24 years. In addition, many patients had already developed liver fibrosis.
The Avon Longitudinal Study of Parents and Children (ALSPAC), a cohort study started in the 1990s, offers a unique opportunity to look into health's development of a generation in a cross-section of a British region.
A recent study from this cohort identified a frighteningly high prevalence of non-alcoholic fatty liver disease (NAFLD) in teenagers and young adults (see source 1). A team from the University of Bristol evaluated 4021 young adults from the cohort who had previously been screened for fatty liver by ultrasound as children, with a prevalence of NAFLD of 2.5%.
In the recent screening of the cohort at an average age of 24 years, investigations were carried out using transient elastography (FibroScan) to evaluate steatosis and fibrosis. Individuals with known excessive alcohol consumption were excluded from the study. Finally, scans of 3128 people were included in the analysis. In 20.8% of the scanned persons, steatosis was diagnosed, which was classified as severe (S3) in about half of the affected persons. Fibrosis was also diagnosed in 76 subjects (2.4% of the cohort). In 8 persons the fibrosis corresponded to grade 4.
Fibrosis was significantly positively associated with elevated transaminases (ALT, AST, Gamma-GT). The transaminases also increased with the fibrosis score (p≤0,002). Positive associations were also observed between the fibrosis score and the controlled attenuation parameter (CAP) score, which measures the extent of liver damage, and between elevated transaminase levels and the CAP score (p<0.001). Increasing steatosis was associated with elevated cholesterol, triglycerides and elevated LDL (p<0.001). Last but not least, there was a significant association between body weight (BMI) and fibrosis on the one hand and CAP score on the other (p<0.001).
"Our work is the largest study to date on the prevalence of fibrosis and steatosis in young adults based on FibroScans," stressed Dr. Kushala Abeysekera of the University of Bristol in view of the presentation of the data. Abeysekera described such a high frequency of NAFLD in a cohort of such young and asymptomatic people as alarming and admitted that his study may even underestimate the frequency of fibrosis because the FibroScan cannot differentiate between fibrosis grades 0 and 1.
Prof. Dr. Philip Newsome, Vice-Secretary of the EASL, spoke in this context of a time bomb that calls for a rapid political response, especially as the effects of increasing obesity are already visible in such young people.
Sources:
1 Abeysekera K et al.: The prevalence of the non-alcoholic fatty liver disease in young adults: an impending public health crisis? ILC 2019, GS-08
2 International Liver Congress (ILC) of the European Association for the Study of the Liver (EASL), 12 April 2019, Vienna