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1 in 5 young adults show signs of fatty liver; 1 in 40 have fibrosis

VIENNA — Young adults aged around 24 years showed a high prevalence of nonalcoholic fatty liver disease, with progression increasing with age even in this small birth cohort, according to new data presented during the International Liver Congress 2019.

“This is the only study to assess NAFLD prevalence in young adults using elastography. We found one in five had evidence of NAFLD; half had [steatosis grade 3 (S3)]. One in 40 in our cohort have evidence of fibrosis and this is in asymptomatic predominantly Caucasian participants with unselected general population birth cohort,” Kushala Abeysekera, MD, MBBS, BSc, from the University of Bristol, said during his presentation. “We’ve demonstrated that the prevalence of NAFLD in our birth cohort appears to have progressed from age 18 to 24 from 2.5% to 20.8%.”

Abeysekera presented data looking at the children from the Avon Longitudinal Study of Parents and Children. These subjects are now young adults who have been followed for the past 28 years, comprising “one of the most phenotyped birth cohorts in the world,” he said.

Researchers previously looked at this birth cohort around age 18 years, using ultrasound as a modality, and found the prevalence of NAFLD to be 2.5%. In the current study, Abeysekera and colleagues used transient elastography (Fibroscan, Echosens) to measure liver stiffness.

More than 10,000 participants were invited to participate and after exclusion due to alcohol use, 3,128 attended clinic and had valid Fibroscan scores while 3,277 had valid controlled attenuation parameter (CAP) scores.

After CAP score analysis, researchers found that 20.8% of participants had steatosis and, of those, 48.7% had S3 steatosis.

Additionally, 2.4% were suspected to have fibrosis — 0.9% with fibrosis stage 2, 1.2% with stage 3 and 0.3% with stage 4.

“We know Fibroscan cannot differentiate [fibrosis stage 0] to [fibrosis stage 1] so we might be under reporting the amount of fibrosis in the population,” he added.

In analyzing other variables, Abeysekera showed that BMI, alanine aminotransferase, aspartate aminotransferse, gamma-glutamyl transferase, insulin resistance, cholesterol and triglycerides were all positively correlated with steatosis levels (P < .001 for all) while HDL was negatively correlated (P < .001). Of those at S3, 57.3% were considered to have obesity.

“ALT, felt to have limited utility in NAFLD, was positively associated with CAP score in young adults. Perhaps more work needs to be done to look at the appropriate cutoff value for people with NAFLD in this age group,” Abeysekera said.

When looking at fibrosis, CAP score, BMI, AST and GGT had similar correlations (P < .001) and ALT correlated positively (P = .0013).

Abeysekera said anyone suspected of having steatosis or fibrosis was referred to tertiary care and they hope to unblind that data and report more in-depth in the future. He also said they hope to return to the data and include those with excessive alcohol use in order to do a multivariate analysis to examine the overlap between NAFLD and alcoholic liver disease. – by Katrina Altersitz

Reference:

Abeysekera K. GS-08. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.

Disclosures: Abeysekera reports no relevant financial relationships.