Significant Burden of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Iranian Population: A Cross-Sectional Analysis
The main cause of chronic liver disease in Iran is Non-alcoholic fatty liver disease (NAFLD). A common pathological feature of chronic liver disease is fibrosis, so particular vigilance against patients with liver fibrosis is necessary to lead healthcare resource planning. The aims of the current study were to determine the prevalence and predictors of significant fibrosis and advanced ones among individuals with NAFLD. In the current cross-sectional study conducted during 2013-2016, the presence of fibrosis among NAFLD patients was assessed using the NAFLD fibrosis score (NFS) and AST to Platelet Ratio Index (APRI) systems. Multivariate logistic regression models were used to predict significant fibrosis or advanced fibrosis among NAFLD patients. Analysis of the results of over 999 patients (569 females and 430 males) with the mean age of 43.28±14.034 years in Iran during 2015-2016 showed that the overall prevalence of NAFLD among Iranian adults was 19.6%. NAFLD prevalence was not significantly higher in males compared to females (51.5% vs. 48.5%, P=0.66). On multivariate logistic regression analyses, females were less likely to have NAFLD compared to males (OR 0.32, 95% CI 0.24-0.42, P<0.001). The overall prevalence of liver fibrosis among NAFLD patients was 38.8%.20.4% and 6.12% of NAFLD patients had evidence of significant and advanced fibrosis, respectively. Our most recent dataset analysis emphasized the major burden of NAFLD among people of Iranian origin. A high prevalence of individuals with NAFLD and advanced fibrosis was observed.
2. Muddu AK, Guha IN, Elsharkawy AM, Mann DA.
Resolving fibrosis in the diseased liver: translating the scientific promise to the clinic. Int J Biochem Cell Biol 2007;39:695-714.
3. Neuschwander‐Tetri BA, Caldwell SH. Non-alcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 2003;37:1202-19.
4. Wieckowska A, McCullough AJ, Feldstein AE. Non-invasive diagnosis and monitoring of non-alcoholic steatohepatitis: present and future. Hepatology 2007;46:582-9.
5. Younossi ZM, Otgonsuren M, Venkatesan C, Mishra A. In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabolism 2013;62:352-60.
6. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011;9:524-30.
7. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, et al. Non-alcoholic fatty liver disease in lean individuals in the United States. Medicine 2012;91:319-27.
8. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non‐alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012;55:2005-23.
9. Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, et al. Performance of the aspartate aminotransferase‐to‐platelet ratio index for the staging of hepatitis C‐related fibrosis: An updated meta‐analysis. Hepatology 2011;53:726-36.
10. Vernon G, Baranova A, Younossi Z. Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274-85.
11. Doycheva I, Cui J, Nguyen P, Costa EA, Hooker J, Hofflich H, et al. Non‐invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther 2016;43:83-95.
12. Dowman JK, Tomlinson J, Newsome P. Systematic review: the diagnosis and staging of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis. Aliment Pharmacol Ther 2011;33:525-40.
13. Roberts K, Cochet A, Lamb P, Brown P, Battafarano D, Brunt E, et al. The prevalence of NAFLD and NASH among patients with psoriasis in a tertiary care dermatology and rheumatology clinic. Aliment Pharmacol
14. Husain N, Blais P, Kramer J, Kowalkowski M, Richardson P, El‐Serag HB, et al. Non-alcoholic fatty liver disease (NAFLD) in the Veterans Administration population: development and validation of an algorithm for NAFLD using automated data. Aliment Pharmacol Ther 2014;40:949-54.
15. Lankarani KB, Ghaffarpasand F, Mahmoodi M, Lotfi M, Zamiri N, Heydari ST, et al. Non alcoholic fatty liver disease in southern Iran: a population based study. Hepatitis monthly 2013;13.
16. Amirkalali B, Poustchi H, Keyvani H, Khansari MR, Ajdarkosh H, Maadi M, et al. prevalence of non-alcoholic fatty liver disease and its predictors in north of Iran. Iran J Public Health 2014;43:1275-83.
17. Moghaddasifar I, Lankarani K, Moosazadeh M, Afshari M, Ghaemi A, Aliramezany M, et al. Prevalence of non-alcoholic fatty liver disease and its related factors in Iran. Int J Organ Transplant Med 2016;7:149-60.
18. Lankarani KB,Ghaffarpasand F,Mahmoodi M,Lotfi M,Zamiri N,Heydari ST, et al. Non alcoholic fatty liver disease in southern Iran: A population based study. Hepatitis Monthly 2013,13:e9248.
19. Welsh JA, Karpen S, Vos MB. Increasing prevalence of non-alcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. J Pediatr 2013;162:496-500.
20. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Non-alcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015;148:547-55.
21. Wong RJ, Cheung R, Ahmed A. Nonalcoholic
steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the US. Hepatology 2014;59:2188-95.
22. Younossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, et al. The economic and clinical burden of non-alcoholic fatty liver disease in the United States and Europe. Hepatology 2016;64:1577-86.
23. Younossi ZM, Henry L. Economic and quality-of-life implications of non-alcoholic fatty liver disease. Pharmacoeconomics 2015;33:1245-53.
24. Chehreh MEG, Vahedi M, Pourhoseingholi MA, Ashtari S, Khedmat H, Amin M, et al. estimation of diagnosis and treatment costs of non-alcoholic Fatty liver disease: a two-year observation. Hepatitis monthly 2013;13.
25. Dolgin NH, Movahedi B, Martins PN, Goldberg R, Lapane KL, Anderson FA, et al. Decade-Long Trends in Liver Transplant Waitlist Removal Due to Illness Severity: The Impact of Centers for Medicare and Medicaid Services Policy. J Am Coll Surg 2016;222:1054-65.
26. Loria P, Lonardo A, Carulli L, Verrone A, Ricchi M, Lombardini S, et al. the metabolic syndrome and non‐alcoholic fatty liver disease. Aliment Pharmacol Ther 2005;22:31-6.
27. Chitturi S, Abeygunasekera S, Farrell GC, Holmes‐Walker J, Hui JM, Fung C, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002;35:373-9.
28. Smits MM, Ioannou GN, Boyko EJ, Utzschneider KM. Non‐alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: Results of a US national survey in three ethnic groups. J Gastroenterol Hepatol 2013;28:664-70.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.