Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver disease in 2 decades: the NAGALA study

Abstract

Background: In this study, to clarify the evolving background of people with non-alcoholic fatty liver disease (NAFLD), we compared the current prevalence of NAFLD with that of 2 decades ago.

Methods: We included two cohorts. The past cohort was from 1994 to 1997 and included 4279 men and 2502 women. The current cohort was from 2014 to 2017 and included 8918 men and 7361 women. NAFLD was diagnosed by abdominal ultrasonography.

Results: The prevalence of NAFLD increased in both genders throughout these 2 decades (18.5% in the past cohort and 27.1% in the current cohort for men; and 8.0% in the past cohort and 9.4% in the current cohort for women). The prevalence of hyperglycemia increased, whereas the prevalence of low high-density lipoprotein cholesterol levels and hypertriglyceridemia significantly decreased. There was no significant difference in the mean body mass index. Multivariate analysis revealed that the prevalence of obesity and body mass index were significantly associated with the prevalence of NAFLD in both the past and current cohorts.

Conclusions: The incidence of NAFLD significantly increased throughout these 2 decades, and obesity is the most prevalent factor. Thus, body weight management is an essential treatment option for NAFLD.

Keywords: Cohort; Epidemiology; NAFLD; Non-alcoholic fatty liver disease; Trend.

Fig. 1

Participant registration. NAGALA NAfld in Gifu Area, Longitudinal Analysis, CKD chronic kidney disease

Fig. 2

Area under the curve (AUC) for receiver operating characteristic (ROC) [95% confidence interval (CI)] of several factors for NAFLD incidence. Upper figure indicates ROC curve, AUC and cut-off value for each factor. Black line indicates body mass index (BMI); red line indicates systolic blood pressure (SBP); yellow line indicates fasting plasma glucose (FPG); green line indicates triglycerides (TG); and blue line indicates high density lipoprotein (HDL) cholesterol. Lower figure shows results of the comparison among each factor. a Men in the past cohort. b Men in the current cohort. c Women in the past cohort. d Women in the current cohort. a AUC for BMI was 0.802 (95% CI 0.786–0.802, p < 0.001), and that of SBP, FPG, TG, and HDL cholesterol was 0.611 (0.590–0.632, p < 0.001), 0.631 (0.609–0.652, p < 0.001), 0.710 (0.691–0.728, p < 0.001), and 0.688 (0.669–0.728, p < 0.001) in men of the past cohort, respectively. Cut-off value for BMI, SBP, FPG, TG, and HDL cholesterol was 23.2 kg/m², 116.5 mmHg, 5.3 mmol/l, 1.3 mmol/l, and 1.0 mmol/l, respectively. b AUC for BMI was 0.794 (95% CI 0.784–0.804, p < 0.001), and for SBP, FPG, TG, and HDL cholesterol was 0.608 (0.595–0.621, p < 0.001), 0.642 (0.629–0.655, p < 0.001), 0.715 (0.703–0.726, p < 0.001), and 0.726 (0.715–0.738, p < 0.001) for men in the current cohort, respectively. Cut-off value for BMI, SBP, FPG, TG, and HDL cholesterol was 23.3 kg/m², 118.5 mmHg, 5.6 mmol/l, 0.8 mmol/l, and 1.5 mmol/l, respectively. c AUC for BMI was 0.854 (95% CI 0.831–0.877, p < 0.001), and for SBP, FPG, TG, and HDL cholesterol was 0.731 (0.697–0.765, p < 0.001), 0.723 (0.685–0.760, p < 0.001), 0.802 (0.775–0.829, p < 0.001), and 0.700 (0.664–0.735, p < 0.001) for women in the past cohort, respectively. Cut-off value for BMI, SBP, FPG, TG, or HDL cholesterol was 22.4 kg/m², 116.0 mmHg, 5.0 mmol/l, 1.2 mmol/l, and 1.3 mmol/l, respectively. d AUC for BMI was 0.863 (95% CI 0.849–0.877, p < 0.001), and for SBP, FPG, TG, and HDL cholesterol was 0.717 (0.697–0.737, p < 0.001), 0.747 (0.728–0.766, p < 0.001 vs. BMI), 0.807 (0.789–0.824, p < 0.001), and 0.765 (0.746–0.784, p < 0.001) for women in the past cohort, respectively. Cut-off value for BMI, SBP, FPG, TG, or HDL cholesterol was 22.5 kg/m², 113.0 mmHg, 5.3 mmol/l, 0.7 mmol/l, and 1.6 mmol/l, respectively