Prevalence of and risk factors for hepatic steatosis in Northern Italy

Ann Intern Med. 2000 Jan 18;132(2):112-7. doi: 10.7326/0003-4819-132-2-200001180-00004.


Background: Although hepatic steatosis is seen with increasing frequency in clinical practice, its prevalence and risk factors are unknown.

Objective: To investigate the prevalence of and risk factors for hepatic steatosis, such as alcohol consumption and obesity.

Design: Cross-sectional, observational study.

Setting: Participants in the Dionysos Study.

Patients: 257 participants assigned to one of four categories (67 controls, 66 obese persons, 69 heavy drinkers, and 55 obese heavy drinkers).

Measurements: Ethanol intake, assessed by a validated questionnaire and expressed as daily (g/d) and lifetime (kg) consumption, and body mass, expressed as body mass index. Biochemical tests of liver and metabolic function and hepatic ultrasonography were done.

Results: The prevalence of steatosis was increased in heavy drinkers (46.4% [95% CI, 34% to 59%]) and obese persons (75.8% [CI, 63% to 85%]) compared with controls (16.4% [CI, 8% to 25%]). Steatosis was found in 94.5% (CI, 85% to 99%) of obese heavy drinkers. Compared with controls, the risk for steatosis was higher by 2.8-fold (CI, 1.4-fold to 7.1-fold) in heavy drinkers, 4.6-fold (CI, 2.5-fold to 11.0-fold) in obese persons, and 5.8-fold (CI, 3.2-fold to 12.3-fold) in persons who were obese and drank heavily. In heavy drinkers, obesity increased the risk for steatosis by twofold (CI, 1.5-fold to 3.0-fold) (P < 0.001), but heavy drinking was associated with only a 1.3-fold (CI, 1.02-fold to 1.6-fold) increase in risk in obese persons (P = 0.0053). Elevated alanine aminotransferase and triglyceride levels are the most reliable markers of steatosis.

Conclusions: Steatosis is frequently encountered in healthy persons and is almost always present in obese persons who drink more than 60 g of alcohol per day. Steatosis is more strongly associated with obesity than with heavy drinking, suggesting a greater role of overweight than alcohol consumption in accumulation of fat in the liver.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alanine Transaminase / blood
  • Alcoholism / complications
  • Biomarkers / blood
  • Child
  • Cross-Sectional Studies
  • Fatty Liver / blood
  • Fatty Liver / epidemiology*
  • Fatty Liver / etiology
  • Female
  • Humans
  • Italy / epidemiology
  • Liver / enzymology
  • Male
  • Middle Aged
  • Obesity / complications
  • Prevalence
  • Risk Factors
  • Surveys and Questionnaires
  • Triglycerides / blood
  • gamma-Glutamyltransferase / blood


  • Biomarkers
  • Triglycerides
  • gamma-Glutamyltransferase
  • Alanine Transaminase