Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Indians: A Case-Control Study

J Clin Exp Hepatol. 2015 Dec;5(4):295-302. doi: 10.1016/j.jceh.2015.09.001. Epub 2015 Sep 8.


Background/aims: NAFLD has today emerged as the leading cause of liver disorder. There is scanty data on risk factors associated with NAFLD emanating from India. The present study was conducted to identify the risk factors associated with NAFLD.

Methods: 464 consecutive NAFLD patients and 181 control patients were subjected to detailed questionnaire regarding their lifestyle and dietary risk factors. Anthropometric measurements were obtained and biochemical assays were done. Comparison of different variables was made between NAFLD patients and controls using principal component analysis (PCA).

Results: NAFLD patients had higher BMI [26.25 ± 3.80 vs 21.46 ± 3.08 kg/m(2), P = 0.000], waist-hip ratio [0.96 ± 0.12 vs 0.90 ± 0.08, P = 0.000] and waist-height ratio [0.57 ± 0.09 vs 0.50 ± 0.06, P = 0.000] compared to controls. Fasting blood sugar [101.88 ± 31.57 vs 90.87 ± 10.74 mg/dl] and triglyceride levels [196.16 ± 102.66 vs 133.20 ± 58.37 mg/dl] were significantly higher in NAFLD group. HOMA-IR was also higher in NAFLD group [2.53 ± 2.57 vs 1.16 ± 0.58, P = 0.000]. Majority (90.2%) of NAFLD patients were sedentary. Family history of metabolic syndrome (MS) was positively correlated with NAFLD. Dietary risk factors associated with NAFLD were non-vegetarian diet [35% vs 23%, P = 0.002], fried food [35% vs 9%, P = 0.000], spicy foods [51% vs 15%, P = 0.001] and tea [55% vs 39%, P = 0.001]. Diabetes, hypertension, snoring and sleep apnoea syndrome were common factors in NAFLD. On multivariate PCA, waist/height ratio and BMI were significantly higher in the NAFLD patients.

Conclusion: The risk factors associated with NAFLD are sedentary lifestyle, obesity family history of MS, consumption of meat/fish, spicy foods, fried foods and tea. Other risk factors associated with NAFLD included snoring and MS.

Keywords: ALT, Alanine Transaminase; AST, Aspartate Transaminase; BMI, Body Mass Index; FBG, fasting blood glucose; HC, hip circumference; HCC, hepatocellular carcinoma; HDL, high-density lipoprotein; HOMA, Homeostatic Model Assessment; HOMA-B, beta-cell function; IR, insulin resistance; MS, Metabolic syndrome; NAFLD, Non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; PCA, Principal Component Analysis; SD, standard deviation; WC, waist circumference; anthropometry; diet; fatty liver; lifestyle; metabolic syndrome.