Clinical and Metabolic Characteristics of Non-Alcoholic Fatty Liver Disease Patients in Saudi Arabia: Data from the Systematic Observatory Liver Disease (SOLID) Registry

Khalid Alswat; Faisal M Sanai; Waleed Al-Hamoudi; Mona Ismail; Yaser Dahlan; Hamdan Saleh AlGhamdi; Ibrahim Altraif; Abduljaleel Alalwan; Mohamed M A Babatin; Saleh A Alqahtani

doi:10.2147/DMSO.S300051

Clinical and Metabolic Characteristics of Non-Alcoholic Fatty Liver Disease Patients in Saudi Arabia: Data from the Systematic Observatory Liver Disease (SOLID) Registry

Diabetes Metab Syndr Obes. 2021 Mar 16:14:1167-1175. doi: 10.2147/DMSO.S300051. eCollection 2021.

Authors

Khalid Alswat¹, Faisal M Sanai², Waleed Al-Hamoudi¹, Mona Ismail³, Yaser Dahlan², Hamdan Saleh AlGhamdi^{4

5}, Ibrahim Altraif^{4

5}, Abduljaleel Alalwan^{4

5}, Mohamed M A Babatin⁶, Saleh A Alqahtani^{7

8}

Affiliations

¹ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
² Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
³ Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia.
⁴ King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁵ Hepatology Division, Department of Hepatobiliary Sciences and Organs Transplant Center, King Abdulaziz Medical City of National Guard, Riyadh, Saudi Arabia.
⁶ Gastroenterology Unit, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia.
⁷ Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
⁸ Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Background and aims: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in Saudi Arabia (SA), but descriptions of the clinical and metabolic characteristics of these patients are limited. The present study aims to fill this gap.

Methods: Demographic, clinical, and laboratory data of all NAFLD patients from 2009 to 2019 were retrieved from the Systematic Observatory Liver Disease Registry (SOLID) [n=832 (337 males; 495 females); mean (± standard deviation, SD) age was 42.6±13.6 years; mean body mass index (BMI) was 35.0±9.3kg/m²]. Non-invasive surrogate scores of fibrosis (eg AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4), and NAFLD fibrosis (NFS) scores) were calculated and analyzed. In addition, data from NAFLD patients with normal and high alanine aminotransferase (ALT) were compared using two different methods: the standard laboratory reference range which defines normal as ALT<61 IU/L, and the range proposed by a recent national study which sets upper limits of normal ALT at 33 IU/l for men and 22 IU/l for women.

Results: Hyperlipidemia was the most common comorbidity (41.7%), followed by type 2 diabetes mellitus (T2DM) (35.3%) and hypertension (28.4%). Prevalence of advanced fibrosis varied widely across definitions [FIB-4, N=19 (2.5%); APRI, N=21 (2.8%); NFS, N=62 (8.6%)] and exhibited sexual dimorphism with males having worse metabolic characteristics. NAFLD patients with normal ALT were more likely to be older, female, have a lower BMI, and have a higher prevalence of cirrhosis, DM, hypertension, hyperlipidemia, and renal dysfunction.

Conclusion: Patients with NAFLD have metabolic characteristics associated with several comorbidities, including NAFLD patients with normal ALT. Mechanistic studies are needed to examine and analyze complex, interactive effects between sex, age, and other factors that may accelerate NAFLD disease progression.

Keywords: Saudi Arabia; Systematic Observatory Liver Disease Registry; non-alcoholic fatty liver disease; non-invasive biomarkers of fibrosis.

Grants and funding

This work was funded by the National Plan for Science, Technology, and Innovation (MAARIFAH), King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia, (Grant Number: 08-MED512-02).