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Nonalcoholic Fatty Liver Disease Found In Large Numbers Of Teenagers And Young Adults: Is A Public Health Crisis Looming?

ILC 2019: UK population-based study finds large numbers of young adults have nonalcoholic fatty liver disease (NAFLD) and many of these already have fibrosis

12 April 2019, Vienna, Austria

EASL (EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER)

A large population-based study in the UK has revealed new evidence that large numbers of young adults have features suggestive of nonalcoholic fatty liver disease (NAFLD), and that one in 40 of these have already developed fibrosis. The study, based at the University of Bristol and presented today at The International Liver Congress™ 2019 in Vienna, Austria, suggests that greater awareness of NAFLD is needed among young adults if a public health crisis is to be avoided.

NAFLD is described as the accumulation of lipids in the liver (steatosis) that is not related to alcohol consumption.1 The condition is considered the hepatic manifestation of metabolic syndrome and has a clear association with obesity, diabetes and hyperlipidaemia.2 NAFLD is the most common form of chronic liver disease among both adults and children, with an estimated global prevalence of 20–30%,2,3  although this varies with age.4 Prevalence is continuing to rise,5 which has major public health and economic implications, including increased cardiovascular disease-related morbidity,6 greater burden on transplant services,7 and a rising hepatocellular carcinoma (HCC) prevalence.8

For the study presented today, investigators from the University of Bristol in the UK evaluated 4021 young adults from the Children of the 90s prospective birth cohort (also known as the Avon Longitudinal Study of Parents and Children, or ALSPAC), which had previously been assessed for NAFLD as teenagers using ultrasound criteria. The prevalence of NAFLD in the original cohort of teenagers was 2.5%. Revisiting the same cohort as young adults (mean age of 24 years), the investigators used transient elastography to assess steatosis and fibrosis. All individuals with known excessive alcohol intake were excluded from the analyses.

Of the 3128 individuals whose scans were eligible for analysis, 76/3128 (2.4%) had some degree of fibrosis and eight (0.3%) had fibrosis evaluations equivalent to stage 4 (F4) fibrosis. A total of 680 out of 3277 individuals (20.8%) were found to have steatosis (indicative of NAFLD), with just under half of these (n=331; 10.1% of the entire cohort) staged as severe (S3). A positive association was observed between increases in liver enzymes (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase), increasing fibrosis (F) scores (all p≤0.002), and increasing controlled attenuated parameter (CAP) scores (p<0.001), indicative of liver damage. Positive associations were seen between F score and CAP score (p<0.001) and between increasing steatosis grade, cholesterol levels, triglycerides, and low-density lipoprotein (p<0.001). Finally, BMI rose significantly with both F and CAP scores (p<0.001 for both).

‘This is the largest study to date to analyse fibrosis and steatosis in young adults with suspected NAFLD using transient elastography,’ said Dr Kushala Abeysekera, from the University of Bristol in the UK, who presented the results of the study. ‘We were concerned to find that, at only 24 years of age, one in five had steatosis and one in 40 had evidence of fibrosis, based on elastography results, in a group of largely asymptomatic, predominantly Caucasian young people.’

‘The results of our study suggest greater public health awareness of NAFLD is needed in young adults in the UK.’

Prof Philip Newsome (Vice-Secretary, EASL) said, “These data highlight the impact of the obesogenic environment and, in particular, its role in the development of NAFLD in a much younger sector of the population. This requires swift changes in public policy if we are to defuse the ticking time-bomb of obesity and NAFLD.”

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2019 will take place from 10­–14 April 2019 at the Reed Messe Wien Congress and Exhibition Center, Vienna, Austria.

About The European Association for the Study of the Liver (EASL)

Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Contact

For more information, please contact the ILC Press Office at:

Onsite location reference

Session title: ‘General session II’

Time, date and location of session: 08:45–09:00, 12 April 2019, Main Plenary

Presenter: Kushala Abeysekera, UK

Abstract: The prevalence of non-alcoholic fatty liver disease in young adults: An impending public health crisis? (GS-08)

Author disclosures

Funding from the UK Medical Research Council (Grant ref: R103083-101), David Telling Charitable Trust, and the University of Bristol provide core support for ALSPAC.

References

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  2. Andronescu CI, et al. Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications. J Med Life. 2018;11(1):20–3.
  3. Abd El-Kader SM and El-Den Ashmawy EM. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol. 2015;7(6):846–58.
  4. Sherif ZA, et al. Global Epidemiology of Nonalcoholic Fatty Liver Disease and Perspectives on US Minority Populations. Dig Dis Sci. 2016;61(5):1214–25.
  5. Younossi Z, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15(1):11–20.
  6. Francque SM, et al. Non-alcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications. J Hepatol. 2016;65(2):425–43.
  7. Pais R, et al. NAFLD and liver transplantation: Current burden and expected challenges. J Hepatol. 2016;65(6):1245–57.
  8. Said A and Ghufran A. Epidemic of non-alcoholic fatty liver disease and hepatocellular carcinoma. World J Clin Oncol. 2017;8(6):429–36.