Prevalence Of Non-Alcoholic Fatty Liver Disease And Fibrosis In A Large Population Cohort In The North Of The Netherlands: A Lifelines Cohort Study

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is an increasing health issue, being part of the worldwide epidemic of obesity. The aim of this study was to investigate the prevalence of NAFLD and fibrosis and analyze biochemical characteristics in a large population-based cohort study. Methods: The study was conducted in the framework of the LifeLines Cohort, a population-based cohort study examining the health and health-related behaviours of participants living in the Northern region of the Netherlands (n = 167,000), of which 57,682 participants older than 18 years with available biomedical data were eligible. A priori-defined liver function tests, lipid profile, leukocyte count, CRP, haemoglobin A1c (HbA1c) and fasting glucose (FG) were studied. NAFLD was defined by using the validated Fatty Liver Index (FLI); FLI ≥ 60 was categorized as NAFLD. Advanced liver fibrosis (stages 3/ 4) was defined by using the validated NAFLD Fibrosis Score; a score u003e0.676 was categorized as fibrosis. Exclusion criteria were non-Dutch participants, participants with missing data, excessive alcohol use and previous diagnosed hepatitis and/or cirrhosis. Statistical analysis included t test, Mann-Whitney U test and Chi-square test when applicable. A p-value 0.676, indicative of significant fibrosis, was found in 223 (0.6%) participants. Conclusions: NAFLD is a potential health problem in the Northern part of the Netherlands; 22% of the population is suspected of having NAFLD which is associated with the metabolic syndrome and inflammatory indices. Even more, 223 participants were suspected to suffer from advanced liver fibrosis. Future validation and population-based studies are mandatory to better understand the natural history of NAFLD and prevent its complications.