BACKGROUND
Non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) is
the most common form of chronic liver disease worldwide and is no
longer considered a benign disease. Its prevalence has not been determined
in a large-scale population-based study in Iran.
METHODS
A total of 6583 individuals aged 18 to 65 were randomly selected
from three geographically distinct provinces in Iran. Blood samples
were obtained from each subject and a questionnaire was completed
exploring data including self-admitted regular alcohol use. Serums
were tested for anti-HCV antibody (anti-HCV), hepatitis B surface
antigen and anti-hepatitis B core antibody. Positive samples for
anti-HCV antibody were re-tested and those positive in a repeat
ELISA were confirmed by a recombinant immunoblot assay (RIBA)
test. Serums were also tested for ALT levels. Subjects with elevated
ALT defined as serum ALT =40 IU/L with no history of alcohol
consumption and negative HBV and HCV infection were considered
as “presumed NASH”.
RESULTS
In this study 5589 subjects were analyzed. Two hundred and forty two
individuals (4.3%) were diagnosed with elevated ALT levels. Among
individuals with elevated ALT, 15 (6.2%) were diagnosed with either
hepatitis B or hepatitis C. The overall weighted prevalence of presumed
NASH was 2.9%. According to multivariate analysis, male
sex, urban lifestyle, and being overweight or obese were significantly
associated with “presumed NASH”.
CONCLUSION
Obesity and metabolic syndrome, the most predictive factors of fatty
liver disease, are increasing in Iran, therefore the prevalence of NAFLD/
NASH and related complications are expected to increase in the
future. This population based study gives a crude estimate of the
prevalence of NASH around the country. Studies with more accurate
surrogates of NASH need to be done. The disparity among different
provinces merits special consideration.