Risk Factors for Progression of Fatty Liver Disease

Moniyka Sachar, MD, Jason Pan, MD and James Park, MD
New York University Langone Medical Center

This presentation is an excerpt from the ALF 2021 Poster Competition. This competition showcases posters and a brief video created by early career investigators from across the country on six areas of educational focus: fatty liver disease, liver cancer, liver transplantation, pediatric liver disease, rare liver disease and viral hepatitis. Participants are tasked with translating complicated medical information into a poster which can be easily understood by patients or the public. Posters are reviewed by a formal panel of judges comprised of Medical Advisory Council members, Board Members and friends of ALF to select a winner in each category.

Fatty liver disease (FLD) is a form of liver damage due to increased fat in liver cells, and can be due to alcohol use, hepatitis, and/or a “metabolic syndrome.” Metabolic syndrome includes having a BMI in the overweight and above category, or having type 2 diabetes, or having abnormal lab results (i.e. high fasting blood sugar, high triglycerides). We investigated the risk factors for severe FLD in patients with some degree of fatty liver. We utilized a database of 4746 participants ≥ 18 years in the 2017-2018 National Health and Nutrition Examination Survey (NHANES), a national survey assessing physical health of individuals in the U.S. We focused on 2693 patients who had some degree of fatty liver seen on an ultrasound exam called “CAP” or controlled attenuation parameter. To identify severe FLD, we used ultrasound data from a scan called “transient elastography,” the gold standard for detecting liver fibrosis, to identify severe FLD. We found that diagnosis of hepatitis C is the most significant risk factor for severe FLD. Of modifiable risk factors, having an overweight BMI and high waist circumference increased the risk of severe FLD by 5-fold and 3-fold respectively. High fasting blood sugar, high triglycerides, and high ferritin (a marker of chronic inflammation) each individually increased the risk by nearly 2-fold. Notably, alcohol use, diabetes, and hypertension were not associated with an elevated risk of severe FLD. For clinicians, we designed a score to predict risk of severe FLD, by incorporating BMI, waist circumference, and plasma glucose into the existing FIB-4 score. Our modified FIB-4 score predicts fibrosis with 3 times greater likelihood than existing FIB-4. Our findings may explain the increased prevalence of FLD in today’s society, which now affects over 25% of the U.S. population. As there are no medication treatments for FLD, lifestyle modifications to maintain a healthy BMI may help prevent the progression of fatty liver disease.