Rural-Urban differentials in prevalence, spectrum and determinants of Non-alcoholic Fatty Liver Disease in North Indian population

• Published in: PloS one 2022-02, Vol.17 (2), p.e0263768-e0263768
• Main Authors: Asadullah, Md, Shivashankar, Roopa, Shalimar, Kandasamy, Devasenathipathy, Kondal, Dimple, Rautela, Garima, Peerzada, Ariba, Grover, Bhanvi, Amarchand, Ritvik, Nayak, Baibaswata, Sharma, Raju, Ramakrishnan, Lakshmy, Prabhakaran, Dorairaj, Krishnan, Anand, Tandon, Nikhil
• Format: Article
• Language: English
• Subjects: Adult; Adults; Age; Alanine; Alanine transaminase; Alanine Transaminase - metabolism; Biology and Life Sciences; Blood pressure; Body mass index; Cardiovascular disease; Chronic illnesses; Cirrhosis; Comparative analysis; Cross-Sectional Studies; Data collection; Demographic aspects; Diabetes; Diabetes mellitus; Disease control; Earth Sciences; Elasticity Imaging Techniques; Endocrinology; Fatty liver; Female; Fibrosis; Gastroenterology; Hepatitis; Humans; India - epidemiology; Insulin; Insulin resistance; Liver; Liver cancer; Liver cirrhosis; Liver diseases; Male; Medicine and Health Sciences; Metabolic disorders; Metabolic syndrome; Metabolism; Middle Aged; Mortality; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - metabolism; Obesity; Population; Prevalence; Public health; Questionnaires; Research and Analysis Methods; Risk factors; Rural areas; Rural health; Rural Population - statistics & numerical data; Sex; Social Sciences; Statistics; Steatosis; Stiffness; Transaminase; Ultrasonic imaging; Ultrasound; Urban areas; Urban health; Urban Population - statistics & numerical data; Vibration; Women; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263768

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis, non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. We assessed the prevalence, spectrum, and determinants of NAFLD among adults in urban and rural North India. A representative sample of adults aged 30-60 years were recruited from urban Delhi and rural Ballabhgarh during 2017-2019. Participants underwent abdominal ultrasonography (USG) and vibration controlled transient elastography (VCTE) with FibroScan to assess fatty liver and fibrosis, respectively. We estimated the age- and sex-standardised prevalence of NAFLD and its spectrum. The factors associated with 'ultrasound-diagnosed NAFLD' were identified using multivariate logistic regression. A total of 828 urban (mean ± SD age: 45.5 ± 8.0 years; women: 52.7%) and 832 rural (mean ± SD age: 45.1 ± 7.9 years; women: 62.4%) participants were recruited. The age- and sex-standardized prevalence of ultrasound-diagnosed NAFLD was 65.7% (95%CI: 60.3-71.2) in the urban and 61.1% (55.8-66.5) in the rural areas, respectively. The prevalence of NAFLD with elevated alanine transaminase (≥40IU/L) was 23.2% (19.8-26.6), and 22.5% (19.0-26.0) and any fibrosis by liver stiffness measurement on transient elastography (≥6.9 kPa) was 16.5% (13.8-19.8) and 5.2% (3.8-6.7) in urban and rural participants, respectively. In both urban and rural areas, diabetes, central obesity and insulin resistance were significantly associated with NAFLD. NAFLD prevalence was high among rural and urban North Indian adults, including fibrosis or raised hepatic enzymes. The strong association of metabolic determinants confirms its linkage with metabolic syndrome.