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

Md Asadullah; Roopa Shivashankar; Shalimar; Devasenathipathy Kandasamy; Dimple Kondal; Garima Rautela; Ariba Peerzada; Bhanvi Grover; Ritvik Amarchand; Baibaswata Nayak; Raju Sharma; Lakshmy Ramakrishnan; Dorairaj Prabhakaran; Anand Krishnan; Nikhil Tandon

doi:10.1371/journal.pone.0263768

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

PLoS One. 2022 Feb 10;17(2):e0263768. doi: 10.1371/journal.pone.0263768. eCollection 2022.

Authors

Affiliations

¹ Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
² Centre for Chronic Disease Control, New Delhi, India.
³ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India.
⁵ Public Health Foundation of India, Gurgaon, India.
⁶ Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
⁷ Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alanine Transaminase / metabolism*
Cross-Sectional Studies
Elasticity Imaging Techniques
Female
Humans
India / epidemiology
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / diagnostic imaging
Non-alcoholic Fatty Liver Disease / epidemiology*
Non-alcoholic Fatty Liver Disease / metabolism
Prevalence
Rural Population / statistics & numerical data*
Urban Population / statistics & numerical data*

Substances

Alanine Transaminase

Grants and funding

This study was financially supported by Indian Council of Medical Research (ICMR), New Delhi, India (Grant No. 5/4/3-3/TF/2012/NCD-II). Funding agency had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.