Epidemiological, clinical, and biochemical characteristics of Saudi patients with nonalcoholic fatty liver disease: a hospital-based study

BACKGROUND: The estimated prevalence of nonalcoholic fatty liver disease (NAFLD) in Saudi Arabia is 7% to 10%. Despite the high prevalence of risk factors including diabetes, obesity, and hyperlipidemia, no recent epidemiological studies have measured the disease burden. We aimed to determine the characteristics of Saudi NAFLD patients attending a university hospital, and study factors affecting alanine aminotransferase (ALT) levels. DESIGN AND SETTING: A prospective study among patients referred for ultrasonography in King Khalid University Hospital in Riyadh, Saudi Arabia from February to May 2009. PATIENTS AND METHODS: NAFLD was defined as an appearance of fatty liver on routine abdominal ultrasound in the absence of coexisting liver disease and alcohol consumption. Patients were classified into normal and high ALT (ALT >60 U/L) level groups for analysis. RESULTS: The prevalence of NAFLD was 16.6% (218/1312). Patients with normal ALT had the mean (SD) age of 45.9 (10.6) years and the mean body mass index of 34.5 (7.9) kg/m(2). Forty percent of the 151 patients with normal ALT had diabetes, 66.2% were obese, and 29.1% had hypertension. Forty-three patients (23%) had high ALT levels. These patients had significantly lower age (P=.003) and fasting blood sugar (P=.03) than the normal ALT group. Non-diabetic patients (odds ratio 0.30, 95% CI 0.1-0.8), men (female OR 0.23, 95% CI 0.1-0.5), lower cholesterol (P=.001), high-density lipoprotein (P=.006), and low-density lipoprotein (P=.008) levels were more likely to be observed among patients with high ALT levels. In a multivariate analysis, younger age (OR 0.96, 95% CI 0.93-0.99), being male (OR 0.23, 95% CI 0.09-0.57), and a lower cholesterol level (OR 0.55, 95% CI 0.37-0.82) were significant predictors of high ALT levels. CONCLUSION: Based on the high prevalence of obesity and diabetes, the prevalence of NAFLD will continue to be high, unless awareness is inculcated among the local population.