Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 12, December, p. 1615–1620

doi: 10.17219/acem/106173

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Clinical outcomes of non-alcoholic fatty liver disease: Polish-case control study

Radosław Kempiński1,A,B,C,D,E,F, Agata Łukawska2,B,D,E,F, Filip Krzyżanowski2,B,D,E,F, Dominika Ślósarz2,B,D,E,F, Elżbieta Poniewierka1,A,D,E,F

1 Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland

2 Gastroenterology Student Organization, Wroclaw Medical University, Poland


Background. Non-alcoholic fatty liver disease (NAFLD) is becoming the most common cause of chronic liver disease worldwide, affecting up to 30% of population. Non-alcoholic fatty liver disease can lead to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Age, obesity, insulin resistance, type 2 diabetes, and dyslipidemia are important risk factors for developing hepatic steatosis. Concomitant diseases, especially cardiovascular, are discussed as important causes of death in NAFLD patients.
Objectives. The objective of this study was to conduct a retrospective comparison of the frequency of concomitant diseases in NAFLD patients and controls, especially metabolic syndrome and cardiovascular disease (CVD).
Material and Methods. A total of 1,058 (558 NAFLD patients and 500 controls). Diagnosis of NAFLD was established with ultrasound examination in the absence of other causes of fatty liver. The control group included patients with no history of liver disease, normal liver image in ultrasound examination and normal liver laboratory tests.
Results. Overweight and/or obesity were diagnosed in 80.8% of patients in the study group and 40.8% in the controls (p < 0.001). Metabolic syndrome was present in 48.7% patients in the study group compared with 14.4% controls, (p < 0.001). In the study group, we found higher prevalence of hypertension (56.1% vs 37%; p < 0.001), type 2 diabetes mellitus (24.4% vs 8.6%; p < 0.001), decreased concentration of serum HDL (35.1% vs 19.5%; p < 0.001), elevated serum triglycerides (36.5% vs 15.4%; p < 0.001). Cardiovascular disease was found in 13.6% of individuals in the study group and in 15% controls (NS, p = 0.32). The most frequent concomitant gastrointestinal disease present in the study group was gastroesophageal reflux disease (GERD) (31.9% vs 22.8%; p < 0.001) followed by colonic diverticulosis (23.7% vs 15.8%; p < 0.005).
Conclusion. Metabolic syndrome with its components is more common in NAFLD patients compared to matched controls. Additionally, NAFLD patients are more often affected by GERD and colonic diverticulosis but not by CVD.

Key words

metabolic syndrome, cardiovascular disease, concomitant diseases, non-alcoholic fatty liver disease

References (26)

  1. Masuoka HC, Chalasani N. Nonalcoholic fatty liver disease: An emerging threat to obese and diabetic individuals. Ann N Y Acad Sci. 2013;1281:106–122.
  2. Armstrong MJ, Adams LA, Canbay A, Syn WK. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59(3):1174–1197.
  3. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Hepatology. 2004;40(6):1387–1395.
  4. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot--Thoraval F. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol. 2013;58(3):593–608.
  5. Hamaguchi M, Kojima T, Itoh Y, et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol. 2007;102(12):2708–2715.
  6. Musso G, Gambino R, Bo S, et al. Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects. Diabetes Care. 2008;31(3):562–568.
  7. Kwon YM, Oh SW, Hwang SS, Lee C, Kwon H, Chung GE. Association of nonalcoholic fatty liver disease with components of metabolic syndrome according to body mass index in Korean adults. Am J Gastroenterol. 2012;107(12):1852–1858.
  8. Speliotes EK, Massaro JM, Hoffmann U, et al. Fatty liver is associated with dyslipidemia and dysglycemia independent of visceral fat: The Framingham heart study. Hepatology. 2010;51(6):1979–1987.
  9. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of noninvasive tests for liver disease severity. Ann Med. 2011;43(8):617–649.
  10. Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14(5):417–431.
  11. Musso G, Gambino R, Tabibian JH, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: A systematic review and meta-analysis. PLoS Med. 2014;11(7):e1001680.
  12. Kopylov U, Ben-Horin S, Lahat A, Segev S, Avidan B, Carter D. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion. 2012;86(3):201–205.
  13. Nagata N, Sakamoto K, Arai T, et al. Visceral abdominal obesity measured by computed tomography is associated with increased risk of colonic diverticulosis. J Clin Gastroenterol. 2015;49(10):816–822.
  14. Festi D, Schiumerini R, Marzi L, et al. Review article: The diagnosis of non-alcoholic fatty liver disease – availability and accuracy of non-invasive methods. Aliment Pharmacol Ther. 2013;37(4):392–400.
  15. Kempiński R, Neubauer K, Wieczorek S, Dudkowiak R, Jasińska M, Poniewierka E. 13C-methacetin breath testing in patients with non-alcoholic fatty liver disease. Adv Clin Exp Med. 2016;25(1):77–81.
  16. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–2497.
  17. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317–1325.
  18. Sookoian S, Pirola CJ. Review article: Shared disease mechanisms between non-alcoholic fatty liver disease and metabolic syndrome – translating knowledge from systems biology to the bedside. ­Aliment Pharmacol Ther. 2019;49(5):516–527.
  19. Rinella ME. Nonalcoholic fatty liver disease: A systematic review. JAMA. 2015;313(22):2263–2273.
  20. Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24(7):908–922.
  21. Noureddin M, Rinella ME. Nonalcoholic fatty liver disease, diabetes, obesity, and hepatocellular carcinoma. Clin Liver Dis. 2015;19(2):361–379.
  22. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol. 2016;65(3):589–600.
  23. Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265–1273.
  24. Min YW, Kim Y, Gwak GY, et al. Non-alcoholic fatty liver disease and the development of reflux esophagitis: A cohort study. J Gastroenterol Hepatol. 2018;33(5):1053–1058. doi:10.1111/jgh.14042
  25. Jia L, Haiyan L, Chengqi Z, et al. Non-alcoholic fatty liver disease associated with gallstones in females rather than males: A longitudinal cohort study in Chinese urban population. BMC Gastroenterol. 2014;14:213.
  26. Sahin A, Tunc N, Demirel U, Poyrazoglu OK, Yalniz M, Bahcecioglu IH. Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients. J Int Med Res. 2018;46(4):1545–1554.