AFLD represents a broad range of histological changes ranging from simple steatosis to heavier forms of liver injury, including alcoholic hepatitis (AH), cirrhosis, or the parallel development of hepatocellular carcinoma (HCC). (8) NAFLD is emerging as the most common chronic liver condition in the Western world. It is associated with insulin resistance and frequently occurs with features of the metabolic syndrome.
Paik YH et al included a total of 186 patients in their study, out of that 106 cases were NAFLD and 80 were AFLD. There was no significant difference between the NAFLD and ALFD groups (p = 0.635) (9). In our study, we studied a total of 100 patients which included 44 with NAFLD and 56 with AFLD and similar to their study there was no significant difference between the NAFLD and AFLD groups (p-value = 0.8).
Mahaling DU et al, in their study out of 70 cases which were diagnosed as NAFLD on USG, NAFLDG1 cases were 47.15%, NAFLDG2 were 42.85% and NAFLDG3 were 10%. The mean age of the patients was found to be 49.14 years. Male to female ratio was 3:4. Serum TG, TC, LDL and VLDL levels were raised in 67.14%, 45.71% 34.28%, 25.71% of cases respectively. Low serum HDL levels were seen in 62.85% of patients. Their study has shown increasing grades of NAFLD were significantly associated with increasing values of TC. (4) In our study, NAFLDG3 and AFLDG3 cases were not present. The male to female ratio was 1.8:1. The median age of the patients was found to be 45.90 years which is similar to their study. TC, TG and VLDL and LDL were raised in 29%, 64% and 15% of the cases respectively. Some variables of the lipid profile showed a significant elevation of TG (85%) (p < 0.05) and significant raised TC levels (82.5%). (p < 0.01) (10) Similar to their study, Low serum HDL levels were seen in 61% of the cases. The significant association was only observed in median HDL level between AFLDG1 and NFLDG1 (p-value: 0.019) and AFLDG2 and NAFLDG2 (p-value: 0.012). Unlike their study, no significant association was seen between other lipid profiles except HDL with fatty liver disease.
Pradhan B et al in their study which included a total of 1,500 patients, they found that 447 patients had AFLD. Chronic liver disease (CLD) was detected in 144 patients (9.6%). On multivariate analysis, they found the following variables to be significantly associated with CLD: male sex (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.12–2.94; P = 0.02) (11). Similar to the study male predominance was found in our study as well.
Bhusal K, Simkhada R, Nepal P had shown mild NAFLD in 83%, moderate in 17% and severe in none of the participants which is similar finding in our study. Age of the participants ranged from 26 to 79 years with mean being 45 ± 11.99 years. Similar to their study, the present study has shown TG, TC and LDL levels were raised in 57.14%, 26.78%, 10.71% of the NAFLD cases respectively and High density lipoprotein level was decreased in 55.35% of cases. Similarly, TG, TC and LDL levels were raised in 72.72%, 31.87%, 20.45% of the AFLD cases respectively and High density lipoprotein level was decreased in 68.18% of cases. In contrast to their study NAFLDG1 was observed in 48.1% and 26.3% in NAFLDG2. We studied patients with AFLD too in whom 51.9% were having grade 1 and 73.7% had grade 2 FLD. This indicates alcoholism and chronicity progresses with the FLD grade. The increasing grades of non-alcoholic fatty liver disease weren’t significantly associated with increasing level of lipid abnormalities. (12) Unlike their study, we found no association between the presence of dyslipidemia and either type of the fatty liver disease. Similar to their study, no significant association of different grades of FLD was observed with increasing lipid abnormalities.
Khalil F et al, in their study, found that the largest group of patients (38%) was in the fifth decade of life. followed by 30% in the sixth decade of life. As the grade of NAFLD increased, there was associated significant increase in levels of serum TC (p-value 0.005), TG (p-value 0.002) LDL (p-value 0.001) and VLDL (p-value 0.003) and associated significant decrease in HDL (P-value 0.001). (13) Unlike their study, most of the patients were in their third to fourth decade of life (46%) followed by fifth to sixth decade (39%) and lowest number of patients were older than 60 years of age (15%) and there was no association between dyslipidemia and FLD.
Khanal U et al had found that the mean age of fatty liver in males was 44.3 years and in females was 51.9 years. 22.9% of patients with NAFLD had increased liver size. Significant association with increasing grades of fatty liver was found with increasing levels of TC (p = 0.028), LDL (p = 0.017), liver size (p = 0.001), and body mass index (BMI) (p = 0.045) in patients diagnosed with NAFLD. No significant association with increasing grades of FLD was found with increasing levels of TG (p = 0.32) and high density lipoprotein (p = 0.25). (14) (15) In contrast our study has shown strong association with median HDL level and there was no significant association with TG, TC and LDL. This difference in the lipid abnormality spectrum might have arisen due to wide distribution of lipid level values and pattern of alcohol consumption and USG grading of FLD.