Epidemiologic features of non-alcoholic fatty liver disease in Russia
Abstract
Aim of investigation. To estimate prevalence nonalcoholic fatty liver disease (NAFLD) with assessment of age dynamics of distribution, interrelation of stages and value of clinical cardio-vascular markers in patients addressing for medical aid to physicians of polyclinics of Russia.
Material and methods. First Russian epidemiologic observational study DIREG L 01903 on prevalence of non-alcoholic fatty liver disease was carried out in the Russian Federation in 2007. Overall 30 754 patients (56% of women, 44% of men) in the age of 18 to 80 years who sought medical attention of municipal polyclinics irrespective of the reference reason (either with subjective symptoms of liver disease or in the absence of those) have been investigated in 208 large medical centers for 8 months. Investigation included general (anthopometrical), laboratory and instrumental investigations, such as assessment of hepatites B and C markers, liver transaminases, gamma-glutamyltranspeptidase, blood lipid spectrum, glucose level, and abdominal ultrasound investigation, if required — esophagogastroduodenoscopy. In 4–6 wks at the second visit of the patient biochemical tests were repeated or supplemented with tests for alkaline phosphatase, bilirubin, albumin, gammaglobulin, serum iron.
Results. The prevalence of NAFLD among adult population of the Russian Federation was 27%, including 80,3% of hepatic steatosis cases, 16,8% — nonalcoholic steatohepatitis and 2,9% — liver cirrhosis. Frequency of NAFLD detection increase by the age of 50. In the age group of 50–59 years the prevalence of disease reached the highest values, making 31,1% among the whole screened population. The impact of all studied risk factors of cardio-vascular diseases (р<0,001) has been found. The major risk factors revealed in NAFLD patients population, were systemic hypertension (69,9%), abdominal obesity (56,2%), hypercholesterolemia (68,8%).
Conclusions. Prevalence of NAFLD among adult population of Russia is very high: almost every third patient who was looking for medical attention in polyclinic, has one of NAFLD-related disease entities. Metabolic syndrome and its components have been determined as leading risk factors of this disease, that once again emphasizes significance of interrelation of cardio-vascular diseases and NAFLD. Therefore, development of management approach and search of effective treatment should be carried out in two directions — for liver and cardiac diseases.
About the Authors
O. M. DrapkinaRussian Federation
Drapkina Oksana M — MD, PhD, professor of chair of propedeutics of internal diseases
119991, Moscow, Pogodinskaya street, 1 bld. 1
V. T. Ivashkin
Russian Federation
References
1. Tommy Pacana, Michael Fuchs. The cardiovascular link to nonalcoholic fatty liver disease. Clin Liver Dis 2012; 16:599-613.
2. Драпкина О. М., Гацолаева Д. С., Ивашкин В. Т. Неалкогольная жировая болезнь печени как компонент метаболического синдрома. Рос мед вести 2010; 2:72-8.
3. Moller D.E., Filler JS. Insulin resistance: mechanisms, syndromes and implications. N Engl J Med 2005; 325:93848.
4. Matteoni C., Younossi Z.M., Gramlich T. Nonalcoholic fatty liver disease: A spectrum of clinical pathological severity. Gastroenterology 2009; 116:1413-19.
5. Hamaguchi M., Kojima T., Takeda N., et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol 2007; 13:1579-84.
6. Haring R., Wallaschofski H., Nauck M., Dörr M., Baumeister S.E., Völzke H. Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl-transpeptidase levels. Hepatology 2009; 50:1403-11.
7. Lazo M., Hernaez R., Bonekamp S., et al. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ 2011; 343:d6891.
8. Giovanni Targher, Christopher P. Day. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363:1341-50.
9. Драпкина О. М. Чапаркина C. О. Взаимосвязь метаболического синдрома, асептического воспаления и дисфункции эндотелия. Рос мед вести 2007; 12(3):6775.
10. Kotronen A., Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol 2008; 28:27-38.
11. Adams L.A., Lymp J.F., St Sauver J., et al. The natural history of nonalcoholic fatty liver disease: a populationbased cohort study. Gastroenterology 2005; 129:113-21.
12. Dunn W., Xu R., Wingard D.L., et al. Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study. Am J Gastroenterol 2008; 103:2263-71.
13. Mensah G.A., Mokdad A.H., Ford E., et al. Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. Cardiol Clin 2004; 22:485-504.
14. Neuschwander-Tetri B.A., Caldwell S.H. Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 2003; 37:1202-19.
15. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine 7th ed. Saunders, 2011; 8-12.
16. Bedogni G., Bellentani S., Miglioli L., et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis BMC Gastroenterol 2006; 6:33.
17. Lorenzo C., Williams K., Hunt K.J., et al. The National Cholesterol Education Program — Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007; 30:8-13.
18. Browning J.S., Szczepaniak L.S., Dobbings L.S., et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40 (7):1387-95.
19. Nomura H., Kashiwaqi S., Hayashi J., et al. Prevalence of fatty liver in a general population of Okinawa Japan. Jap J Med 1998; 27(1):142-9.
20. Драпкина О. М., Смирин В. И., Ивашкин В. Т. Неалкогольная жировая болезнь печени — современный взгляд на проблему. Лечащий врач 2010; 5(5):57-61.
21. Драпкина О. М., Смирин В. И., Ивашкин В. Т. Сахарный диабет как фактор риска неалкогольной жировой болезни печени. Врач 2010; 3:30-3.
22. Bedogni G., Miglioli L., Massutti F., et al. Incidence and natural course of fatty liver in the general population: the Dionysos Study. Hepatology 2007; 46(6):1387-91.
23. Picardi A., Vespasiani-Gentilucci U. Association between non-alcoholic fatty liver disease and cardiovascular disease: a first message should pass. Am J Gastroenterol 2008; 103:3036-8.
24. Kotronen A., Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol 2008; 28:27-38.
25. Драпкина О. М., Корнеева О. Н., Чернова Е. М. Эпикардиальный жир и неалкогольная жировая болезнь печени. Сердце: журн для практикующих врачей 2012; 4.
Review
For citations:
Drapkina O.M., Ivashkin V.T. Epidemiologic features of non-alcoholic fatty liver disease in Russia. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014;24(4):32-38. (In Russ.)