Characteristics of Saudi patients with NAFLD

Khalid Alswat, 1 Faisal M Sanai, 2 Waleed Al-hamoudi, 1 Mona Ismail, 3 Yaser Dahlan, 2 Hamdan Saleh AlGhamdi, 4,5 Ibrahim Altraif, 4,5 Abduljaleel Alalwan, 4,5 Mohamed MA Babatin, 6 Saleh A Alqahtani 7 8th

1Liver Disease Research Center, Department of Medicine, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 3 Gastroenterology Division, Internal Medicine Department, King Fahd University Hospital, Medical Faculty, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia; 4King Saud bin Abdulaziz University of Health Sciences, Ministry of Health of the National Guard, Riyadh, Saudi Arabia; 5 Department of Hepatology, Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City of the National Guard, Riyadh, Saudi Arabia; 6Gastroenterology Unit, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia; 7 Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 8 Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA

Correspondence: Khalid Alswat
Liver Disease Research Center, Department of Medicine, Faculty of Medicine, King Saud University, PO Box 2925 (59), Riyadh, 11461, Saudi Arabia
Tel +966114670810
Fax +966114672403

Background and goals: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in Saudi Arabia (SA), but the description of the clinical and metabolic characteristics of these patients is limited. The present study aims to close this gap.
Methods: Demographic, clinical, and laboratory data of all NAFLD patients from 2009 to 2019 were retrieved from the Systematic Observatory Liver Disease Registry (SOLID). [n=832 (337 males; 495 females); mean (± standard deviation, SD) age was 42.6± 13.6 years; mean body mass index (BMI) was 35.0± 9.3kg/m2]. Non-invasive replacement fibrosis scores (e.g., AST Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4), and NAFLD Fibrosis Scores (NFS)) were calculated and analyzed. In addition, data from NAFLD patients with normal and high alanine aminotransferase (ALT) were compared using two different methods: the standard laboratory reference range, which defines normal as ALT <61 IU / L, and the range determined by a recent national Study suggested upper limits for normal ALT were 33 IU / L for men and 22 IU / L for women.
Results: Hyperlipidemia was the most common comorbidity (41.7%), followed by type 2 diabetes mellitus (T2DM) (35.3%) and hypertension (28.4%). The prevalence of advanced fibrosis varied greatly depending on the definition [FIB-4, N=19 (2.5%); APRI, N=21 (2.8%); NFS, N=62 (8.6%)] and showed sexual dimorphism in men with poorer metabolic properties. NAFLD patients with normal ALT were more likely to be older, female, had a lower BMI, and a higher prevalence of cirrhosis, DM, hypertension, hyperlipidemia, and renal impairment.
Conclusion: Patients with NAFLD have metabolic properties associated with several comorbidities, including NAFLD patients with normal ALT. Mechanistic studies are needed to examine and analyze complex, interactive effects between gender, age and other factors that can accelerate the progression of NAFLD disease.

Keywords: non-alcoholic fatty liver disease, non-invasive biomarkers for fibrosis, Systematic Observatory Liver Disease Registry, Saudi Arabia

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