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18 January 2000 | Volume 132 Issue 2 | Pages 112-117
Background: Although hepatic steatosis is seen with increasing frequency in clinical practice, its prevalence and risk factors are unknown.
Objective: To investigate the prevalence of and risk factors for hepatic steatosis, such as alcohol consumption and obesity.
Design: Cross-sectional, observational study.
Setting: Participants in the Dionysos Study.
Patients: 257 participants assigned to one of four categories (67 controls, 66 obese persons, 69 heavy drinkers, and 55 obese heavy drinkers).
Measurements: Ethanol intake, assessed by a validated questionnaire and expressed as daily (g/d) and lifetime (kg) consumption, and body mass, expressed as body mass index. Biochemical tests of liver and metabolic function and hepatic ultrasonography were done.
Results: The prevalence of steatosis was increased in heavy drinkers (46.4% [95% CI, 34% to 59%]) and obese persons (75.8% [CI, 63% to 85%]) compared with controls (16.4% [CI, 8% to 25%]). Steatosis was found in 94.5% (CI, 85% to 99%) of obese heavy drinkers. Compared with controls, the risk for steatosis was higher by 2.8-fold (CI, 1.4-fold to 7.1-fold) in heavy drinkers, 4.6-fold (CI, 2.5-fold to 11.0-fold) in obese persons, and 5.8-fold (CI, 3.2-fold to 12.3-fold) in persons who were obese and drank heavily. In heavy drinkers, obesity increased the risk for steatosis by twofold (CI, 1.5-fold to 3.0-fold) (P < 0.001), but heavy drinking was associated with only a 1.3-fold (CI, 1.02-fold to 1.6-fold) increase in risk in obese persons (P = 0.0053). Elevated alanine aminotransferase and triglyceride levels are the most reliable markers of steatosis.
Conclusions: Steatosis is frequently encountered in healthy persons and is almost always present in obese persons who drink more than 60 g of alcohol per day. Steatosis is more strongly associated with obesity than with heavy drinking, suggesting a greater role of overweight than alcohol consumption in accumulation of fat in the liver.
Author and Article Information
From Fondo per lo Studio delle Malattie del Fegato and University of Trieste, Trieste, Italy.
Presented in part at the 33rd European Association for the Study of the Liver Annual Meeting, Lisbon, Portugal, 15-18 April 1998.
Acknowledgments: The authors thank Dr. Giovanni Costa for critical reading of the manuscript and helpful suggestions.
Grant Support: In part by grants from the Ministry of Education (MURST), Rome, Italy, and from the Health Regional Authorities of Regione Friuli-Venzia Giulia and Emilia-Romagna, Italy. Dr. Saccoccio was supported by a research fellowship from Banca Popolare Emilia-Romagna, and Dr. Masutti received a research fellowship from Fondazione Cassa Risparmio Trieste.
Requests for Reprints: Claudio Tiribelli, MD, Centro Studi Fegato, Department of Biochemistry, Biophysics, and Chemistry of Macromolecules, University of Trieste, Via Giorgieri 1, 34100 Trieste, Italy; e-mail, liver{at}fmc.univ.trieste.it. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Bellentani, Saccoccio, and Brandi: Fondo Studio Malattie del Fegato, Sezione di Modena, Via Wagner 12, 41000 Modena, Italy.
Drs. Masutti, Crocè, Sasso, Cristanini, and Tiribelli: Fondo Studio Malattie del Fegato, Via Donota 1, 34121 Trieste, Italy.
Author Contributions: Conception and design: S. Bellentani, G. Saccoccio, F. Masutti, L.S. Crocè, G. Brandi, G. Cristanini, C. Tiribelli.
Analysis and interpretation of the data: S. Bellentani, L.S. Crocè, F. Sasso, C. Tiribelli.
Drafting of the article: S. Bellentani, C. Tiribelli.
Critical revision of the article for important intellectual content: G. Saccoccio, F. Masutti, L.S. Crocè, G. Brandi, F. Sasso, G. Cristanini, C. Tiribelli.
Final approval of the article: S. Bellentani, G. Saccoccio, F. Masutti, L.S. Crocè, G. Brandi, F. Sasso, G. Cristanini, C. Tiribelli.
Provision of study materials or patients: S. Bellentani, G. Saccoccio, F. Masutti, G. Brandi, G. Cristanini.
Statistical expertise: S. Bellentani, L.S. Crocè, F. Sasso.
Obtaining of funding: S. Bellentani, C. Tiribelli.
Collection and assembly of data: S. Bellentani, G. Saccoccio, F. Masutti, G. Brandi, F. Sasso, G. Cristanini, C. Tiribelli. ARTICLE
Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy
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