Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy

  1. Stefano Bellentani, MD, PhD;
  2. Gioconda Saccoccio, MD;
  3. Flora Masutti, MD;
  4. Lory S. Crocè, MD;
  5. Giovanni Brandi, MD;
  6. Franco Sasso, MD;
  7. Giovanni Cristanini, MD; and
  8. Claudio Tiribelli, MD, PhD
  1. From Fondo per lo Studio delle Malattie del Fegato and University of Trieste, Trieste, Italy.

    Abstract

    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.

    Article and Author Information

    • 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.

    Summary for Patients

    • Summaries for Patients:Fatty Liver among Persons in a Community in Northern Italy Ann Intern Med January 18, 2000 132:112
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    1. Ann Intern Med January 18, 2000 vol. 132 no. 2 112-117
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