High prevalence of advanced fibrosis in association with the metabolic syndrome in a Belgian prospective cohort of NAFLD patients with elevated ALT. Results of the Belgian NAFLD registry

Introduction : Non-alcoholic Fatty Liver Disease (NAFLD) is increasingly recognised as a source of liver related morbidity and mortality. Hard data on epidemiology and natural history are scarce. Aim : To study demographic and metabolic characteristics of the NAFLD patients seen by Belgian hepatologists. Methods : Belgian hepatologists filled in a questionnaire for every newly diagnosed NAFLD patient between January 1st and December 31st 2004. Liver biopsy was advised if ALT > 1.5 × ULN and if 3/5 of the criteria for the metabolic syndrome (MS) (ATPI- II) were present, but was not mandatory. Biopsy was scored using the Brunt classification. Results : 230 patients were prospectively included in 9 centres ; 54% were males ; mean age was 49.4 ± 13.9 y ; mean BMI was 30.6 ± 4.6 kg/m2. The MS was present in 53%. In 16% formerly undiag- nosed diabetes was discovered. 51% had a liver biopsy : 25% met the criteria, 26% did not. Grading did not differ between patients with or without MS. Staging was significantly more severe in patients with MS (2.43 ± 1.25 vs. 1.73 ± 1.18, p < 0.001). A sub- group of patients with GGT > 5 × ULN were significantly older (55.9 vs. 47.64 y, p = 0.02), more frequently diabetic (53% vs. 23%, p = 0.01) and had more advanced fibrosis (3.42 vs. 1.08, p = 0.008). ALT levels were variable. Conclusions : The MS is highly prevalent in Belgian NAFLD patients and is associated with more severe disease. Mild to moder- ate fibrosis is frequent, and the proposed criteria for liver biopsy are not accurate in selecting these patients. Patients with elevated GGT constitute a subgroup with more advanced disease. (Acta gastroenterol. belg., 2011, 74, 9-16).