Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy

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.