Published online Oct 27, 2019. doi: 10.4254/wjh.v11.i10.710
Peer-review started: May 14, 2019
First decision: June 13, 2019
Revised: August 3, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: October 27, 2019
Processing time: 166 Days and 2 Hours
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by steatosis in the absence of significant alcohol consumption. However, MetS and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.
To assess the clinical characteristics of patients with both alcoholic and NAFLD (BAFLD) in a large cohort in the United States.
Adults from the National Health and Nutrition Examination Survey between 2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase (ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either MetS or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score (FIB4 index).
The prevalence of NAFLD was at 25.9% (95%CI; 25.1-26.8) and that of BAFLD was 0.84% (0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase, triglycerides, and lower platelets; P < 0.01 for all. More importantly, after adjusting for MetS components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR (95%CI) based on FIB4 index > 2.67 was 3.2 (1.4, 7.0), P = 0.004].
A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.
Core tip: Using the National Health and Nutrition Examination Survey dataset, we studied a new classification of fatty liver disease that we believe is due to risk factors for both non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease occurring in the same individual. We propose to call this entity Both Alcoholic and NAFLD (BAFLD). As most of the risk factors that lead to BAFLD are potentially modifiable, understanding their reciprocal association and combined effect on the liver may aid in understanding, treating, and preventing BAFLD.