Results of the observational cross-over PRELID 2 study (2015–2016). Part 2. Risk factors of non-alcoholic fatty liver disease and treatment options in patients seeking general practitioners’ and gastroenterologists’ help in Ukraine

Yu.M. Stepanov


Background. The purpose was to evaluate the presence of risk factors and underlying disorders in patients with confirmed and unconfirmed diagnosis of non-alcoholic fatty liver disease (NAFLD); the bene­fits of practicing physicians regarding pharmacological and non-pharmacological treatments of NAFLD under conditions of real clinical practice. Materials and methods. The study included 5,000 patients (an average of 50 patients from 100 research centers), 2,450 women (49.00 %) and 2,550 men (51.00 %), middle age — (52.83 ± 12.33) years. To conduct research in Ukraine, 100 gastroenterological departments were selected. The list of research centers included departments with qualified staff, provided with proper materials and technical equipment, with the obligatory presence of the local Ethics Committee. The data used in the study were obtained during one regular patient’s visit to the center included in the study. During the visit, the basic data of the patient, data of instrumental examination (ultrasound of the liver), results of laboratory tests, data on the application of treatment methods (pharmacological and non-pharmacological) were recorded. Diagnosis of NAFLD was established or excluded on the basis of laboratory and instrumental data entered into medical cards. Results. Ove­rall, the risk factors for NAFLD were detected in 4,650 (93.00 %) patients. Most often, overweight (91.90 %), hypercholesterolemia (61.44 %), and hyperlipidemia (41.23 %) were found. The frequency of virtually all investigated risk factors (with the exception of hypercholesterolemia) is significantly higher (p < 0.05) in the group of patients with a confirmed diagnosis of NAFLD than in those with an unconfirmed diagnosis of NAFLD. Non-pharmacological and pharmacological treatment methods were used in most patients (90.44 and 93.82 %, respectively). Most non-pharmacological and pharmacological treatments were significantly more frequently used in patients with a confirmed diagnosis of NAFLD (p < 0.05). Conclusions. According to the results of the study, the most important risk factors of NAFLD were identified. The frequency of virtually all investigated risk factors (with the exception of hypercholesterolemia) is significantly higher (p < 0.05) in the group of patients with confirmed diagnosis of NAFLD than in persons with an unconfirmed diagnosis of NAFLD. The research also allowed evaluating the pharmacological and non-pharmacological methods that are most often used in the treatment of patients with NAFLD in Ukraine.


non-alcoholic fatty liver disease; risk factors; pharmacological and non-pharmacological methods of treatment


Perdomo CM, Frühbeck G, Escalada J. Impact of nutritional changes on nonalcoholic fatty liver disease. Nutrients. 2019 Mar 21;11(3). pii: E677. doi: 10.3390/nu11030677.

Iqbal U, Perumpail BJ, Akhtar D, Kim D, Ahmed A. The epidemiology, risk profiling and diagnostic challenges of nonalcoholic fatty liver disease. Medicines (Basel). 2019 Mar 18;6(1). pii: E41. doi: 10.3390/medicines6010041.

Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015 Apr;62(1 Suppl):S47-64. doi: 10.1016/j.jhep.2014.12.012.

Konerman MA, Walden P, Joseph M, Jackson EA, Lok AS, Rubenfire M. Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2019 Feb;49(3):296-307. doi: 10.1111/apt.15063.

Williams CD, Stengel J, Asike MI, al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: A prospective study. Gastroenterology. 2011 Jan;140(1):124-31. doi: 10.1053/j.gastro.2010.09.038.

Fan JG, Zhu J, Li XJ, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005 Sep;43(3):508-14. doi:10.1016/j.jhep.2005.02.042.

Hu X, Huang Y, Bao Z, et al. Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai work-units. BMC Gastroenterol. 2012 Sep 14;12:123. doi: 10.1186/1471-230X-12-123.

Eguchi Y, Hyogo H, Ono M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: A multicenter large retrospective study. J Gastroenterol. 2012 May;47(5):586-95. doi: 10.1007/s00535-012-0533-z.

Yang JD, Abdelmalek MF, Pang H, et al. Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis. Hepatology. 2014 Apr;59(4):1406-14. doi: 10.1002/hep.26761.

Argo CK, Northup PG, Al-Osaimi AM, Caldwell SH. Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis. J Hepatol. 2009 Aug;51(2):371-9. doi: 10.1016/j.jhep.2009.03.019.

Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am. 2010 Mar;39(1):1-7. doi: 10.1016/j.gtc.2009.12.014.

Júnior WS, Nonino-Borges CB. Clinical predictors of different grades of nonalcoholic fatty liver disease. Obes Surg. 2012 Feb;22(2):248-52. doi: 10.1007/s11695-011-0438-6.

Zelber-Sagi S, Lotan R, Shlomai A, et al. Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up. J Hepatol. 2012 May;56(5):1145-51. doi: 10.1016/j.jhep.2011.12.011.

Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: A systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015 Apr;13(4):643-54.e1-9; quiz e39-40. doi: 10.1016/j.cgh.2014.04.014.

Kabir M, Catalano KJ, Ananthnarayan S, et al. Molecular evidence supporting the portal theory: A causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab. 2005 Feb;288(2):E454-61.

Rocha PM, Barata JT, Minderico CS, Silva AM, Teixeira PJ, Sardinha LB. Visceral abdominal and subfascial femoral adipose tissue have opposite associations with liver fat in overweight and obese premenopausal caucasian women. J Lipids. 2011;2011:154672. doi: 10.1155/2011/154672.

Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: Disparate associations among Asian populations. World J Hepatol. 2014 May 27;6(5):263-73. doi: 10.4254/wjh.v6.i5.263.

Lu FB, Hu ED, Xu LM, et al. The relationship between obesity and the severity of non-alcoholic fatty liver disease: Systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2018 May;12(5):491-502. doi: 10.1080/17474124.2018.1460202.

Sanyal AJ, Chalasani N, Kowdley KV, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010 May 6;362(18):1675-85. doi: 10.1056/NEJMoa0907929.

Said A, Akhter A. Meta-analysis of randomized controlled trials of pharmacologic agents in non-alcoholic steatohepatitis. Ann Hepatol. 2017 Jul-Aug;16(4):538-547. doi: 10.5604/01.3001.0010.0284.

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 Jan;67(1):328-357. doi: 10.1002/hep.29367.

Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1):37-46.

Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56. doi: 10.1001/jama.2011.1437.

Cusi K, Orsak B, Bril F, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med. 2016 Sep 6;165(5):305-15. doi: 10.7326/M15-1774. 

Aghamohammadzadeh N, Niafar M, Dalir Abdolahinia E, et al. The effect of pioglitazone on weight, lipid profile and liver enzymes in type 2 diabetic patients. Ther Adv Endocrinol Metab. 2015 Apr;6(2):56-60. doi: 10.1177/2042018815574229.

Erdmann E, Charbonnel B, Wilcox RG, et al. Pioglitazone use and heart failure in patients with type 2 diabetes and preexisting cardiovascular disease: data from the PROactive study (PROactive 08). Diabetes Care. 2007 Nov;30(11):2773-8. doi: 10.2337/dc07-0717.

Feng W, Gao C, Bi Y, et al. Randomized trial comparing the effects of gliclazide, liraglutide, and metformin on diabetes with non-alcoholic fatty liver disease. J Diabetes. 2017 Aug;9(8):800-809. doi: 10.1111/1753-0407.12555.

Simon TG, King LY, Zheng H, Chung RT. Statin use is associated with a reduced risk of fibrosis progression in chronic hepatitis C. J Hepatol. 2015 Jan;62(1):18-23. doi: 10.1016/j.jhep.2014.08.013.

Kargiotis K, Athyros VG, Giouleme O, et al. Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome. World J Gastroenterol. 2015 Jul 7;21(25):7860-8. doi: 10.3748/wjg.v21.i25.7860.

Bril F, Portillo Sanchez P, Lomonaco R, et al. Liver safety of statins in prediabetes or T2DM and nonalcoholic steatohepatitis: post hoc analysis of a randomized trial. J Clin Endocrinol Metab. 2017 Aug 1;102(8):2950-2961. doi: 10.1210/jc.2017-00867.

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