Screening for non-alcoholic fatty liver disease (NAFLD) among adults in Puducherry, India: A community-based cross-sectional study

Background & objectives Non-alcoholic fatty liver disease (NAFLD) is an emerging public health issue and affects 20-30 per cent of the general population globally and 9-53 per cent in India. We aimed to estimate the prevalence of NAFLD and associated risk factors among adults at high risk for NAFLD (≥30 yr) in Puducherry. Methods A community-based cross-sectional study was conducted among 350 adults at high risk for NAFLD (simple random sampling) in a rural area of Puducherry. Clinical assessment, and blood investigations (liver function tests, lipid profile) were performed. NAFLD was diagnosed using the fatty liver index and risk stratification for advanced liver fibrosis by using the FIB-4 score. The indeterminate/high-risk participants underwent vibration controlled transient elastography (VCTE). Prevalence of NAFLD [proportions with 95 per cent confidence interval (CI)] and risk factors associated with NAFLD (multivariable regression) were reported. Results Prevalence of NAFLD among adults at high risk was 22.8 per cent (95% CI:18.7% -27.5%); and higher among men (35.2%), those with diabetes mellitus (33.3%) and obesity (40.2%). Male sex, diabetes mellitus and elevated alanine transferase were significantly associated with high risk of NAFLD. Interpretation & conclusions One in four screened adults had NAFLD, increasing to one in two among those with comorbidities.