Are Obese Patients Evaluated for Non-Alcoholic Fatty Liver Disease in an Endocrinology Outpatient Clinic?

Background: Obesity is an increasing global health problem worldwide and Uruguay mirrors these trends. It leads to various complications that include non-alcoholic fatty liver disease (NAFLD). NAFLD is one of the most common liver disorders in industrialized countries with an estimated global prevalence of 25–30%. It is one of the main causes of liver transplant, for which is considered a global public health problem. It includes simple steatosis, and nonalcoholic steatohepatitis, that can progress to cirrhosis and hepatocellular carcinoma. Several studies have shown a close relationship between NAFLD and obesity, with a reported prevalence of up to 80% in these patients. The diagnosis of NAFLD requires demonstration of hepatic steatosis by imaging and exclusion of other causes (absence of significant alcohol consumption, hepatitis infection, autoimmune hepatitis and hemochromatosis). We aimed to determine whether obese patients are evaluated for NAFLD in our endocrinology outpatient clinic. Methods: We conducted a cross-sectional study among 130 obese adults attending our clinic from December 2019 to March 2020. Results: The mean age was 53.8 years (range 19–80) and 80% were women. The mean BMI was 35.9 kg/m(2) ± 5.3. Obesity class I, II and III was present in 55%, 25% and 20% of patients, respectively. Type 2 diabetes (DM2), hypertension and dyslipidemia were found in 46.2%, 61.5% and 76.2% of patients, respectively. Abdominal ultrasound was not performed in 62% of patients. Abdominal ultrasound was performed significantly more often in diabetics compared to non-diabetics (48.3% vs. 38%, p=0.046). There was no significant association between obesity class and presence of ultrasound (p=0.20), or liver steatosis (LS) (p=0.58). Seventy-eight percent showed LS (56% mild, 31% moderate and 13% severe). The majority (87.7%) had liver enzymes measured. Patients with and without LS showed similar proportion of elevated enzymes (36% and 36.4%, respectively). The most frequent raised enzyme was gamma-glutamyl transferase, present in 82.9% of patients, and in similar proportion between patients with and without LS (30.8% and 36.4%, respectively). Elevated liver enzymes were found in 22.7%, 46.6% and 80% of mild, moderate and severe LS, respectively. There was significant association between LS grade and liver enzymes elevation (p<0.01). Secondary causes of LS were evaluated in 35.9% of patients, in all cases except one by the gastroenterology service. Half of the individuals had other causes of liver disease (alcoholism (28.6%), hepatitis B virus (28.6%) and methotrexate (28.6%) and prednisone (14.2%)treatment). Conclusion: NAFLD is a scantily evaluated disorder in our obese patients. In those evaluated we found a high frequency of LS, with almost 50% having moderate or severe disease. Further research is warranted to determine its prevalence and associated complications in our population.