Hormonal
Nonalcoholic fatty liver (NAFL) and significant liver disease, including cryptogenic cirrhosis, have a high prevalence (8.7% and 0.2% respectively) in nonobese, low-income populations in developing countries, driven by metabolic syndrome markers rather than general obesity.
If you live in or visit developing regions with limited healthcare, do not assume a normal or low BMI protects you from liver disease. Screen for metabolic markers like fasting glucose and liver enzymes, as fatty liver can develop due to insulin resistance even without excess body weight.
The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively... Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m2, and 54% were neither overweight nor had abdominal obesity.
Why this rating
Large sample size (n=1,911), prospective design, rigorous exclusion of alcohol/viral hepatitis, and histological confirmation via biopsy in a subset.
Source
Nonobese Population in A Developing Country Has A High Prevalence of Nonalcoholic Fatty Liver and Significant Liver Disease
Kausik Das et al. · Hepatology · 2010
DOI 10.1002/hep.23567
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