Prevalence of Transaminitis and Metabolic Dysfunction-Associated Steatotic Liver Disease Among Young Indian Adults-A Population-Based Study

Overview

Journal J Clin Exp Hepatol

Publisher Elsevier

Date 2025 Jan 27

PMID 39868010

Authors

Abilash Nair

Jabbar Puthiyaveettil Khadar

Archana Mohan Preetha

Jayakumari Chellamma

Krishnadas Devadas

Tanvir Kaur Gandhi

Bipin K Gopal

Sreejith Babu U S

Amal Kingsley

Anish Thekkumkara Surendran Nair

Ramesh Gomez

Praveen G

Ajosh Thambi T S

Sumitha N

Affiliations

Soon will be listed here.

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) with onset in youth may be more consequential for adverse outcomes than that detected later in adulthood. Transaminitis in the general population is a marker of the prevalence of MASLD. There are no previous community-based studies in Indian youth assessing the prevalence of transaminitis. The purpose of this study was to find out the prevalence of transaminitis, MASLD and elevated Fibrosis-4 (FIB-4) index among young South Indian adults.

Methods: This was a cross-sectional study done over a period of 1 year from January 2022 among adults aged 18-30 years. Multistage sampling was used to recruit participants with body mass index (BMI) < 30 kg/m and without moderate to heavy alcohol consumption from four different sociogeographic regions. Detailed history, physical examination and investigations including liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), platelet count, and metabolic workup were carried out. FIB-4 index and Nonalcoholic fatty liver disease-liver fat score (NAFLD-LFS) were calculated. LFS ≥ -0.64 was used to rule in MASLD.

Results: A total of 2373 (1170 males) participants with a mean age of 24 ± 3.5 years were included. Transaminitis (AST or ALT≥35 IU/L) was seen in 25.9% of the cohort. MASLD by NAFLD-LFS was present in 27.4% of the population. FIB-4 index ≥1.3 was found in 54 (2.27%) participants. Neck circumference and Trivandrum Medical College adiposity index were associated with transaminitis, MASLD, and elevated FIB-4. Blood pressure, triglycerides, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower among participants with transaminitis, but they were not different among those with elevated FIB-4 index. BMI and waist-hip ratio were not different among participants with and those without transaminitis or MASLD.

Conclusion: There is a high prevalence of transaminitis and MASLD in community-dwelling young adult Indians. We recommend screening all young adult Indians for MASLD and transaminitis.

References

Younossi Z, Golabi P, Paik J, Henry A, Van Dongen C, Henry L . The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023; 77(4):1335-1347. PMC: 10026948. DOI: 10.1097/HEP.0000000000000004. View

Ioannou G, Boyko E, Lee S . The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002. Am J Gastroenterol. 2006; 101(1):76-82. DOI: 10.1111/j.1572-0241.2005.00341.x. View

Thong V, Quynh B . Correlation of Serum Transaminase Levels with Liver Fibrosis Assessed by Transient Elastography in Vietnamese Patients with Nonalcoholic Fatty Liver Disease. Int J Gen Med. 2021; 14:1349-1355. PMC: 8057835. DOI: 10.2147/IJGM.S309311. View

Biswas S, Vaishnav M, Farooqui N, Aggarwal A, Pathak P, Yadav R . Impact of body mass index on disease progression and outcomes in patients with nonalcoholic fatty liver disease. Postgrad Med J. 2023; 99(1176):1094-1103. DOI: 10.1093/postmj/qgad035. View

Choudhary N, Saraf N, Saigal S, Duseja A, Gautam D, Rastogi A . Nonalcoholic Fatty Liver in Lean Individuals: Clinicobiochemical Correlates of Histopathology in 157 Liver Biopsies from Healthy Liver Donors. J Clin Exp Hepatol. 2021; 11(5):544-549. PMC: 8414316. DOI: 10.1016/j.jceh.2021.01.004. View

Mohan V, Vijayaprabha R, Rema M, Premalatha G, Poongothai S, Deepa R . Clinical profile of lean NIDDM in South India. Diabetes Res Clin Pract. 1998; 38(2):101-8. DOI: 10.1016/s0168-8227(97)00088-0. View

Limdi J, HYDE G . Evaluation of abnormal liver function tests. Postgrad Med J. 2003; 79(932):307-12. PMC: 1742736. DOI: 10.1136/pmj.79.932.307. View

Newsome P, Cramb R, Davison S, Dillon J, Foulerton M, Godfrey E . Guidelines on the management of abnormal liver blood tests. Gut. 2017; 67(1):6-19. PMC: 5754852. DOI: 10.1136/gutjnl-2017-314924. View

Huber Y, Schulz A, Schmidtmann I, Beutel M, Pfeiffer N, Munzel T . Prevalence and Risk Factors of Advanced Liver Fibrosis in a Population-Based Study in Germany. Hepatol Commun. 2022; 6(6):1457-1466. PMC: 9134815. DOI: 10.1002/hep4.1899. View

10.

Shalimar , Elhence A, Bansal B, Gupta H, Anand A, Singh T . Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis. J Clin Exp Hepatol. 2022; 12(3):818-829. PMC: 9168741. DOI: 10.1016/j.jceh.2021.11.010. View

11.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

12.

August G, Caprio S, Fennoy I, Freemark M, Kaufman F, Lustig R . Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008; 93(12):4576-99. PMC: 6048599. DOI: 10.1210/jc.2007-2458. View

13.

Lau D, Douketis J, Morrison K, Hramiak I, Sharma A, Ur E . 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007; 176(8):S1-13. PMC: 1839777. DOI: 10.1503/cmaj.061409. View

14.

McLernon D, Donnan P, Ryder S, Roderick P, Sullivan F, Rosenberg W . Health outcomes following liver function testing in primary care: a retrospective cohort study. Fam Pract. 2009; 26(4):251-9. DOI: 10.1093/fampra/cmp025. View

15.

Kotronen A, Peltonen M, Hakkarainen A, Sevastianova K, Bergholm R, Johansson L . Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology. 2009; 137(3):865-72. DOI: 10.1053/j.gastro.2009.06.005. View

16.

Kunene S, Taukobong N . Level of physical activity of health professionals in a district hospital in KwaZulu-Natal, South Africa. S Afr J Physiother. 2018; 71(1):234. PMC: 6093129. DOI: 10.4102/sajp.v71i1.234. View

17.

Cheung C, Lam K, Wong I, Cheung B . Non-invasive score identifies ultrasonography-diagnosed non-alcoholic fatty liver disease and predicts mortality in the USA. BMC Med. 2014; 12:154. PMC: 4207316. DOI: 10.1186/s12916-014-0154-x. View

18.

Jabbar P, Nair A, Chellamma J, Jayakumar R, Ramesh J, Gomez R . Type 2 Diabetes and Precursors in Community Dwelling Asian Indian Adult Youth. Indian J Endocrinol Metab. 2023; 27(4):307-314. PMC: 10586547. DOI: 10.4103/ijem.ijem_331_22. View

19.

Pirimoglu B, Sade R, Polat G, Islek A, Kantarci M . Analysis of correlation between liver fat fraction and AST and ALT levels in overweight and obese children by using new magnetic resonance imaging technique. Turk J Gastroenterol. 2020; 31(2):156-162. PMC: 7062128. DOI: 10.5152/tjg.2020.18594. View

20.

De A, Mehta M, Singh P, Bhagat N, Mitra S, Das A . Lean Indian patients with non-alcoholic fatty liver disease (NAFLD) have less metabolic risk factors but similar liver disease severity as non-lean patients with NAFLD. Int J Obes (Lond). 2023; 47(10):986-992. DOI: 10.1038/s41366-023-01346-w. View