Prevalence of hepatic steatosis in healthy health care workers as quantified by controlled attenuation parameter (CAP)

Background: Hepatic fat accumulation is the hallmark of non-alcoholic fatty liver (NAFL), for which prevalence estimates range widely from 5 to 50% in the population due to differences of screening and detection strategies. Since up to 25% of patients with NAFLD might develop advanced liver fibrosis and cirrhosis, which increase the risk of liver-associated mortality, better NAFL screening is needed. Our aim was to assess the frequency of hepatic steatosis in participants without a history of chronic liver disease who were recruited from the Occupational Health Department at Saarland University Medical Center.

Methods: For this prospective study, 81 participants volunteered (80% women, median age 29 years, range 21 – 63 years). Hepatic steatosis was assessed using controlled attenuation parameter (CAP), which quantifies the degree of ultrasound attenuation based on vibration- controlled transient elastography (VCTE; FibroScan®, Echosens). Body composition was determined using an eight electrode bioelectrical impedance analyzer (BIA; TANITA BC-418 MA). Liver function tests (LFT) and serum lipids were measured from plasma samples with standardized clinical assays.

Results: The median CAP score was 226 dB/m (range 100 – 400 dB/m). In total, 33 participants (41%) presented with hepatic steatosis, when using 238 dB/m as cut-off for liver fat accumulation (Sasso Ultrasound Med Biol 2010). The median body mass index was significantly (P < 0.001) higher in participants with than without liver steatosis (26 vs. 22 kg/m², respectively) and accordingly, the majority of NAFL patients were overweight (42%) or obese (15%). In contrast, only 15% of participants without hepatic steatosis were overweight, and none were obese (P < 0.0001). In line with these associations, body fat mass as determined by BIA was elevated in 48% of participants with hepatic steatosis, as compared to only 6% in those with low liver fat contents. In contrast, LFT and serum lipid parameters did not differ significantly between the two groups.

Conclusions: Presence of hepatic steatosis was documented in almost half of the cohort of perceived healthy individuals. Whereas serum surrogate markers did not differentiate the individuals, body composition reflected the differences in liver fat contents among the two groups. CAP (and BIA) represent rapid non-invasive methods that facilitate the identification of fatty liver. Broad NAFL screening in the workplace might be encouraged, since it may allow timely detection of at risk individuals and early implementation of lifestyle changes.

Corresponding author: Arslanow, Anita

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