Association between different obesity phenotypes, liver steatosis and fibrosis and metabolic health in adult patients with Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) represents a major global healthcare challenge in the twenty first century. NAFLD has emerged as one of the leading causes of cirrhosis, hepatocellular carcinoma and liver transplant in India.Prevalence of the disease is estimated to be around 9-32% in the general Indian population, with a higher incidence rate amongst obese and diabetic patients. Researchers have suggested that NAFLD can be regarded as hepatic manifestation of metabolic syndrome. Overweight and obesity are the main drivers of metabolic disease and NAFLD. Nevertheless, not all obese are metabolically unhealthy, neither all normal weight /lean are metabolically healthy. Being normal weight with metabolic abnormalities was also associated with risk of NAFLD. The link between NAFLD and metabolic syndrome is more complex that previously thought. Indeed the metabolic syndrome shows mutual and bi-directional associations with NAFLD such that NAFLD is now considered to be both a cause and consequence of metabolic syndrome. Future research is required to better understand the association between NAFLD, obesity phenotypes and metabolic syndrome. So, The present study will aim to find the association between NAFLD and different obesity phenotypes (Metabolically healthy non obese (MHNO), Metabolically healthy obese (MHO), Metabolically unhealthy non obese (MUNO), Metabolically unhealthy obese (MUO) among study population.

This will be a cross sectional observational study, all the patients attending Out Patient Department (OPD) of Tertiary Care Hospital in Delhi will be screened for inclusion and exclusion criteria. Both male and female aged between 18-60 years and are diagnosed with fatty liver with a BMI above 18.5 kg/m2 will be recruited in the study and the patients diagnosed with diabetes mellitus, have any end organ damage, or have any history of pancreatitis will be excluded from the study. Approval from Institutional Ethical Committee (IEC) from Lady Irwin college and tertiary care hospital will be obtained before conducting the study. A written consent will be obtained and study information sheet will be given to each participant. Different tools and techniques will be used for data collection. All the participants will undergo fibroscan analysis for NAFLD diagnosis, clinical, anthropometry, biochemical and dietary data will also be obtained. Proir to data collection, pilot testing of all the tools will be done. All the data obtained through questionnaire, anthropometric measurement and dietary intake will be cleaned, coded and computerized using Microsoft Excel 2007 and SPSS software (version 24.0). Missing data will be checked to prevent errors. The qualitative data will be treated to obtain frequencies and percentages. Mean, median, standard deviation and range will be obtained using quantitative data. Karl pearson’s correlation test will be used to find association between different variables. Dietary data will entered in Diet Cal software and will be compared with the recommendations given by ICMR.