46 Original Research

Indian Journal Article.

of Public Health Research & Development, October 2020, Vol.DOI Number:10.37506/ijphrd.v11i10.11105
11, No.
10
Study of Cardiovascular Risk Assessment in Patients with
Fatty Liver Disease

Prashant Satwaji Shinde1, Suchita Narayan Kawale2, Dharmesh Kapoor3

1
Senior Consultant, Hepatology Department, Yashoda Hospital, Secunderabad, Hyderabad, Telangana,
2
Associate Professor, Community Medicine, ESIC Medical College and Hospital, Sanathnagar,
Hyderabad, 3Senior Consultant, Hepatology Department, Yashoda Hospital, Secunderabad, Hyderabad,
Telangana

Abstract
Background- The term ‘fatty liver disease’ (FLD) is used to describe a variety of liver diseases of
different severity, from pure steatosis to steatohepatitis and cirrhosis and hepatocellular carcinoma.
Objective- To Study Of Cardiovascular Risk Assessment In Patients With Fatty Liver Disease.
Methodology- This prospective single center study was conducted from 1st March 2015 to 1st March
2016, in the Department of Gastroenterology in collaboration with Department of Community medicine at
Global hospitals. All Adult (18 years to 70 years) patients, both sexes, reporting to Medical
Gastroenterology with FLD were included in the study which were 32.Result - Maximum 28 subjects
(87.5 %) were male while 4(12.5%) were female. Male to female ratio was 7:1. Maximum patients
20(62.5%) belonged to Grade II fatty liver followed by 09 (28.12%) Grade I and 03(9.3%) Grade III.
11(34.37%) were overweight,17 (53.12%) were obese,only 4 patients had normal BMI. 27(96.42%) out of
28 male patients had abnormal waist while four (100%) out of 4 female patients had abnormal waist
circumference. 12(37.50) Patients with FLD had significantly higher levels of total
cholesterol.Conclusion- . FLD may serve as a trigger for assessment of cardiovascular risk factors, and
such patients should undergo further cardiovascular assessment.

Keywords- Cardiovascular risk assessment; fatty liver disease.

Introduction steatosis to steatohepatitis (NASH) and cirrhosis and,

The importance of the liver in the regulation of
metabolism has been recognized for over a century and
a half. Several pathological conditions are associated
with intra-hepatic triacylglycerol accumulation, but
fatty liver has long been considered a trivial finding.
The term ‘fatty liver disease’ (FLD) is used to describe
a variety of liver diseases of different severity, from
pure
Corresponding author:
Dr. Suchita Narayan Kawale,
MBBS, MD Community Medicine, Associate
Professor, Community Medicine,
ESIC Medical college and Hospital, Sanathnagar,
Hyderabad, Telangana, zip- 500038.
Mobile no.- [91]8668463510,
email suchisuccess80@gmail.com
rarely, hepatocellular carcinoma.The large majorities of
patients with FLD are overweight or obese or have type
2 diabetes; another common associated clinical feature
is atherogenic dyslipidemia i.e; high triacylglycerol,
low HDL-cholesterol and increased small dense LDL-
cholesterol levels. A large body of evidence suggests
that FLD is the hepatic manifestation of the metabolic
syndrome1. Accordingly, the cardiovascular disease
(CVD) risk dictates the outcome(s) of these patients
more frequently and to a greater extent than does liver
disease progression2
In the community, the prevalence of ultrasound-
diagnosed FLD is ∼30%, this figure being largely
influenced by obesity and/or alcohol consumption3
.Hence this study is carried out to highlight the
cardiovascular risk factors among patents of FLD.
 Indian Journal of Public Health Research & Development, October 2020, Vol. 11, No.
10
Aim and Objective- To Study Of Cardiovascular details of the subject. Workup of these patients was
Risk Assessment In Patients With Fatty Liver Disease. done on standard lines [history, anthropometry,
physical examination etc.]
Material & Methods-
Statistical Analysis
This prospective single center study was conducted
from 1st March 2015 to 1st March 2016, in the Data was entered in Microsoft excel sheet and it
Department of Gastroenterology in collaboration with was analyzed with Epi info software. Statistical
Department of Community medicine at Global analysis was done by using simple proportions,
hospitals, Hyderabad, Telangana State, India. All Adult percentages and mean±SD Throughout the study
(18 years to 70 years) patients, both sexes, reporting to anonymity of all patients was maintained and privacy
Medical Gastroenterology and Hepatology outpatient as well as confidentiality of the data was assured.
department with FLD were included in the study. A
total of 39 subjects were enrolled into the study over Results
this period of time, but 7 subjects could not complete This prospective study was conducted
the protocol and hence were excluded. Therefore, data from 1st March 2015 to 1st March
pertaining to a total of 32 subjects were analyzed. After 2016 in the Department of Gastroenterology
explaining the purpose of study and obtaining verbal and Hepatology in collaboration
informed consent from the patients, all patients were with Department of Community medicine at Global
interviewed with the help of preformed structured hospitals, Hyderabad, Telangana State, India.
questionnaire comprising of questions related to
epidemiological and clinical Table No. 1: Distribution of study subjects
according to sex-

Sex Number

Males 28

Females 04

Total 32

Table No. 1shows Distribution of study subjects

according to sex. Maximum 28 subjects (87.5 %)
were male while 4(12.5%) were female. Male to
female ratio was 7:1.
Table No. 2: Distribution of study subjects
according to Grades of fatty liver-

Grades of fatty liver Number of patient

Grade I 9

Grade II 20

Grade III 3

TOTAL 32

Table No. 2 shows Distribution of study subjects

according to Grades of fatty liver. Maximum patients
 Indian Journal of Public Health Research & Development, October 2020, Vol. 11, No.
20(62.5%) belonged to Grade II fatty
10 liver followed by
09 (28.12%) Grade I and 03(9.3%) Grade III.
 Table No. 3: Distribution of study subjects according to clinico-social factors

Number
Clinico-social factor Percentage
(n=450)

B.M.I

18.5-24.9 04 12.50

25-29.9 13 40.62

30-34.99 14 43.75

35-39.99 01 03.12

Waist Hip Ratio (Male)

Normal 01 03.12

Abnormal 27 84.37

Waist Hip Ratio (Female)

Normal 00 00

Abnormal 04 12.50

Total cholesterol

<200 20 62.50

>200 12 37.50

Table No. 3shows Distribution of study subjects

according to clinico-social factors.Eleven patients
(34.37%) were overweight while seventeen patients
(53.12%) were obese. Thus only 4 patients had normal
BMI. 27(96.42%) out of 28 male patients had abnormal
waist while four (100%) out of 4 female patients had
abnormal waist circumference. 12(37.50) Patients with
FLD had significantly higher levels of total cholesterol.
Discussion
During this prospective single centre study, a total
of 32 patients of fatty liver disease (FLD) were
enrolled. The mean age of subjects in the study was
43.12 years (SD=10.53 years ), while median age was
45.5 years (range from 20 to 61 years).
Our study had a male preponderance, 28 subjects
(87.5 %) were male while 4(12.5%) were female. Male
to female ratio was 7:1. Studies by Guleria et al and
Agarwal et al showed that similar finding comparable
with our study5,6
Table No. 2 shows Distribution of study subjects
according to Grades of fatty liver. Maximum patients
20(62.5%) belonged to Grade II fatty liver followed by
09 (28.12%) Grade I and 03(9.3%) Grade III.The study
findings are parallel to a study done by Greenland P et
al 4.
Table No. 3shows Distribution of study subjects
according to clinico-social factors.Eleven patients
(34.37%) were overweight while seventeen patients
(53.12%) were obese. Thus only 4 patients had normal
BMI. No statistically significant association was found
between BMI of the subjects and grades of fatty liver (F
= 1.006; p=0.378). 27(96.42%) out of 28 male patients
had abnormal waist while four (100%) out of 4 female
patients had abnormal waist circumference. Statistically
highly significant association was found between WHR
of the subjects and grades of fatty liver (F = 3.419;
p<0.05).
Similar findings were reported by Guleria et al5
Thirteen (65%) patients were obese in the NAFLD
group compared to 7 (35%) among controls. Five
(25%) patients were overweight among the cases
compared to 7 (35%) among controls (p=0.127). Thus,
only 2 (10%) patients in the NAFLD group and 6
(30%) among controls had normal BMI. Eight (66.7%)
out of 12 male patients in the NAFLD group had
abnormal waist circumference in comparison to 3
(25%) male controls (p=0.041). 7(87.5%) out of 8
female patients in the NAFLD group had abnormal
waist circumference in comparison to 6 (75%) female
controls. However Mohammadi et al7 reported
statistical significant association between BMI and
NAFLD ( BMI 29.88 (±3.88) vs 25.29 (±4.19) p=
0.001).
12(37.50) Patients with FLD had significantly
higher levels of total cholesterol. Similar observations
were also reported by Mohammadi et al7
Limitations Of The Study-
Sample size was somewhat limited (n =32) and
may have affected our ability to detect more subtle
grades of fatty liver. The small number of patients also
limits our study but the results suggest that patients
with FLD have increased cardiovascular risk. Further
studies with larger sample size are required to establish
a link between increased cardiovascular risk in patients
with FLD.
Conclusion-
In conclusion, FLD may be an independent risk
factor for developing atherosclerosis. Therefore,
FLD without other cardiovascular risk factors can be
associated with increased increased risk of
cardiovascular events in patients with FLD
incidentally diagnosed on abdominal
ultrasonography. FLD may serve as a trigger for
assessment of cardiovascular risk factors, and such
patients should undergo further cardiovascular
assessment.
Ethical approval: The study was approved by the
Institutional Ethics Committee.
Funding- There are no sources of funding for this
study.
Conflict of interest - All authors declare that there
are no conflicts of interest in this study.
Acknowledgement - We sincerely appreciate the
support and co-ordination of the medical and
paramedical faculty of the hospital.
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