Prevalence of non alcoholic fatty liver and Non alcoholic Steatohepatitis in Peshawar Cantonment, Khyber Pakhtunkhwa, Pakistan.

Non-alcoholic fatty liver disease prevalence has not been well established. The aims of this study was to define prospectively non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) prevalence in hospitalized and ambulatory patients 20-65 years old during June 2013 to June 2014 were selected from Combined Military Hospital Peshawar Cantonment area. A base line questionnaire and right upper quadrant ultrasound was completed by all patients. On identifications of fatty liver among the selected cases further lab test data and liver biopsy reports were obtained. Mean BMI of female was 29.9 + 5.65 while prevalence of hypertension and diabetes was 49.8% and 16.6% respectively. Among all patients 62% were Punjabies, 23% were Pathans while 12% were Sindhies. Overall NAFLD prevalence was 47% while NASH was confirmed in 20 patients (12.3% of total and 30%of ultrasound positive patients). Pathans had the highest prevalence of NAFLD (58.5%) as compared to Punjabies (44.5%) and Sindhies (35.3%). Pathans also had a higher prevalence of NASH compared with Punjabies (19.5% VS 10%: P= 0.03). In general, NAFLD patients were more prevalent among male (59%), Diabetic (P<0.00005), hypertensive (P<0.00005) and older (P =0.005). They consumed more fast food (P=.049) had a higher BMI (P<0.0005) and had little or no exercise as compared to their normal or non NAFLD counter parts (P=0.02). NAFLD was found in 75% and NASH in 22.5% among the 26 diabetic patients. ALT, AST, BMI, insulin, quantitative insulin sensitivity checks index and cytokeratin - 18 correlated with NASH. It was concluded that NAFLD and NASH prevalence is higher than estimated previously, Pathans and Patients with diabetes are at high risk.