TMSS Medical College Journal

Abstract: Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver condition closely associated with metabolic abnormalities, including obesity and dyslipidaemia. Alterations in lipid metabolism may contribute to the development and progression of hepatic steatosis. Objective: To evaluate the correlation between NAFLD with serum lipid profile and BMI status. Materials and Methods: This cross-sectional study was conducted in the Departments of Medicine and Hepatology at Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh, from July 2023 to June 2025. A total of 200 patients aged 18-70 years with ultrasonographically diagnosed NAFLD were enrolled. Clinical assessment, anthropometric measurements, and laboratory investigations, including fasting blood glucose, lipid profile, liver and renal function tests, and viral markers, were performed. Data were analyzed using SPSS version 25.0. Results: The mean age was 39.84 ± 12.84 years, and 58% of participants were male. The mean BMI and waist circumference were 25.78 ± 2.58 kg/m² and 85.23 ± 5.61 cm, respectively. Obesity was present in 58% of participants. Mean triglyceride, LDL, HDL, and total cholesterol levels were 256.13 ± 69.41, 118.83 ± 21.68, 43.67 ± 7.41, and 250.96 ± 52.41 mg/dL, respectively. Mild and moderate fatty liver were observed in 72% and 28% of participants, respectively. TG, LDL, and total cholesterol were significantly higher, while HDL was significantly lower, among patients with moderate fatty liver. Conclusions: NAFLD is strongly associated with obesity, dysglycaemia, and dyslipidaemia. An increasingly adverse lipid profile is associated with greater severity of fatty liver disease. Conclusions: NAFLD is strongly associated with obesity, dysglycaemia, and dyslipidaemia. An increasingly adverse lipidprofile is associated with greater severity of fatty liver disease. Keywords: Non-alcoholic fatty liver disease (NAFLD), Serum lipid profile, Ultrasonography, Dyslipidemia, Fatty liverseverity, Metabolic syndrome.dyslipidaemia, insulin resistance, metabolic syndrome,and type 2 diabetes mellitus (T2DM).*> Metabolicsyndrome, which is highly prevalent among SouthAsian populations, is considered a major risk factor forNAFLD. Bangladeshi ethnicity has also beenidentified as an independent risk factor for thedevelopment of NAFLD. Consequently, NAFLD isoften regarded as the hepatic manifestation ofmetabolic syndrome and insulin resistance.*°

Non-alcoholic fatty liver disease (NAFLD) is one ofthe most prevalent chronic liver diseases worldwideand encompasses a spectrum of hepatic disordersranging from simple steatosis, characterized byexcessive triglyceride accumulation withinhepatocytes, to non-alcoholic steatohepatitis (NASH),which may progress to fibrosis, cirrhosis, andultimately hepatocellular carcinoma.'? According tothe American Association for the Study of LiverDiseases (AASLD), NAFLD is defined as theaccumulation of fat in more than 5%—10% of the liverby weight? NAFLD is strongly associated withmetabolic msk factors including obesity,dyslipidaemia, insulin resistance, metabolic syndrome,and type 2 diabetes mellitus (T2DM).*> Metabolicsyndrome, which is highly prevalent among SouthAsian populations, is considered a major risk factor forNAFLD. Bangladeshi ethnicity has also beenidentified as an independent risk factor for thedevelopment of NAFLD. Consequently, NAFLD isoften regarded as the hepatic manifestation ofmetabolic syndrome and insulin resistance.*° The prevalence of NAFLD has increased markedly inthe Asia-Pacific region owing to rapid urbanization,sedentary lifestyles, increased dietary fat consumption,and the growing burden of T2DM.”* The occurrence of NAFLD is influenced by several factors, includingage, sex, ethnicity, obstructive sleep apnea, andendocrine disorders such as hypothyroidism,hypopituitarism, hypogonadism, and _ polycysticovarian syndrome.? NAFLD has been reported inapproximately 40% of obese individuals and 15% ofoverweight individuals. Furthermore, a _ strongassociation exists between NAFLD and T2DM.NAFLD is frequently asymptomatic and is oftendiagnosed incidentally in patients without overt signsor symptoms of liver disease.'°'?Patients with cardiovascular disease (CVD) riskfactors, particularly dyslipidaemia and diabetesmellitus, are more likely to develop NAFLD. Studieshave demonstrated a strong association betweenNAFLD and hypertriglyceridaemia, elevated low-density lipoprotein (LDL) cholesterol, increased verylow-density lipoprotein (VLDL) levels, and reducedhigh- density lipoprotein (HDL) cholesterol levels.This dyslipidaemic pattern is highly atherogenic andcontributes significantly to the increasedcardiovascular morbidity and mortality observedamong NAFLD patients. Moreover, NAFLD itselfmay serve as an important marker of metabolicsyndrome, insulin resistance, and cardiovascular risk.!Several observational studies have shown thatindividuals with NAFLD are at increased risk ofdeveloping extrahepatic complications, includingmetabolic syndrome, cardiovascular disease, anddiabetes mellitus. The accumulation of triglycerideswithin hepatocytes is considered a central event in thepathogenesis of NAFLD, although the precisemechanisms remain incompletely understood.Elevated serum concentrations of VLDL, triglycerides,and LDL cholesterol, together with reduced HDLcholesterol levels, have consistently been associatedwith NAFLD and may contribute to the increasedcardiovascular disease burden observed in thesepatients.'* Although many patients with NAFLD remainasymptomatic, some may complain of fatigue, malaise,or a feeling of fullness and discomfort in the rightupper quadrant of the abdomen. Hepatomegaly is oftenthe only physical finding. In most cases, NAFLD is detected incidentally during abdominalultrasonography or during evaluation for associatedconditions such as obesity, hypertension, or diabetesmellitus." The risk of progression from NASH tocirrhosis is estimated to range from 8% to 15%, andpatients with NASH have a risk of cirrhosiscomparable to that of patients with chronic hepatitis Cvirus infection.'4 Recent evidence suggests that chronic systemicinflammation plays a pivotal role in the pathogenesisof metabolic dysfunction-associated fatty liver disease(MAFLD). C-reactive protein (CRP), a widelyrecognized biomarker of systemic inflammation, hasbeen shown to be significantly associated withNAELD in several recent studies.'>?° Although liver biopsy remains the gold standard forthe diagnosis and staging of NAFLD, it is an invasiveprocedure associated with pain, expense, patientdiscomfort, and potential complications. In contrast,ultrasonography is a safe, non-invasive, inexpensive,and readily available diagnostic modality for detectingfatty liver disease. It is widely used as the first-lineimaging technique for the diagnosis and grading ofNAFLD and for screening asymptomatic individualswith elevated liver enzymes.”'”? Ultrasonographicgrading systems classify fatty liver into differentseverity grades that correlate reasonably well withhistopathological findings and clinical outcomes.