Background: Although hepatic steatosis is seen with increasing frequency in
clinical practice, its prevalence and risk factors are unknown.
Objective: To investigate the prevalence of and risk factors for hepatic st
eatosis, such as alcohol consumption and obesity.
Design: Cross-sectional, observational study.
Setting: Participants in the Dionysos Study.
Patients: 257 participants assigned to one of four categories (67 controls,
66 obese persons, 69 heavy drinkers, and 55 obese heavy drinkers).
Measurements: Ethanol intake, assessed by a validated questionnaire and exp
ressed as daily (g/d) and lifetime (kg) consumption, and body mass, express
ed as body mass index. Biochemical tests of liver and metabolic function an
d hepatic ultrasonography were done.
Results: The prevalence of steatosis was increased in heavy drinkers (46.4%
[95% CI, 34% to 59%]) and obese persons (75.8% [CI, 63% to 85%]) compared
with controls (16.4% [CI, 8% to 25%]). Steatosis was found in 94.5% (CI, 85
% to 99%) of obese heavy drinkers. Compared with controls, the risk for ste
atosis was higher by 2.8-fold (CI, 1.4-fold to 7.1-fold) in heavy drinkers,
4.6-fold (CI, 2.5-fold to 11.0-fold) in obese persons, and 5.8-fold (CI, 3
.2-fold to 12.3-fold) in persons who were obese and drank heavily. In heavy
drinkers, obesity increased the risk for steatosis by twofold (CI, 1.5-fol
d to 3.0-fold) (P < 0.001), but heavy drinking was associated with only a 1
.3-fold (CI, 1.02-fold to 1.6-fold) increase in risk in obese persons (P =
0.0053). Elevated alanine aminotransferase and triglyceride levels are the
most reliable markers of steatosis.
Conclusions: Steatosis is frequently encountered in healthy persons and is
almost always present in obese persons who drink more than 60 g of alcohol
per day. Steatosis is more strongly associated with obesity than with heavy
drinking, suggesting a greater role of overweight than alcohol consumption
in accumulation of fat in the liver.