Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) Utilizing Ultrasound and Percutaneous Liver Biopsy
Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) Utilizing Ultrasound and Percutaneous Liver Biopsy
Prospective determination of the prevalence of non-alcoholic fatty liver disease (NAFLD) and
 non-alcoholic steatohepatitis (NASH)in a primary care setting using ultrasound and
 percutaneous liver biopsy.
Patients between the ages of 18 and 70 years who are eligible for care at Brooke Army Medical
 Center are considered for enrollment. After obtaining informed consent, a baseline
 questionnaire is given to patients who present to the Primary Care Clinic for routine clinic
 visits or during colon cancer screening classes within the Gastroenterology Clinic. The
 questionnaire includes information about the patient's past medical history to include: known
 history of chronic liver disease, current medications, current and past alcohol ingestion,
 dietary habits that included consumption of fructose containing beverages and frequency of
 fast food visits. Patients are excluded if they are found to have a history of chronic liver
 disease, HIV, on medications that are associated with a fatty liver, or consumption of more
 than 20 grams of alcohol per day. Right upper quadrant ultrasound will then be performed to
 determine if there is evidence of fatty liver disease. All patients with a positive
 ultrasound for hepatic steatosis are then offered a liver biopsy after obtaining fasting
 blood work that included a complete blood count, coagulation studies, liver function tests,
 fasting lipid panel, glucose and insulin. Patients with a negative ultrasound for fatty liver
 are not referred for liver biopsy and are considered as completed study patients. Serum is
 also stored for adipokine and cytokine analysis. A study investigator using a 14g Bard
 Monopty biopsy gun will perform the liver biopsy. A single expert hepatopathologist will
 review all liver biopsies and utilize the Brunt system (9) for grading and staging of
 steatohepatitis if present.
Inclusion Criteria:

 -  Patients 18 to 70 years of age were recruited from the Primary Care Clinics or the
 Gastroenterology Clinic at Brooke Army Medical Center. After completing a baseline
 questionnaire, all patients had a right upper quadrant ultrasound. If fatty liver was
 identified, then laboratory data and a liver biopsy were obtained.

 Exclusion Criteria:

 -  ETOH consumption over 20 grams/day

 -  known fatty liver disease, chronic liver disease, HIV, or medication ingestion
 associated with fatty liver disease