AGE-STRATIFIED PROGRESSION OF NAFLD TO NASH IN PAKISTAN: PREVALENCE, RISK FACTORS, AND CLINICAL IMPLICATIONS

Abstract

In this study, we aimed to quantify the progression of non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) in Pakistan by age group and therefore fill a critical gap in local knowledge regarding prevalence, risk factors and clinical characteristics of NAFLD and NASH across different ages. Using cross-sectional analysis with 450 patients from tertiary care hospitals divided by age groups (young adult 18-35 years, middle-aged 36-55 years, and old adult > 55 years), we diagnosed patients with NAFLD and NASH using imaging, biochemistry and clinical criteria. Our data showed that as age increased disease severity of NAFLD and NASH also increased significantly, with the highest prevalence of NAFLD in middle aged adults (52%) and NASH increasing from 10% in young adults to 40% in old adults (p <0.05). NASH was strongly associated with metabolic comorbidities (diabetes, obesity, dyslipidemia)—particularly in the older adult population where diabetes prevalence was approximately 62%. The levels of liver enzymes (ALT/AST) and markers of fibrosis were also found to be increased with advancing age, indicating cumulative exposure to metabolic stress. Our data also indicate that most of the younger patients had simple steatosis whereas the older adults had more severe histological damage, indicating that NAFLD is a progressive disease. Finally, these results demonstrate the need for urgent interventions aimed at increasing screening and promoting lifestyle changes, particularly in the elderly population, to help combat the increasing burden of NAFLD-related complications in Pakistan