CLINICAL STUDIES Non-alcoholic fatty liver disease and its association with obesity, insulin resistance and increased serum levels of C-reactive protein in Hispanics Arnoldo Riquelme 1 , Marco Arrese 1 , Alejandro Soza 1 , Arturo Morales 2 , Ren ´ e Baudrand 3 , Rosa Mar´ ıa P ´ erez-Ayuso 1 , Robinson Gonz ´ alez 1 , Manuel Alvarez 1 , Ver ´ onica Hern ´ andez 1 , Mar´ ıa Jos ´ e Garc´ ıa-Zattera 3 , Francisco Otarola 1 , Brenda Medina 1 , Attilio Rigotti 1 , Juan Francisco Miquel 1 , Guillermo Marshall 4 and Flavio Nervi 1 1 Departamentos de Gastroenterolog´ ıa, Facultad de Medicina, Pontificia Universidad Cat ´ olica de Chile, Santiago, Chile 2 Medicina Interna, Facultad de Medicina, Pontificia Universidad Cat ´ olica de Chile, Santiago, Chile 3 Endocrinolog´ ıa, Facultad de Medicina, Pontificia Universidad Cat ´ olica de Chile, Santiago, Chile 4 Departamento de Estad´ ıstica, Facultad de Matem ´ aticas, Pontificia Universidad Cat ´ olica de Chile, Santiago, Chile Keywords epidemiology – fatty liver – high-sensitivity C-reactive protein – Hispanics – insulin resistance – steatohepatitis Abbreviations ALT, alanine aminotransferase; ATP III, adult treatment panel III; BMI, body mass index; CI, confidence interval; DPC, diagnostics product corporation; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessment insulin resistance; hs-CRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein; NAFLD, non-alcoholic fatty liver disease; NASH, non- alcoholic steatohepatitis; OR, odds ratio; ROC, receiver operating characteristic Correspondence Arnoldo Riquelme, MD, MMedEd, Departmento de Gastroenterolog´ ıa, Facultad de Medicina, Pontificia Universidad Cat ´ olica de Chile, Marcoleta 367, Casilla 114-D., Santiago, Chile Tel: 156 2 3543820 Fax: 156 2 6397780 e-mail: arnoldoriquelme@gmail.com Received 26 December 2007 Accepted 20 May 2008 DOI:10.1111/j.1478-3231.2008.01823.x Abstract Background: Non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder of the liver, which may progress to fibrosis or cirrhosis. Recent studies have shown a significant impact of ethnicity on susceptibility to steatosis-related liver disease. Aims: To estimate the prevalence of NAFLD among Chilean Hispanics as well as the clinical and biochemical variables associated with the disease. Methods: Popu- lation-based study among Chilean Hispanics. The diagnosis of NAFLD was made on the basis of ultrasound evidence of fatty liver and absence of significant alcohol consumption and hepatitis C virus infection. Results: A total of 832 Hispanic subjects were included. Ultrasound findings revealed diffuse fatty liver in 23% of the subjects. Variables associated with fatty liver in multivariate analysis were body mass index 4 26.9 [odds ratio (OR) 6.2; 95% confidence interval (CI) 3.3–11.5], abnormal aspartate aminotransferase levels (OR 14; 95% CI 8.2–23.7), presence of insulin resistance as measured by homoeostasis model assessment-insulin resis- tance (OR 3; 95% CI 1.8–4.8) and serum levels of high-sensitivity C-reactive protein (hs-CRP) greater than 0.86 mg/L (OR 2.9; 95% CI 1.6–5.2). Among subjects with NAFLD, levels of hs-CRP were similar regardless of the alanine aminotransferase (ALT) level. Conclusions: Chilean Hispanics exhibit a high prevalence of NAFLD. Obesity, insulin resistance, abnormal aminotransferase levels and elevated hs-CRP were independently associated with the presence of NAFLD. ALT elevation underestimates the presence of ultrasonographical fatty liver, whereas hs-CRP is a sensitive independent marker of NAFLD, which may be useful for detecting fatty liver in the general population. Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of fat in the liver in the absence of alcohol consumption ( 4 20 g/day) and other causes of chronic liver disease such as viral hepatitis or drugs (1, 2). This clinical and pathological entity encom- passes a wide spectrum of liver damage ranging from simple steatosis to inflammation, fibrosis and cirrho- sis. More recently, NAFLD has also been associated with the development of hepatocellular carcinoma (3). Available epidemiological data on NAFLD indi- cate that this disease is an increasingly common problem worldwide (4). However, marked variability in prevalence rates has been reported owing to differ- ent study designs and different patient recruitment Liver International (2008) c  2008 The Authors. Journal compilation c  2008 Blackwell Munksgaard 1 Liver International ISSN 1478-3223