Study protocol

Risk factors associated with non-alcoholic fatty liver disease in subjects from primary care units. A case-control study

Llorenç Caballería¹ , Ma Antonia Auladell¹ , Pere Torán² , Guillem Pera² , Dolores Miranda³ , Alba Alumà⁴ , José Dario Casas⁵ , Laura Muñoz² , Carmen Sanchez⁶ , Albert Tibau⁷ , Marti Birules⁸ , Santiago Canut⁹ , Jesús Bernad¹⁰ , Josep Aub๹ , Miren Maite Aizpurua¹² and Enriqueta Alcaraz⁷

¹Primary Healthcare Centre Premià de Mar, Catalan Health Institute, IDIAP Jordi Gol, La Plaça 93, 08330 Premià de Mar, Spain

²Primary Healthcare Research Support Unit Barcelonés Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36, 08303 Mataró, Spain

³Radiology Department, Primary Healthcare El Maresme, Catalan Health Institute, Camí del Mig 36, 08303 Mataró, Spain

⁴Laboratory Department, Primary Healthcare Centre Dr. Robert, Catalan Health Institute, C/Pl. de la Medicina s/n, 08911 Badalona, Spain

⁵Radiology Department, Primary Healthcare Badalona, Catalan Health Institute, C/Pl. de la Medicina s/n, 08911 Badalona, Spain

⁶Radiology Department, Primary Healthcare Santa Coloma de Gramanet, Catalan Health Institute, C/Major, 49-53, 08921 Santa Coloma de Gramanet, Spain

⁷Primary Healthcare Centre Premià de Mar, Catalan Health Institute, C/La Plaça 93, 08330 Premià de Mar, Spain

⁸Primary Healthcare Centre Poble Nou, Catalan Health Institute, C/Lope de Vega 132, 08005 Barcelona, Spain

⁹Primary Healthcare Centre Vilassar de Dalt, Catalan Health Institute, C/Plaça de la Vila 8, 08339 Vilassar de Dalt, Spain

¹⁰Primary Healthcare Centre Vilassar de Mar, Catalan Health Institute, C/Santa Maria 59-79, 08340 Vilassar de Mar, Spain

¹¹Primary Healthcare Barcelonés Nord i Maresme, Catalan Health Institute, Sardana s/n, 08915 Badalona, Spain

¹²Primary Healthcare Centre Gatassa, Catalan Health Institute, Camí del Mig 36 (4a planta), 08303 Mataró, Spain

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BMC Gastroenterology 2008, 8:44doi:10.1186/1471-230X-8-44

Published:	3 October 2008

Abstract

Background

Non alcoholic fatty liver disease (NAFL) consists in the accumulation of fat vacuoles in the cytoplasm of hepatocytes. Many etiologic factors are associated with NAFL, such as, the metabolic syndrome factors, medications, bariatric surgery, nutritional disorders. However, very little information is available on the clinical relevance of this disorder as a health problem in the general population.

Methods and design

The aim of the study is establish the risk factors most frequently associated with NAFL in a general adult population assigned to the primary care units and to investigate the relationship between each component of the metabolic syndrome and the risk of having a NAFL.

A population based case-control, observational and multicenter study will be carried out in 18 primary care units from the "Area de Gestión del Barcelonés Nord y Maresme" (Barcelona) attending a population of 360,000 inhabitants and will include 326 cases and 370 controls. Cases are defined as all subjects fulfilling the inclusion criteria and with evidence of fatty liver in an abdominal ultrasonography performed for any reason. One control will be randomly selected for each case from the population, matched for age, gender and primary care center. Controls with fatty liver or other liver diseases will be excluded.

All cases and controls will be asked about previous hepatic diseases, consumption of alcohol, smoking and drugs, and a physical examination, biochemical analyses including liver function tests, the different components of the metabolic syndrome and the HAIR score will also be performed. Paired controls will also undergo an abdominal ultrasonography.

Discussion

This study will attempt to determine the factors most frequently associated with the presence of NAFL investigate the relationship between the metabolic syndrome and the risk of fatty liver and study the influence of the different primary care professionals in avoiding the evolution of the disease.