Non-alcoholic Fatty Liver Disease Prevalence and Its Relationship with Obesity and Metabolic Health in Saudi Adults: Findings from a Cross-sectional Study
Authors: Alkathem Jafar Ali , Almasary Manal Hassan , Almuwalad Nada Hussain , Alrezqi Wafa Ali , Khamag Yara Abdullah , Alluqmani Yazeed Ahmed , Alali Abdulaziz Ali , Almoslem Abdulrahman 
Published: December 2024

Abstract

Introduction:
Non-alcoholic Fatty Liver Disease (NAFLD) has become a global health concern, affecting a substantial proportion of the population worldwide. In Saudi Arabia, the prevalence of NAFLD is notably high, primarily attributed to the increasing rates of obesity and sedentary lifestyles. Understanding the intricate relationships between NAFLD, obesity and metabolic health is crucial for developing effective preventive and treatment strategies. Cross-sectional studies offer a suitable framework for examining these relationships by concurrently analysing multiple variables.

Methods:
This cross-sectional study involved a representative sample of Saudi adults, recruited from diverse regions using a random sampling technique. Data collection included standardised questionnaires and data analysis was performed using SPSS 28.0. Descriptive statistics, such as means, standard deviations and percentages, were employed to summarise demographic information, health indicators and lifestyle factors. Chi-square tests were used to investigate associations, particularly between NAFLD and BMI categories, as well as between NAFLD and metabolic syndrome, With a P < 0.05 considered statistically significant. Adjustments for age, gender and covariates identified NAFLD risk factors in the Saudi adult population. Subgroup analyses and sensitivity tests were conducted to validate the findings.

Results:
The study encompassed participants across various age groups, with the majority falling within the 18–24 age range (52.9%). Gender distribution was relatively balanced, with 53.2% of participants identifying as female. Our findings reveal that individuals categorised as ‘Overweight’ had the highest prevalence of NAFLD at 74.7%, followed closely by those categorised as ‘Obese’ at 59.6%. In contrast, participants categorised as ‘Normal weight’ and ‘Underweight’ exhibited lower prevalences of NAFLD, at 59.4% and 67.0%, respectively. These results emphasise a significant association between NAFLD and higher BMI categories (P = 0.03). Furthermore, our analysis indicated significant differences in the prevalence of metabolic syndrome amongst individuals with NAFLD compared to those without NAFLD. Specifically, 26.1% of participants with NAFLD had been diagnosed with metabolic syndrome, while only 96.3% of those without NAFLD received this diagnosis. This difference was statistically significant (P < 0.001), as determined by a Chi-square test.

Conclusion:
This study underscores the complex interplay between NAFLD, obesity and metabolic health in Saudi adults. It highlights the strong association between NAFLD and higher BMI categories and its correlation with adverse metabolic markers. These findings emphasise the necessity for targeted public health interventions, early detection and intervention strategies for NAFLD, particularly in individuals with high BMI, to mitigate its impact in Saudi Arabia.