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Background  Nonalcoholic fatty liver disease (NAFLD) is a common problem across the world. We aimed to determine the prevalence of NAFLD and its associations in Sri Lankan adolescents living in an urban Sri Lankan community .Method  The study population consisted of the birth cohort of the year 2000, residing in the Ragama Medical Officer of Health area. Socio-demographic and anthropometric data [anthropometric measurements, blood pressure and total body fat distribution] of these adolescents were collected by trained data collectors. Fasting blood sugar, serum insulin, fasting serum lipids and serum alanine aminotransferase (ALT) levels were measured and an abdominal ultrasound was performed. NAFLD was diagnosed on established ultrasound criteria for fatty liver and absent alcohol consumption.    Results  The study sample consisted of 499 adolescents [263 (51.8%) girls]. Forty two (8.4%) had NAFLD. NAFLD was significantly associated with being breast fed for less than 4 months (33.3% vs. 17.1 in controls,  p  = 0.02), higher waist circumference (prevalence risk ratio 83.3/20.3, 4.1,  p  < 0.0001), higher body mass index (prevalence risk ratio 40.5/4.8, 8.4,  p  < 0/0001),higher HOMA-IR (3.7 vs. 1.9,  p  < 0.0001) and high triglycerides (prevalence risk ratio 14.3/5.8, 2.5,  p  = 0.033). Adolescents with NAFLD also had a higher amount of total body fat ( p  < 0.001) and subcutaneous fat ( p  < 0.001) than those without NAFLD. The number of children with metabolic derangements was higher among adolescents with NAFLD than those without (85.8 vs 26.3 in controls,  p  < 0.0001), but a family history of hypertension, diabetes, myocardial infarction or dyslipidaemia were not.    Conclusion  Prevalence of NAFLD was high in Sri Lankan adolescents, and was associated with metabolic derangements, especially obesity, insulin resistance and early cessation of breast feeding.

Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri Lankan community