# PREVALENCE AND PREDICTORS OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN VETERANS

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2021 · —

## Abstract

The objective of this application is to determine the burden of non-alcoholic fatty liver disease (NAFLD) among
patients receiving primary care at the Department of Veterans Affairs (VA) health care system. NAFLD affects
an estimated 20%-30% of the adult non-VA US population and is projected to become the main cause of end-
stage liver disease in the next 10 years. NAFLD encompasses a histologic spectrum ranging from simple
steatosis to non-alcoholic steatohepatitis (NASH). Around 20% of patients with NASH undergo fibrotic
progression to cirrhosis, which increases risk of liver failure the risk of hepatocellular carcinoma. NAFLD is
considered the hepatic complication of obesity and insulin resistance. Proper diagnosis of NAFLD and
subsequent treatment (e.g., dietitian services) is associated with improved biochemical and histological
features of NAFLD. There are also ongoing clinical trials with promising medications (e.g., obeticholic acid) for
NASH.
Given the veteran population is disproportionately affected by the main risk factors for NAFLD (e.g., diabetes,
obesity), our central hypothesis is that the veteran population in primary care is particularly susceptible to a
high burden from NAFLD. It is unclear whether the VA is currently equipped to deal with this costly disorder
given the lack of basic information on the prevalence, determinants, and clinical recognition of NAFLD in the
VA.
Advances in magnetic resonance imaging (MRI) has revolutionized the diagnosis and severity staging of
NAFLD, thus obviating the need for liver biopsy in most cases. However, the use of MRI for NAFLD screening
in a primary care setting is impractical and expensive. There are no agreed upon clinical prediction rules, and
none that is tested in VA settings.
We will address our hypothesis by conducting a probability-based cross-sectional study of 1000 veterans (500
males and 500 females) enrolled in the VA for their primary healthcare.
Specific Aim #1: To determine the overall and race- and sex- specific prevalence of NAFLD (and Advanced
Hepatic Fibrosis) using highly sensitive and specific MRI criteria in a large and representative sample of
veterans enrolled at the Michael E. DeBakey VA Medical Center in Houston for their primary healthcare. This
aim will be accomplished by combined use of liver magnetic resonance imaging proton density fat fraction
(MRI-PDFF) and elastography (MRE).
Specific Aim #2: To evaluate the association between presence and severity of NAFLD and potential risk
factors, including demographic (gender, race/ethnicity), anthropometric (BMI, waist circumference, and body
fat by bioimpedance analysis), clinical (medical history, family history, and medications), serologic (CD18),
genetic (PNPLA3), biochemical (LFTs, serologic biomarkers of hepatic fibrosis and steatosis), metabolic
(serologic markers of metabolic syndrome), and lifestyle (smoking, alcohol, exercise) factors.
Specific Aim #3: Use the information on risk factors and biomarkers t...

## Key facts

- **NIH application ID:** 10038804
- **Project number:** 5I01CX001616-04
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Hashem B El-Serag
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10038804

## Citation

> US National Institutes of Health, RePORTER application 10038804, PREVALENCE AND PREDICTORS OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN VETERANS (5I01CX001616-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10038804. Licensed CC0.

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