The spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from simple fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), which may progress to liver fibrosis and cirrhosis. The rising prevalence of NAFLD in western societies has been paralleling the obesity epidemic, however, data on young adults in countries with high obesity rates like Egypt are lacking.

We evaluated 120 healthy Egyptian undergraduates (54.2% female, age range 19-22 years) using Controlled Attenuation Parameter (CAP) and Liver Stiffness Measurement (LSM) (Fibroscan®): Mean body weight was 73.3±18.1 kg, BMI 25.7±6 kg/m2, and A1C 5.1±0.24%. Variable steatosis stages were present in 47.5% of this cohort (15.8% mild, 19.2% moderate, and 12.5% severe), whereas 56.7% had fibrosis (48.35% mild, 8.35% moderate). We stratified subjects according to their BMI into 4 groups: Underweight (UW) with BMI<20 kg/m2 (25.83%, mean CAP 202.65±29.1 dB/m, and LSM 5.2±1.2 kPa), Normal weight (NW) with BMI 20-24.9 kg/m2 (25%, mean CAP 204.8±27.9 dB/m, and LSM 4.65±1.1 kPa), Overweight (OW) with BMI 25-29.9 kg/m2 (23.33%, mean CAP 243.5±43.4 dB/m, and LSM 5.9±1.7 kPa), and Obese (OB) with BMI >30 kg/m2 (25.83%, mean CAP 266.9±74 dB/m, and LSM 5.3±1.4 kPa).

Higher BMI values were significantly associated with higher CAP values (β=4.17, p<0.0001). Severe steatosis was significantly higher in OB group compared to other groups (29% vs. 7.14% in OW and none in NW or UW, p<0.0001). Moreover, CAP values were inversely associated with serum HDL-C (β=-1.42, p=0.001), and positively associated with serum triglycerides (TG) (β=0.33, p<0.01).

In conclusion, prevalence of NAFLD among Egyptian young adults is alarmingly high with 50%< having mild or moderate fibrosis. Obesity, high serum TG and low serum HDL-C are strong predictors of severe steatosis which warrants an urgent need for intervention programs aimed at reducing body weight and improving lipid profile in this population.


S. Tomah: Stock/Shareholder; Self; Amarin Corporation. E.M. Eid: None. M.M. Abouelmagd: None. A.H. Hassan: None. A.H. Eldib: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at