Background: Non-alcoholic fatty liver disease (NAFLD) and its severe form, non-alcoholic
steatohepatitis (NASH), are major health problems worldwide. Genetics may play a role in
the pathogenesis of NAFLD/NASH.
Aims: To investigate the prevalence of NAFLD/NASH in 5,400 military personnel and evaluate
the effect of treatment with 3 statins on NAFLD/NASH using 2 non-invasive scores [NAFLD Activity
Score (NAS); Fibrosis-4 score (FIB-4)].
Methods: During the mandatory annual medical check-up, military personnel underwent a clinical
and laboratory evaluation. Participants with NAFLD/NASH were randomized into 4 groups
(n=151 each): diet-exercise, atorvastatin, rosuvastatin, or pitavastatin for 1 year (i.e., until the next
Results: From all the participants, 613 had NAFLD/NASH (prevalence 11.3 vs 39.8% in the general
population, p<0.001), and a total of 604 consented to participate in the study. After a year of
treatment, the diet-exercise group showed no significant changes in both scores (NAS 4.98 baseline
vs. 5.62, p=0.07; FIB-4 3.42 vs. 3.52, p=0.7). For the atorvastatin group, both scores were reduced
(NAS 4.97 vs 1.95, p<0.001, FIB-4 3.56 vs 0.83, p<0.001), for rosuvastatin (NAS 5.55 vs
1.81, p<0.001, FIB-4 3.61 vs 0.79, p<0.001), and for pitavastatin (NAS 4.89 vs 1.99, p<0.001,
FIB-4 3.78 vs 0.87, p<0.001).
Conclusion: Atorvastatin, rosuvastatin, and pitavastatin have a beneficial and safe effect in
NAFLD/NASH patients as recorded by the improvement in the NAS (representing NAFLD activity)
and FIB-4 (representing liver fibrosis) scores. Since both those with and without NAFLD/-
NASH shared several baseline characteristics, genetics may play a role in the pathogenesis of
NAFLD/NASH and its treatment with statins.