Abstract 20174: Impact of Entrance Examination on Development of Nonalcoholic Fatty Liver Disease in New University Students

Introduction: Nonalcoholic fatty liver disease (NAFLD) has emerged as a risk factor for cardiovascular diseases. In Japan, most of high-school graduates who fail to pass the university entrance examinations attend full-time cram schools to devote themselves to preparing for the examinations for another year(s). These full-time cram-school students, called as “Ronin samurais” in Japanese, could be at risk for development of NAFLD because they live sedentary lifestyle under persistent academic stress. Hypothesis: We assessed the hypothesis that the Ronin-samurai period before entering university is associated with NAFLD in new university students. Methods: This cross-sectional study included 1777 new university students who underwent a group medical check-up immediately after admission into Kanazawa University. Results: Of the 1777 students, 319 (18%) went through the Ronin-samurai period before entering university (Ronin-samurai group). The Ronin-samurai group showed significantly higher body mas index, total cholesterol levels, and alanine aminotransferase (ALT) values compared to the non-Ronin group (n = 1458). The estimated mean difference (B) in ALT values between the two groups was 5.6 ± 1.2 IU/L (P <0.0001). The association persisted even after adjusting for age, gender and metabolic risk factors (B = 3.7 ± 1.5, P = 0.014). The follow-up analysis in 94 students with elevated ALT values (≥ 40 IU/L) after medical check-up showed a drastic decrease in mean ALT values in both groups only 9 weeks after entering the university (Figure), although no lifestyle intervention was performed during the time period. Conclusions: Spending an extra year(s) preparing for the entrance examination, as Ronin samurais, could contribute to this previously unrecognized “entrance examination-related NAFLD” in new university students.