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Ojong EW, Ngemenya MN, Tafili MM, Tanue EA, Achidi EA. Association of non-alcoholic fatty liver disease with glycemic control among patients with type 2 diabetes mellitus at Limbe Regional Hospital, Southwest, Cameroon. World J Hepatol 2025; 17:101936. [PMID: 40027557 PMCID: PMC11866161 DOI: 10.4254/wjh.v17.i2.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/05/2024] [Accepted: 01/02/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency. Non-alcoholic fatty liver disease (NAFLD) is emerging as a public health problem worldwide and affects up to 70% of patients with T2DM. Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals, varying prevalence rates of NAFLD among patients with T2DM, ranging from 34% to 94%, have been reported. AIM To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control. METHODS A cross-sectional study was carried out from February to June 2024 among patients with T2DM. Gamma-glutamyl transferase (GGT) activity and serum triglycerides (TGs) were measured by spectrophotometry. NAFLD was diagnosed using the fatty liver index score. Data were analyzed using SPSS version 26.0 for Windows. Student's t-test was used to compare the means of two groups. The χ 2 test was applied to determine the association of NAFLD and T2DM. Logistic regression analysis was performed to identify predictors of NAFLD. P < 0.05 was considered statistically significant. RESULTS Of the 150 patients with T2DM recruited for this study, 63 (58%) were females and the majority (84.7%) had good glycemic control (glycated hemoglobin < 7%). Prevalence of NAFLD among patients with T2DM was 19%. Patients with NAFLD had significantly elevated levels of TGs, GGT, and increased body mass index and waist circumference compared to those without NAFLD. There was a significant association between NAFLD and glycemic control. Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week [adjusted odds ratio (aOR): 0.131, 95%CI: 0.020-0.839; P = 0.032], central obesity (aOR: 0.167, 95%CI: 0.037-0.748; P = 0.019), and metformin treatment for T2DM (aOR: 0.167, 95%CI: 0.037-0.718; P < 0.001). CONCLUSION The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%. Age, central obesity, metformin use, and infrequent consumption of vegetables were important predictors of NAFLD.
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Affiliation(s)
- Ebot Walter Ojong
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon.
| | - Moses Njutain Ngemenya
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Melvis Mwantem Tafili
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Elvis Asangbeng Tanue
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Eric Akum Achidi
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
- Department of Biochemistry and Molecular Biology, University of Buea, Buea PO Box 63, Southwest, Cameroon
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Jeele MOO, Mohamed HN, Addow ROB, Hassan MO, Adam BA. Insights Into Non-Alcoholic Fatty Liver Disease and Diabetes Mellitus in Somalia: Prevalence and Risk Factors. Diabetes Metab Syndr Obes 2025; 18:507-514. [PMID: 39990175 PMCID: PMC11847411 DOI: 10.2147/dmso.s486956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 02/14/2025] [Indexed: 02/25/2025] Open
Abstract
Introduction NAFLD is a rapidly expanding global health issue that is distinguished by the accumulation of hepatic fat that is not associated with alcohol consumption. Parallel to the increase in obesity and type 2 diabetes mellitus (T2DM), its prevalence is also increasing. Amidst a backdrop of limited epidemiological data, Somalia, which is undergoing urbanization and dietary adjustments, is contending with escalating rates of NAFLD. Our study aims to addresses critical voids in local epidemiological data regarding this subject in Somalia. Methods and Materials The objective of this retrospective study was to evaluate the prevalence of NAFLD and concomitant risk factors among T2DM patients at the Mogadishu Somalia Turkish Training and Research Hospital. A total of 832 patients diagnosed with T2DM between May 2023 and March 2024 were used to analyze the data. Various variables, such as age, sex, diabetic medications, hypertension, insulin resistance, hyperlipidemia, and NAFLD grade, were obtained from electronic medical records. Statistical analyses were conducted to investigate the associations and predictors of NAFLD using descriptive analysis, logistic regression, and multiple regression. Results The study cohort was predominately female (57%), with a mean age of 53.48 years. The most prevalent grades of NAFLD were grade 1 and grade 2, with NAFLD being identified in 53.8% of patients. NAFLD displayed a robust correlation with insulin resistance (OR: 52.04), with hypertension (OR: 20.091) and hyperlipidemia (OR: 2.528) following shortly thereafter. These factors collectively account for 57% of the variance in NAFLD, as indicated by multiple regression analysis (R2 = 0.57, F (6,823) = 184.302, p < 0.001). Conclusion This investigation emphasizes the presence of a high prevalence of NAFLD among T2DM patients in Mogadishu, Somalia, 53.8% which is substantially influenced by hypertension, insulin resistance, and hyperlipidemia. In this region, the necessity of targeted healthcare strategies to mitigate metabolic liver diseases is underscored by the results.
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Affiliation(s)
- Mohamed Osman Omar Jeele
- Department of Internal Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Hawa Nuradin Mohamed
- Department of Internal Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Mohamed Omar Hassan
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Bakar Ali Adam
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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Mukherjee S, Mukherjee S, Shing Kwok C, Phillips A. Correlation between non-alcoholic fatty liver disease and metabolic parameters in persons with newly diagnosed type 2 diabetes mellitus. World J Hepatol 2024; 16:1120-1130. [PMID: 39221103 PMCID: PMC11362911 DOI: 10.4254/wjh.v16.i8.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/06/2024] [Accepted: 07/17/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND There are limited studies investigating the association between type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) in the region of Bihar, India. AIM To estimate the prevalence of NAFLD in persons with newly diagnosed T2DM in the population of North Bihar, India. METHODS This single centre cross-sectional study was undertaken in the Research Centre for Diabetes Hypertension and Obesity, Samastipur, Bihar, India. Data were collected from persons newly diagnosed with T2DM or those diagnosed within 6 months of when the study was conducted between December 2022 to May 2023. RESULTS A total of 148 people with newly diagnosed T2DM were included (median age 47 years, 46.6% female) and 109 patients with liver disease on ultrasound evaluation. The persons with liver disease consumed more fats and oils (88.1% vs 74.4%, P = 0.042) and they had significantly greater body mass index (27.4 vs 23.0, P < 0.001), waist circumference (37 vs 33, P < 0.001), and waist-to-hip ratio (1.00 vs 0.70, P = 0.025). Females were associated with greater liver disease [odds ratio (OR): 3.09, 95% confidence interval (CI): 1.09-8.80, P = 0.32]. Waist circumference (OR: 1.42, 95%CI: 1.22-1.66, P < 0.001) and low-density lipoprotein cholesterol (OR: 1.01, 95%CI: 1.01-1.02, P = 0.048) were associated with any liver disease. The factors most associated with grade 2/3 liver disease was right upper quadrant pain or heaviness (OR: 5.22, 95%CI: 1.40-19.41, P = 0.14), greater income (OR: 3.58, 95%CI: 1.28-10.04, P = 0.015) and waist circumference (OR: 1.31, 95%CI: 1.02-1.69, P = 0.036). CONCLUSION NAFLD is common in new/recently diagnosed T2DM and disease burden is high and common among patients who are either high consumers of fats and oils or have obesity-associated markers.
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Affiliation(s)
- Supriyo Mukherjee
- Department of Medicine, Research Centre for Diabetes Hypertension and Obesity, Samastipur 848101, India.
| | - Sushmita Mukherjee
- Department of Clinical Ultrasonography, Research Centre for Diabetes Hypertension and Obesity, Samastipur 848101, India
| | - Chun Shing Kwok
- Cardiology Registrar, University Hospitals of North Midlands NHS Trust United Kingdom, Staffordshire ST4 6QG, United Kingdom
| | - Anne Phillips
- Faculty of Health Education and Life Sciences, Department of Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham B4 7AP, United Kingdom
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Ekpor E, Akyirem S, Adade Duodu P. Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002835. [PMID: 38709759 PMCID: PMC11073701 DOI: 10.1371/journal.pgph.0002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/11/2024] [Indexed: 05/08/2024]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes (T2D) are interconnected metabolic disorders with significant health implications. However, a comprehensive understanding of the extent of their co-occurrence in Africa is lacking. The aim of this review was to determine the prevalence of MAFLD and its association with glycemic control (HbA1c) in persons with T2D in Africa. A systematic search was conducted on PubMed, Medline, Embase, Scopus, Global Health, and Web of Science from their inception to December 6, 2023. Data on MAFLD prevalence and correlation coefficients regarding its association with glycemic control were pooled through random effect meta-analyses. Potential sources of heterogeneity were investigated using subgroup analysis and meta-regression. A total of 10 studies were included in the meta-analysis of MAFLD prevalence, while 2 were incorporated in the analysis of the association between MAFLD and glycemic control. The pooled prevalence of MAFLD in persons with T2D was 48.1% (95% CI: 36.1-60.3). The subgroup analysis revealed regional variations in MAFLD prevalence, with rates of 44.7% (95% CI: 28.7-62.0) in sub-Saharan Africa and 55.3% (95% CI: 36.2-73.0) in Northern Africa. Additionally, we observed an increasing trend in MAFLD prevalence, recording 55.1% (95% CI: 43.6-66.1) in the recent five years. There was a weak positive correlation between MAFLD and HbA1c (r = 0.33, 95% CI: 0.18-0.47). The findings of this study highlight a high prevalence of MAFLD in persons with T2D in Africa, with a suggested link between MAFLD and suboptimal glycemic control. Therefore, healthcare providers should prioritize the screening and management of MAFLD in individuals with T2D to enhance their metabolic health.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
- Christian Health Association of Ghana, Accra, Ghana
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, United States of America
| | - Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
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Enriquez R, Homsi M, Ssekubugu R, Nabukalu D, Zeebari Z, Marrone G, Gigante B, Chang LW, Reynolds SJ, Nalugoda F, Ekström AM, Hagström H, Nordenstedt H. Prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in south Central Uganda: A cross-sectional survey. Aliment Pharmacol Ther 2024; 59:1111-1121. [PMID: 38459720 DOI: 10.1111/apt.17931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Despite numerous risk factors and serious consequences, little is known about metabolic dysfunction-associated steatotic liver disease (MASLD) at population level in Africa. AIM The aim of the study was to estimate the prevalence and risk factors of MASLD in people living with and without HIV in Uganda. METHODS We collected data from 37 communities in South Central Uganda between May 2016 and May 2018. We estimated MASLD prevalence using the fatty liver index and advanced liver fibrosis using the dynamic aspartate-to-alanine aminotransferase ratio. We collected additional data on sociodemographics, HIV and cardiovascular disease (CVD) risk factors. We used multivariable logistic regression to determine the association between HIV, CVD risk factors and MASLD. RESULTS We included 759 people with HIV and 704 HIV-negative participants aged 35-49. MASLD prevalence was 14% in women and 8% in men; advanced liver fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV. Being female (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.4-3.3) was associated with a higher odds of MASLD after adjustment for confounders; HIV infection was borderline associated with MASLD (OR = 1.4; 95% CI: 1.0-2.0). CONCLUSIONS In a relatively young cohort in Uganda, 14% of women and 8% of men had MASLD. There was an indication of an association between HIV and MASLD in multivariable analysis. These data are the first to describe the population-level burden of MASLD in sub-Saharan Africa using data from a population-based cohort.
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Affiliation(s)
- Rocio Enriquez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mahmoud Homsi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Hannes Hagström
- Unit of Hepatology, Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
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Onyia CP, Asogwa P, Adiri W, Obienu O, Ijoma UN, Nwokediuko SC, Okeke EN. Nonalcoholic Fatty Liver Disease and Associated Risk Factors in Obese Nigerians: A Cross-Sectional Study. Niger J Clin Pract 2024; 27:352-360. [PMID: 38528356 DOI: 10.4103/njcp.njcp_365_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is now adjudged the most common liver disease in the world, contributing to the rising incidence of hepatocellular carcinoma worldwide. However, the true prevalence of nonalcoholic fatty liver disease among obese individuals and its contribution to the burden of liver disease in Nigeria is unknown. AIM To determine the prevalence of nonalcoholic fatty liver disease and associated risk factors in obese subjects. METHODS This was a cross-sectional analytical study of 280 obese subjects and 280 nonobese age and sex-matched controls seen at our health facility. Data collection was done using an interviewer-administered questionnaire and anthropometric parameters were obtained. Fasting blood samples were collected for blood glucose, lipid profile, and liver biochemistry. Abdominal ultrasound was used to screen for NAFLD. The results were subjected to relevant statistical analysis using SPSS version 20. RESULTS A higher prevalence of NAFLD was found in obese subjects, compared with nonobese controls (36.4% versus 0.4% P < 0.001). The degree of obesity, transaminases, total cholesterol, diastolic hypertension, fasting blood glucose, and waist circumference was significantly associated with a higher prevalence of NAFLD. However, using multivariate logistic regression analysis, diabetes mellitus and hypertension were significant associations for NAFLD. Individuals with NAFLD had a significantly higher prevalence of metabolic syndrome 65.9%, compared with 34.1% in obese individuals without NAFLD (P < 0.001). CONCLUSION The prevalence of NAFLD in obese subjects was significant. NAFLD in obese subjects was associated with degree of obesity, hyperlipidemia, hypertension, and diabetes mellitus.
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Affiliation(s)
- C P Onyia
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - P Asogwa
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - W Adiri
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - O Obienu
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - U N Ijoma
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
- Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - S C Nwokediuko
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
- Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - E N Okeke
- Department of Medicine, Jos University Teaching Hospital, Plateau State, Nigeria
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Lajeunesse-Trempe F, Boit MK, Kaduka LU, De Lucia-Rolfe E, Baass A, Paquette M, Piché ME, Tchernof A, Christensen DL. Validation of the Fatty Liver Index for identifying non-alcoholic fatty liver disease in a Kenyan population. Trop Med Int Health 2023; 28:830-838. [PMID: 37650501 DOI: 10.1111/tmi.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIM Fatty Liver Index (FLI) is a simple clinical scoring system estimating non-alcoholic fatty liver disease (NAFLD). It is validated in European-descent and Asian populations, but not in sub-Saharan Africans. The aim of this study is to evaluate the validity of the FLI for predicting NAFLD in a population from Kenya. METHODS Participants were recruited from a community-based study conducted in Kenya. NAFLD was diagnosed using hepatic ultrasonography. Clinical, anthropometrical, biochemical and lifestyle data were obtained. The accuracy and cut-off point of the FLI to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis. RESULTS A total of 640 participants (94 with NAFLD) were included. Mean age was 37.4 ± 0.4 years and 58.7% were women. Mean body mass index (BMI) was 22.3 ± 0.2 kg/m2 and waist circumference (WC) 79.1 ± 0.4 cm. A total of 15 (2.3%) participants were diagnosed with type 2 diabetes and 65 (10.2%) with obesity (BMI ≥ 30 kg/m2 ). AUROC of FLI for predicting NAFLD was 0.80 (95% CI 0.74-0.85), which was significantly higher compared to individual components gamma-glutamyl transferase and triglycerides (p < 0.05), but not compared to anthropometric parameters BMI (AUROC of 0.83, 95% CI 0.79-0.88) and WC (AUROC of 0.81, 95% CI 0.76-0.87). CONCLUSIONS FLI is a simple valid scoring system to use in rural and urban Kenyan adults. However, this index might not be superior to BMI or WC to predict NAFLD, and those measurements might therefore be more appropriate in limited settings.
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Affiliation(s)
- Fannie Lajeunesse-Trempe
- School of Nutrition, Laval University, Quebec City, Quebec, Canada
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Michael K Boit
- Department of Physical, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Lydia U Kaduka
- Centre for Public Health Research, KEMRI, Nairobi, Kenya
| | - Emanuella De Lucia-Rolfe
- NIHR Cambridge Biomedical Research Centre-Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Alexis Baass
- Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Quebec, Canada
| | - Martine Paquette
- Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Quebec, Canada
| | - Marie-Eve Piché
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - André Tchernof
- School of Nutrition, Laval University, Quebec City, Quebec, Canada
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dirk L Christensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
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Wiafe YA, Afihene MY, Anto EO, Nmai RA, Amoah-Kumi L, Frimpong J, Dickson FD, Antwi SO, Roberts LR. Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Persons with Type 2 Diabetes Mellitus in Ghana: A Study of Prevalence, Severity, and Contributing Factors Using Transient Elastography. J Clin Med 2023; 12:3741. [PMID: 37297935 PMCID: PMC10253760 DOI: 10.3390/jcm12113741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia, insulin resistance, and pancreatic islet cell dysfunction. T2DM is associated with non-alcoholic fatty liver disease (NAFLD) because of impaired glucose metabolism in both conditions. However, it is widely assumed that people with T2DM in sub-Saharan Africa (SSA) have a lower prevalence of NAFLD than in other parts of the world. With our recent access to transient elastography, we aimed to investigate the prevalence of, severity of, and contributing factors to NAFLD in persons with T2DM in Ghana. We performed a cross-sectional study recruiting 218 individuals with T2DM at the Kwadaso Seventh-Day Adventist and Mount Sinai Hospitals in the Ashanti region of Ghana using a simple randomized sampling technique. A structured questionnaire was used to obtain socio-demographic information, clinical history, exercise and other lifestyle factors, and anthropometric measurements. Transient elastography was performed using a FibroScan® machine to obtain the Controlled Attenuation Parameter (CAP) score and liver fibrosis score. The prevalence of NAFLD among Ghanaian T2DM participants was 51.4% (112/218), of whom 11.6% had significant liver fibrosis. An evaluation of the NAFLD group (n = 112) versus the non-NAFLD group (n = 106) revealed a higher BMI (28.7 vs. 25.2 kg/m2, p = 0.001), waist circumference (106.0 vs. 98.0 cm, p = 0.001), hip circumference (107.0 vs. 100.5 cm, p = 0.003), and waist-to-height ratio (0.66 vs. 0.62, p = 0.001) in T2DM patients with NAFLD compared to those without NAFLD. Being obese was an independent predictor of NAFLD in persons with T2DM than known history of hypertension and dyslipidaemia.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (E.O.A.); (R.A.N.); (L.A.-K.); (J.F.)
| | - Mary Yeboah Afihene
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;
| | - Enoch Odame Anto
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (E.O.A.); (R.A.N.); (L.A.-K.); (J.F.)
| | - Richmond Ashitey Nmai
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (E.O.A.); (R.A.N.); (L.A.-K.); (J.F.)
| | - Lois Amoah-Kumi
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (E.O.A.); (R.A.N.); (L.A.-K.); (J.F.)
| | - Joseph Frimpong
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (E.O.A.); (R.A.N.); (L.A.-K.); (J.F.)
| | | | - Samuel O. Antwi
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL 32224, USA;
| | - Lewis R. Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
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Golabi P, Isakov V, Younossi ZM. Nonalcoholic Fatty Liver Disease: Disease Burden and Disease Awareness. Clin Liver Dis 2023; 27:173-186. [PMID: 37024201 DOI: 10.1016/j.cld.2023.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide and has been implying an unprecedented burden to health care systems. The prevalence of NAFLD has exceeded 30% in developed countries. Considering the asymptomatic nature of undiagnosed NAFLD, high suspicion and noninvasive diagnosis have utmost importance especially in primary care level. At this point, patient and provider awareness should be optimal for early diagnosis and risk stratification for patients at risk of progression.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Vasily Isakov
- Department of Gastroenterology & Hepatology, Federal Research Center for Nutrition and Biotechnology, 21 Kashirskoe Shosse, Moscow 115446, Russia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA; Inova Medicine Services, Department of Medicine, Inova Fairfax Medical Campus, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Ong J, Alswat K, Hamid S, El-Kassas M. Nonalcoholic Fatty Liver Disease in Asia, Africa, and Middle East Region. Clin Liver Dis 2023; 27:287-299. [PMID: 37024208 DOI: 10.1016/j.cld.2023.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. The global prevalence of the disease varies according to the geographical region. Despite having distinct models for the western patterns of NAFLD, Africa, Asia, and the Middle East regions exhibited varying prevalence rates of NAFLD. The disease burden is anticipated to significantly increase in these areas. Furthermore, with an increase in NAFLD risk factors in these regions, the disease burden is expected to rise even more. Policies at the regional and international levels are required to address such growing burden of NAFLD consequences.
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Affiliation(s)
- Janus Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Khalid Alswat
- Department of Medicine, Liver Disease Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt.
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11
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El-Kassas M, Cabezas J, Coz PI, Zheng MH, Arab JP, Awad A. Nonalcoholic Fatty Liver Disease: Current Global Burden. Semin Liver Dis 2022; 42:401-412. [PMID: 35617968 DOI: 10.1055/a-1862-9088] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The map and global disease burden of chronic liver diseases are markedly changing, with nonalcoholic fatty liver disease (NAFLD) becoming the most common cause of liver diseases coinciding with the current epidemics of obesity, type 2 diabetes, and metabolic syndrome. Understanding the incidence and prevalence of NAFLD is critical because of its linkage to a significant economic burden of hospitalization and changing patterns in consequences, such as liver transplantation. Moreover, the long-term average health care expenses of NAFLD patients have exceeded those of other liver diseases. To lessen the imminent burden of NAFLD, immediate actions to raise worldwide awareness and address metabolic risk factors are required. This review summarizes key data about the global disease burden of NAFLD, modifiable and nonmodifiable risk factors, and current preventive approaches.
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Affiliation(s)
- Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, University Hospital Marques de Valdecilla, Santander, Spain
- Department of Gastroenterology and Hepatology, Research Institute Valdecilla (IDIVAL), Santander, Spain
| | - Paula Iruzubieta Coz
- Gastroenterology and Hepatology Department, University Hospital Marques de Valdecilla, Santander, Spain
- Department of Gastroenterology and Hepatology, Research Institute Valdecilla (IDIVAL), Santander, Spain
| | - Ming-Hua Zheng
- NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
| | - Abeer Awad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Lin H, Zhang X, Li G, Wong GLH, Wong VWS. Epidemiology and Clinical Outcomes of Metabolic (Dysfunction)-associated Fatty Liver Disease. J Clin Transl Hepatol 2021; 9:972-982. [PMID: 34966660 PMCID: PMC8666360 DOI: 10.14218/jcth.2021.00201] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/24/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022] Open
Abstract
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is currently the most common chronic liver disease and affects at least a quarter of the global adult population. It has rapidly become one of the leading causes of hepatocellular carcinoma and cirrhosis in Western countries. In this review, we discuss the nomenclature and definition of MAFLD as well as its prevalence and incidence in different geographical regions. Although cardiovascular disease remains the leading cause of death in MAFLD patients, the proportion of patients dying from hepatic complications increases sharply as the disease progresses to advanced liver fibrosis and cirrhosis. In addition, patients with MAFLD are at increased risk of various extrahepatic cancers. Although a causal relationship between MAFLD and extrahepatic cancers has not been established, clinicians should recognize the association and consider cancer screening (e.g., for colorectal cancer) as appropriate.
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Affiliation(s)
| | | | | | | | - Vincent Wai-Sun Wong
- Correspondence to: Vincent Wai-Sun Wong, Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. ORCID: https://orcid.org/0000-0003-2215-9410. Tel: 852-3505-1205, Fax: 852-2637-3852, E-mail:
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13
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Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2021; 6:1036-1046. [PMID: 34508671 DOI: 10.1016/s2468-1253(21)00275-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.
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14
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Compaoré NI, Coulibaly A, Koura M, Somda KS, Somé CC, Zombré NMS, Bougouma A. [Metabolic hepatic steatosis associated with obesity in adults living in Burkina Faso]. Pan Afr Med J 2021; 38:266. [PMID: 34122693 PMCID: PMC8179997 DOI: 10.11604/pamj.2021.38.266.22253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 02/20/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction la stéatopathie métabolique est-elle une priorité de santé en Afrique? Le but était d´étudier les facteurs épidémiologiques et les manifestations hépatiques (anomalies biologiques et la stéatose échographique) associés au syndrome métabolique (SM) chez les adultes suivis en ambulatoire. Méthodes étude multicentrique transversale avec un suivi longitudinal des patients. Elle a été menée de mars 2015 à août 2019 dans la ville de Ouagadougou. Etaient inclus les malades présentant un SM selon les critères harmonisés pour les africains subsahariens. Résultats la fréquence du SM était à 15,74%. Il y a eu un recrutement 3,8 fois plus rapide de patients la dernière année. Les femmes (57,04) étaient majoritaires; l´âge moyen de 44,69 ans. Le surpoids et l´obésité concernaient 87,32%. Les composantes du SM retrouvées étaient: la dyslipidémie (64,79%), l´hyperglycémie (49,30%), l´HTA (45,07%), le tour de taille moyen de 98,68 cm chez les hommes et de 101,13 cm chez les femmes. L´infection virale B était associée chez 19,01% et celle au HIV chez 1,40%. Une patiente présentait un syndrome de polykystose ovarienne. Une tradithérapie était en cours chez 14,08%. Les transaminases étaient normales chez 73,94%. Une stéatose hépatique échographique était retrouvée chez 71,13%. Le Fibroscan® avait été effectué par 40,42%. Le résultat de la stéatose était discordant de celui échographique chez 56,14%. Conclusion pour réduire le SM et ses composantes, il est nécessaire de lutter contre l´obésité (surtout féminine). Une meilleure accessibilité au Fibroscan® permettra d´améliorer sa prise en charge au Burkina Faso.
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Affiliation(s)
- Nômawendé Inès Compaoré
- Service de Médecine et de Spécialités Médicales, Centre Médical Avec Antenne Chirurgicale El Fateh-Suka, Ouagadougou, Burkina Faso
| | - Aboubacar Coulibaly
- Service d´Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Mali Koura
- Service d´Hépato-gastroentérologie, Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Kounpiélimé Sosthène Somda
- Service d´Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Couna Christiane Somé
- Service d´Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Nadine Marie Stella Zombré
- Service d´Hépato-gastroentérologie, Centre Hospitalier Régionale de Fada N´Gourma, Fada N´Gourma, Burkina Faso
| | - Alain Bougouma
- Service d´Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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15
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Mehmood A, Zhao L, Wang Y, Pan F, Hao S, Zhang H, Iftikhar A, Usman M. Dietary anthocyanins as potential natural modulators for the prevention and treatment of non-alcoholic fatty liver disease: A comprehensive review. Food Res Int 2021; 142:110180. [PMID: 33773656 DOI: 10.1016/j.foodres.2021.110180] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) refers to a metabolic syndrome linked with type 2 diabetes mellitus, obesity, and cardiovascular diseases. It is characterized by the accumulation of triglycerides in the hepatocytes in the absence of alcohol consumption. The prevalence of NAFLD has abruptly increased worldwide, with no effective treatment yet available. Anthocyanins (ACNs) belong to the flavonoid subclass of polyphenols, are commonly present in various edible plants, and possess a broad array of health-promoting properties. ACNs have been shown to have strong potential to combat NAFLD. We critically assessed the literature regarding the pharmacological mechanisms and biopharmaceutical features of the action of ACNs on NAFLD in humans and animal models. We found that ACNs ameliorate NAFLD by improving lipid and glucose metabolism, increasing antioxidant and anti-inflammatory activities, and regulating gut microbiota dysbiosis. In conclusion, ACNs have potential to attenuate NAFLD. However, further mechanistic studies are required to confirm these beneficial impacts of ACNs on NAFLD.
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Affiliation(s)
- Arshad Mehmood
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China
| | - Lei Zhao
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China.
| | - Yong Wang
- Academy of National Food and Strategic Reserves Administration, Beijing 100037, China
| | - Fei Pan
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China
| | - Shuai Hao
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China
| | - Huimin Zhang
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China
| | - Asra Iftikhar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, The University of Faisalabad, Faisalabad 38000, Pakistan
| | - Muhammad Usman
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, School of Food and Health, Beijing Technology and Business University, Beijing 100048, China
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16
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Paruk IM, Pirie FJ, Motala AA. Non-alcoholic fatty liver disease in Africa: a hidden danger. Glob Health Epidemiol Genom 2019; 4:e3. [PMID: 31019719 PMCID: PMC6465678 DOI: 10.1017/gheg.2019.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022] Open
Abstract
There is a dearth of data on the burden and spectrum of non-alcoholic fatty liver disease (NAFLD) in African populations. The limited available information suggests that the prevalence of NAFLD in the general population is lowest for the Africa region. However, this is likely to be an underestimate and also does not take into consideration the long-term impact of rising rates of obesity, type-2 diabetes mellitus (T2DM) and high human immunodeficiency virus infection burden in Africa. A racial disparity in the prevalence of NAFLD has been observed in some studies but remains unexplained. There is an absence of data from population-based studies in Africa and this highlights the need for such studies, to reliably define the health service needs for this region. Screening for NAFLD at a population-based level using ultrasound is perhaps the ideal method for resource-poor settings because of its relative cost-effectiveness. What is required as a priority from Africa, are well-designed epidemiologic studies that screen for NAFLD in the general population as well as high-risk groups such as patients with T2DM or obesity.
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Affiliation(s)
- Imran M. Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Fraser J. Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Ayesha A. Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
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17
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Zawdie B, Tadesse S, Wolide AD, Nigatu TA, Bobasa EM. Non-Alcoholic Fatty Liver Disease and Associated Factors among Type 2 Diabetic Patients in Southwest Ethiopia. Ethiop J Health Sci 2018; 28:19-30. [PMID: 29622904 PMCID: PMC5866286 DOI: 10.4314/ejhs.v28i1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Non-alcoholic Fatty Liver Disease (NAFLD) among type 2 diabetic patients is completely ignored in developing regions like Africa paving the way for public health and economic burden in the region. Therefore, the main objective of this research was to evaluate non-alcoholic fatty liver disease and associated factors among type 2 diabetic patients in Southwestern Ethiopia attending Diabetic Clinic of Jimma University Specialized Hospital (JUSH). Methods Facility based cross-sectional study design was used. Anthropometry, fatty liver (using utrasonography), liver enzymes, and lipid profiles were measured among type 2 diabetic patients who fulfilled the inclusion criteria. Socio-demographic and clinical characteristics were assessed using standard questionnaires. Results Ninety-six (96) type 2 diabetic patients were enrolled and non-alcoholic fatty liver disease prevalence was 73%. Of non-alcoholic fatty Liver disease documented patients, 35.4%, 31.3% and 6.3% exhibited mild, moderate and severe fatty liver diseases, respectively. Alanine aminotransferase (p ≤0.001), Triacyglycerol (p ≤0.001), total bilirubin (p ≤0.05), direct bilirubin (p ≤0.05) and diabetic duration (p ≤0.01) were significantly associated with non-alcoholic fatty liver disease among type 2 diabetic patients. The Aspartate aminotransferase/Alanine aminotransferase ratio among non alcoholic fatty liver disease patients was greater than one. Conclusions The magnitude of non-alcoholic fatty liver disease is high among study groups and it needs urgent action by healthcare systems. Therefore, targeted treatment approach inclusive of non-alcoholic fatty liver disease should be designed.
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Affiliation(s)
- Belay Zawdie
- School of Biomedical Sciences, Faculty of Medical Sciences, Jimma University
| | - Samuel Tadesse
- School of Biomedical Sciences, Faculty of Medical Sciences, Jimma University
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18
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Afolabi BI, Ibitoye BO, Ikem RT, Omisore AD, Idowu BM, Soyoye DO. The Relationship Between Glycaemic Control and Non-Alcoholic Fatty Liver Disease in Nigerian Type 2 Diabetic Patients. J Natl Med Assoc 2018; 110:256-264. [PMID: 29778128 DOI: 10.1016/j.jnma.2017.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metabolic risk factors associated with non-alcoholic fatty liver disease (NAFLD) include Type 2 diabetes mellitus (T2DM), obesity and dyslipidaemia. Prevention or management of these risk factors with glycaemic control, weight reduction and low serum lipid levels respectively have been reported to reduce the risk of NAFLD or slow its progression. Since ultrasound (USS) is a safe and reliable method of identifying fatty changes in the liver, this study was done to determine the relationship between glycaemic control and ultrasound diagnosed NAFLD in T2DM. METHODOLOGY Demographic data, anthropometric measurements and laboratory tests including glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and serum lipids of 80 T2DM subjects aged 40-80 years were taken. Their livers were evaluated using B-mode ultrasound, and the data obtained were statistically analysed using SPSS version 20. RESULTS Fifty-five of all participants (68.8%) were diagnosed with NAFLD sonographic grades 1, 2 and 3 made up of 13 (16.3%), 26 (32.5%) and 16 (20.0%), respectively while 25 (37.2%) had grade 0. The prevalence of NAFLD in T2DM varied significantly with BMI (p = 0.001) and glycaemic control (p = 0.048) while the USS grades of NAFLD varied significantly with age (p = 0.043) and BMI (p = 0.006). The independent strong predictors of NAFLD were overweight (r = 0.409, p = 0.012, OR = 6.626) and obesity (r = 0.411 p = 0.009, OR = 11.508), while poor glycaemic control (r = 0.270, p = 0.015, OR = 3.473) was a moderate independent predictor. CONCLUSION The prevalence of NAFLD increases with increasing BMI and HBA1c in T2DM, while its ultrasound grade varies with BMI. Overweight, obesity and poor glycaemic control are independent predictors of NAFLD.
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Affiliation(s)
- Babalola Ishmael Afolabi
- Department of Radiology, Obafemi Awolowo University (OAU)/OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Bolanle Olubunmi Ibitoye
- Department of Radiology, Obafemi Awolowo University (OAU)/OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Rosemary Temidayo Ikem
- Department of Internal Medicine, Obafemi Awolowo University (OAU)/ OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeleye Dorcas Omisore
- Department of Radiology, Obafemi Awolowo University (OAU)/OAU Teaching Hospitals Complex, Ile Ife, Nigeria.
| | - Bukunmi Michael Idowu
- Department of Radiology, Obafemi Awolowo University (OAU)/OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - David Olubukunmi Soyoye
- Department of Internal Medicine, Obafemi Awolowo University (OAU)/ OAU Teaching Hospitals Complex, Ile Ife, Nigeria
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19
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Orlien SMS, Ismael NY, Ahmed TA, Berhe N, Lauritzen T, Roald B, Goldin RD, Stene-Johansen K, Dyrhol-Riise AM, Gundersen SG, Morgan MY, Johannessen A. Unexplained chronic liver disease in Ethiopia: a cross-sectional study. BMC Gastroenterol 2018; 18:27. [PMID: 29439653 PMCID: PMC5812015 DOI: 10.1186/s12876-018-0755-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/31/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is assumed to be the major cause of chronic liver disease (CLD) in sub-Saharan Africa. The contribution of other aetiological causes of CLD is less well documented and hence opportunities to modulate other potential risk factors are being lost. The aims of this study were to explore the aetiological spectrum of CLD in eastern Ethiopia and to identify plausible underlying risk factors for its development. METHODS A cross-sectional study was undertaken between April 2015 and April 2016 in two public hospitals in Harar, eastern Ethiopia. The study population comprised of consenting adults with clinical and radiological evidence of chronic liver disease. The baseline evaluation included: (i) a semi-structured interview designed to obtain information about the ingestion of alcohol, herbal medicines and local recreational drugs such as khat (Catha edulis); (ii) clinical examination; (iii) extensive laboratory testing; and, (iv) abdominal ultrasonography. RESULTS One-hundred-and-fifty patients with CLD (men 72.0%; median age 30 [interquartile range 25-40] years) were included. CLD was attributed to chronic HBV infection in 55 (36.7%) individuals; other aetiological agents were identified in a further 12 (8.0%). No aetiological factors were identified in the remaining 83 (55.3%) patients. The overall prevalence of daily khat use was 78.0%, while alcohol abuse, defined as > 20 g/day in women and > 30 g/day in men, was rare (2.0%). Histological features of toxic liver injury were observed in a subset of patients with unexplained liver injury who underwent liver biopsy. CONCLUSION The aetiology of CLD in eastern Ethiopia is largely unexplained. The widespread use of khat in the region, together with histopathological findings indicating toxic liver injury, suggests an association which warrants further investigation.
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Affiliation(s)
| | - Nejib Yusuf Ismael
- Department of Internal Medicine, Hiwot Fana Specialized University Hospital, Harar, Ethiopia.,Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Tekabe Abdosh Ahmed
- Haramaya University College of Health and Medical Sciences, Harar, Ethiopia.,Department of Internal Medicine, Jugal Hospital, Harar, Ethiopia
| | - Nega Berhe
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital Ullevål, Oslo, Norway.,Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Trine Lauritzen
- Department of Medical Biochemistry, Vestre Viken Hospital Trust, Drammen, Norway
| | - Borghild Roald
- Department of Pathology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, Oslo University, Oslo, Norway
| | | | | | - Anne Margarita Dyrhol-Riise
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Svein Gunnar Gundersen
- Research Unit, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Marsha Yvonne Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, University College London, Royal Free Campus, London, UK
| | - Asgeir Johannessen
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital Ullevål, Oslo, Norway. .,Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway.
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20
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Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, George J, Bugianesi E. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018; 15:11-20. [PMID: 28930295 DOI: 10.1038/nrgastro.2017.109] [Citation(s) in RCA: 3704] [Impact Index Per Article: 529.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
NAFLD is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The large number of patients with NAFLD with potential for progressive liver disease creates challenges for screening, as the diagnosis of NASH necessitates invasive liver biopsy. Furthermore, individuals with NAFLD have a high frequency of metabolic comorbidities and could place a growing strain on health-care systems from their need for management. While awaiting the development effective therapies, this disease warrants the attention of primary care physicians, specialists and health policy makers.
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Affiliation(s)
- Zobair Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22042, USA
- Center for Outcomes Research in Liver Disease, 2411 I Street NW, Washington DC, 20037, USA
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, 4 th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Milena Marietti
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Torino, Italy
| | - Timothy Hardy
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, 4 th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Linda Henry
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22042, USA
- Center for Outcomes Research in Liver Disease, 2411 I Street NW, Washington DC, 20037, USA
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, 176 Hawkesbury Rd, Westmead NSW 2145, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, 176 Hawkesbury Rd, Westmead NSW 2145, Sydney, New South Wales, Australia
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Torino, Italy
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