Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: Is metabolic syndrome the culprit?

Prevalence of dyslipidemia among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

Background

Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa.

Methods

Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using I 2 statistics and Egger's test, respectively.

Results

Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1-43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2-61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1-50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2-42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males.

Conclusion

Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.

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

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.

Prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in south Central Uganda: A cross-sectional survey

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.

Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.

METHODS

MEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.

RESULTS

156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2-F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3-F4).

CONCLUSION

This study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.

PROSPERO REGISTRATION NUMBER

CRD42022360251.

Prevalence of Non-alcoholic Fatty Liver Disease (NAFLD) in Saudi Arabia: Systematic Review and Meta-analysis

Liver disease is fast emerging as a global health priority. Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries, with an increasing prevalence associated with the rising prevalence of diabetes mellitus and obesity. The worldwide prevalence of NAFLD may be in the order of 25%, but in the Middle East, it may be even higher. This study aimed to estimate the prevalence of NAFLD in the Kingdom of Saudi Arabia (KSA). A systematic review and meta-analysis were undertaken. Electronic searches were carried out through Medline, EMBASE, CINAHL, Web of Science, and Google Scholar, for articles from inception to April 2020. Studies conducted on adult populations in any setting reporting NAFLD prevalence were included. Pooled proportions and associated 95% confidence intervals (CIs) were presented in forest plots using a random effect model. Eight studies, including 4045 participants, were included. The pooled prevalence of NAFLD among all adult populations in KSA was 16.8% (11.1%-22.5%). Amongst those with type 2 diabetes, the prevalence was 58.0% (45.0%-70.9%). There were no true general population studies of the prevalence of NAFLD in KSA available. This review suggests that NAFLD is common in the KSA, and that type 2 diabetes is a risk factor in KSA as identified elsewhere in the world.

Nonalcoholic Fatty Liver Disease: Disease Burden and Disease Awareness

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.

Risk factors associated with fasting during Ramadan among individuals with diabetes according to IDF-DAR risk score in Atbara city, Sudan: Cross-sectional hospital-based study

BACKGROUND

Ramadan is a holy month for Muslims. The aim of this study was to assess risk associated with Ramadan fasting among Sudanese individuals with diabetes (high, moderate, and low risk) according to International Diabetes Federation in collaboration with Diabetes and Ramadan International alliance (IDF-DAR) Practical Guidelines 2021 risk score.

METHODS

This was a cross-sectional hospital-based study recruited 300 individuals with diabetes (79% have type 2 diabetes) from diabetes centers in Atbara city, the River Nile state, Sudan.

RESULTS

The risk score was distributed as low risk (13.7%), Moderate risk (24%), and High risk (62.3%). T-test showed a significant difference in mean risk score by gender, duration and type of diabetes (p values = 0.004, 0.000, & 0.000, respectively). One-way ANOVA revealed a statistically significant difference in the risk score by age groups (p = 0.000). Logistic regression revealed that the odds of being in the 41-60 years age group had lower probability to be categorized in the moderate risk group of fasting rather than low risk by 4.3 times than being in the age more than 60 years. (p = 0.008), the odds of being in the age group 41-60 years lower probability to be categorized in the high risk of fasting rather than low risk by 8 times than being in the age more than 60 years. (p = 0.000).

CONCLUSION

The majority of patients in this study have a high risk for Ramadan fasting. IDF-DAR risk score is of great significance in assessing individuals with diabetes for Ramadan fasting.

Review article: the epidemiologic burden of non-alcoholic fatty liver disease across the world

BACKGROUND

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in parallel with obesity and type 2 diabetes.

AIM

To review the global epidemiology of NAFLD METHODS: We retrieved articles from PubMed using search terms of NAFLD, epidemiology, prevalence, incidence, and comorbidities.

RESULTS

Over 250 articles were reviewed. In 2016, the global NAFLD prevalence was 25%; this increased to >30% in 2019. Prevalence in Asia, Latin America and Middle East-North Africa (MENA) was 30.8%, 34.5% and 42.6%, respectively. Prevalence increased with age. Although prevalence was higher in men, prevalence in post-menopausal women was similar. NAFLD prevalence was higher in certain subpopulations, especially among the obese and those with metabolic syndrome (MS). However, the prevalence of lean NAFLD was 11.2%. The global prevalence of non-alcoholic steatohepatitis (NASH) is estimated between 2% and 6% in the general population. Approximately 7% of patients with NAFLD have advanced fibrosis; rates were between 21% and 50% among patients with NASH. Overall mortality related to NAFLD was 15-20 per 1000 person-years, and increased substantially in patients with NASH, especially in those with components of MS. Recent data suggest mortality/morbidity from NAFLD is increasing globally but NAFLD awareness remains low among patients and healthcare providers.

CONCLUSIONS

NAFLD poses a global public health problem with a very high disease burden in Asia, MENA and Latin America. Research is needed to better quantify the full impact of NAFLD and to develop strategies to improve awareness and risk stratification.

Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia

INTRODUCTION

The growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis among HIV-positive and negative adults in urban Zambia.

METHODS

Adults 30 years and older who were newly diagnosed with HIV, or tested HIV-negative at two primary care clinics in Lusaka, Zambia, were assessed for liver steatosis. Cardiometabolic data were collected through comprehensive clinical and laboratory assessments. Transient elastography was performed to measure controlled-attenuation parameter (≥248 dB/m). We used multivariable logistic regression models to determine the factors associated with the presence of steatosis.

RESULTS

We enrolled 381 patients, including 154 (40%) antiretroviral therapy-naïve people living with HIV (PLWH) with a median CD4+ count of 247 cells/mm³ and a mean body mass index (BMI) of 23.8 kg/m². Liver steatosis was observed in 10% of participants overall and was more common among HIV-negative adults than in PLWH (15% vs 3%). The proportion of patients with steatosis was 25% among obese (BMI ≥30 kg/m²) participants, 12% among those overweight (BMI 25-29.9 kg/m²), and 7% among those with a BMI <25 kg/m². Among patients with a fasting glucose ≥7 mmol/L or confirmed diabetes, 57% had liver steatosis. In multivariable analyses, HIV status (adjusted odds ratio (aOR) 0.18, 95% CI 0.06 to 0.53), confirmed diabetes or elevated fasting glucose (aOR 3.92, 95% CI 1.57 to 9.78) and elevated blood pressure (aOR 2.95, 95% CI 1.34 to 6.48) were associated with steatosis. The association between BMI>25 kg/m² and liver steatosis was attenuated after adjustment for potential confounders (aOR 1.96, 95% CI 0.88-4.40). Overall, 21 (9%) participants without HIV and 4 (3%) with HIV met the criteria for MAFLD. Among individuals with liver steatosis, 65% (95% CI 49% to 80%) fulfilled criteria of MAFLD, whereas 15 (39%) of them had elevated transaminases and 3 (8%) F2-F4 fibrosis.

CONCLUSIONS

The prevalence of liver steatosis in this urban cohort of HIV-positive and negative adults in Zambia was low, despite a large proportion of patients with high BMI and central obesity. Our study is among the first to report data on MAFLD among adults in Africa, demonstrating that metabolic risk factors are key drivers of liver steatosis and supporting the adoption of the criteria for MAFLD in African populations.

Epidemiology and Clinical Outcomes of Metabolic (Dysfunction)-associated Fatty Liver Disease

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.

The roles of IGF2 and DNMT methylation and elongase6 related fatty acids in metabolic syndrome

Background: The prevalence of metabolic syndrome (MetS) has increased along with rapid socio-economic development in China in recent decades, aggravating the burden of the health care system. Both plasma levels of fatty acids (FAs) and aberrant DNA methylation profiles are associated with MetS risk. However, studies exploring the role of DNA methylation and FAs simultaneously in MetS etiology are sparse. Objective: We aimed to explore the association between the gene methylation levels of insulin-like growth factor II (IGF2), H19, DNA methyltransferases 1 (DNMT1), DNA methyltransferases 3a (DNMT3a), and DNA methyltransferases 3b (DNMT3b) and MetS risk, and the etiological role of elongation of very-long-chain fatty acid elongase 6 (ELOVL6) related fatty acids. Method: Plasma levels of FAs were measured using a Gas Chromatography-Flame Ionization Detector (GC-FID) after organic extraction, and gene methylation was quantified using a real-time Quantitative Polymerase Chain Reaction (Q-PCR) detecting system after bisulfite treatment. The C18/C16 ratio was used as the indicator of ELOVL6 activity. Odds Ratio (OR) and 95% Confidence Interval (CI) were estimated with logistic regression. Results: Methylation levels in IGF2 and DNMT3a were not significantly associated with MetS risk. However, when stratified by C18/C16 ratio (high vs. low), positive associations were observed between the risk of MetS and methylation levels (>median) of IGF2a3 (OR = 3.1, 95% CI = 1.3-7.5) and DNMT3a (OR = 2.5, 95% CI = 1.1-5.8) genes, in individuals with lower C18/C16 ratios, while no significant associations were observed in subjects with high C18/C16 ratios. Conclusion: Methylation levels in IGF2 and DNMT3a genes may affect the risk of MetS in an ELOVL6 activity-dependent way among Chinese adults. Further studies in other populations are needed to validate this finding.

Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

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.

Prevalence of fatty liver disease and its associated factors among Jordanian patients with type 2 diabetes mellitus: A cross-sectional study

Background

Diabetes mellitus (DM) is a well-known risk factor for Non-alcoholic fatty liver disease (NAFLD). Patients with type 2 DM (T2DM) who have NAFLD are at a higher risk of developing advanced stages of liver disease, including fibrosis, cirrhosis, and hepatocellular carcinoma compared to non-diabetic patients. This study aimed to estimate the prevalence of NAFLD among patients with T2DM, using hepatic ultrasonographic changes combined with derangement of hepatic transaminases level.

Materials and methods

This cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan. A total of 408 patients with T2DM and 90 non-diabetic subjects were included in this study. Body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), lipid parameters and abdominal ultrasonography were measured.

Results

Using the ultrasonographic criteria for the diagnosis of NAFLD, the prevalence of NAFLD was 80.4 % and 53.3 % among diabetic and non-diabetic participants, respectively. Among the diabetic participants, 25 %, 40.4 %, and 15 % had mild, moderate, and severe grades of steatosis, respectively. On the other hand, 24.4 %, 21.1 %, and 7.8 % of the non-diabetic participants had mild, moderate, and severe grades of steatosis, respectively. Diabetic patients between 25 and 45 years of age, patients with overweight or obesity, patients with increased waist circumference were significantly at higher risk of having NAFLD. High TG, lower HDL, elevated AST and ALT, and using sulfonylureas and metformin versus using metformin only were significantly associated with increased odds of having NAFLD.

Conclusions

NAFLD is highly prevalent among patients with T2DM. Overweight or obesity, abnormal cholesterol levels and treatment with sulfonylureas were significantly associated with NAFLD.

The prevalence and risk factors of stroke among Sudanese individuals with diabetes: Cross-sectional survey

INTRODUCTION:

Diabetes complications in Sudan were increasing at an alarming rate. The aim of this study was to assess the prevalence of stroke among Sudanese individuals with diabetes.

METHODOLOGY:

This cross-sectional study recruited 283 individuals with diabetes from three diabetes centers in Sudan. Data were collected using a standardized pretested questionnaire, and data were analyzed using Chi-square and logistic regression analysis.

RESULTS:

The average age of participants was 51 (±12 standard deviation) and 35% were aged between 51 and 60 years. Females were 66.8%, and most of the participants (73.9%) were from urban areas and 66.1% received formal education between primary school and university. Body mass index (BMI) classification showed that 34.3% were obese, 31.8% overweight, and 30.4% normal BMI. Diabetes for 1-5 years were observed in 71.7% and for more than 10 years (12%). The majority, i.e., 94.3% had type 2 diabetes mellitus while only 5.7% had type 1. Only one-third of the participants were able to achieve glycosylated hemoglobin (HbA1c) target for diabetes control. The prevalence of cerebrovascular accident (CVA) was 2.5%, hypertension (HTN) was 20%, ischemic heart disease 3.2%, and neuropathy was 45.6%. Chi-square test showed significant association between HbA1c, serum creatinine, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein level, and the presence of CVA. Logistic regression analysis showed HbA1c, and the duration of diabetes are significantly associated with the presence of CVA (P = 0.010, 0.014).

CONCLUSION:

The prevalence of stroke among Sudanese individuals with diabetes was around 2.5%. The main risk factors were HbA1c, HTN, and duration of diabetes.

Association of [1H]-MRS quantified liver fat content with glucose metabolism status

BACKGROUND

Previous literatures have implied that the liver fat deposition plays a crucial role in the development and progression of insulin resistance. In the present study, we aimed to investigate the association of liver fat content (LFC) with glucose metabolism status in the population of newly diagnosed type 2 diabetes mellitus (nT2DM), prediabetes mellitus (PDM) and normal controls (NC), and assessing if the LFC could as an indicator for the prediction of T2DM.

METHODS

A total of 242 subjects (including 141 nT2DM patients, 48 PDM subjects and 53 NC) were enrolled. The levels of LFC were quantified by using the proton magnetic resonance spectroscopy ([¹H]-MRS) technique. Clinical and laboratory parameters of study subjects were collected by medical records and biochemical detection. One-way ANOVA or nonparametric test (Kruskal-Wallis) was applied for intergroup comparisons; intergroup comparison was performed in using of Bonferroni multiple-significance-test correction.

RESULTS

There were significantly increased LFC levels in nT2DM (14.72% ± 6.37%) than in PDM (9.62% ± 4.41%) and that of NC groups (5.11% ± 3.66%) (all p < 0.001). The prevalence of nonalcoholic fatty liver disease (NAFLD) was also found to be increased in nT2DM (91.48%) than in PDM (85.41%) and that of NC (32.07%) groups. Correlation analysis revealed that the increase of LFC positively associated with fast plasma glucose (FPG), 2 h plasma glucose (PG), Delta G30 and homeostatic model assessment of insulin resistance (HOMA-IR), negatively associated with Delta Ins30, Delta C30, Ins30/G30 _AUC, CP30/G30 _AUC, Ins _AUC/G _AUC, CP _AUC/G _AUC, homeostatic model assessment for β-cell function index (HOMA-β) and matsuda insulin sensitivity index (Matsuda ISI). Multilinear regression analysis showed that LFC, body mass index (BMI) and diastolic blood pressure (DBP) contributed for the prediction of HOMA-IR, and total cholesterol (TC), age, waist circumference (WC) and low-density lipoprotein cholesterol (LDL-C) were the significant contributors for HOMA-β.

CONCLUSIONS

Our study revealed an increased LFC level and prevalence of NAFLD in nT2DM than in PDM and that of NC groups, the increase of LFC was closely associated with insulin resistance and impaired glucose metabolism status, may be regarded as potential indicator contributing to the development and progression of T2DM.

Knowledge and practice of diabetic foot care in Sudan: A cross sectional survey

BACKGROUND

Diabetes in Sudan is real health challenge for health authorities especially optimum glycemic control and complications in particular diabetic septic foot. This is study aimed to assess knowledge of individuals with diabetes about self-foot care.

METHODS

This is descriptive cross sectional, health facility-based study conducted in diabetes center in Khartoum, Sudan. The study recruited 150 individuals with diabetes. Data was collected using a standardized pretested questionnaire.

RESULTS

Among the participants 64.7% were females and 35.3% were males, 36% of the participants were between the age of 51-60 years old. Good glycemic control (HbA1c) were achieved by 41.3% only. The participants who had good knowledge about diabetic foot self-care were 46.7%, poor knowledge 29.3% and moderate knowledge 24%. Good self-practice toward diabetic foot self-care was reported by 42.6%, moderate by 36.7% and poor practice by 20.7%. The awareness and practices significantly correlated with an increase in ages (≥51 years), higher level of education, medium income, unemployment, longer duration of diabetes > 10years, family history, controlled diabetes mellitus and education about diabetes complications and diabetic foot care (P value < 0.05).

CONCLUSIONS

Only (46.7%) of participants address good awareness and practices about self-foot care. Accordingly, there is a great need to provide continuous health education to the patients about diabetic foot self-care and this knowledge-application gap must be narrowed down.

Non-alcoholic fatty liver disease in Africa: a hidden danger

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.

Prevalence and risk factors of sonographically detected non alcoholic fatty liver disease in a screening centre in Klang Valley, Malaysia: an observational cross-sectional study

Objectives:

Nonalcoholic fatty liver disease (NAFLD) is a very common liver disorder in Western countries. As of late, it has been found to be prevalent in Asia as well. It is a benign disease unless it develops into necroinflammation and fibrosis. This study was proposed to determine the prevalence and risk factors of sonography-detected NAFLD among Malaysian adults in Klang Valley, West Malaysia.

Study design:

An observational cross-sectional study.

Methods:

The participants were aged between 45 and 75 years who participated in a screening program at the Golden Horses Health Sanctuary in Klang Valley. Lipid profile and anthropometric measurements were collected from the subjects’ medical records. Ultrasound machine and a structured self-administered questionnaire were used as instruments for recruiting data from the subjects. The subjects who consumed alcohol (>140 g/wk for men and >70 g/wk for females), had hepatitis B or C viruses, liver insults, and surgery, and taken lipid-lowering medications were excluded from the study.

Results:

A total of 628 subjects were analyzed, and 235 (37.4%) subjects were diagnosed with definite NAFLD. They comprised 518 (82.5%) Chinese, 92 (14.6%) Malays, and 18 (2.9%) Indians. Peak prevalence of NAFLD was found in 53 to 60 years age group. The higher prevalence of NAFLD was among men (48.3%) than women (27.3%) and among Indians (61.1%) and Malays (51.1%) than among Chinese (34.2%). NAFLD has been found to be strongly correlated with male sex, high body mass index (≥23.0 kg/m²), hypertriglyceridemia, low high-density lipoprotein cholesterol, diabetes mellitus, and hypertension.

Conclusion:

NAFLD is quite common among adults in Malaysian urban population. The prevalence of NAFLD was inordinately high among the 53 to 60 years age group, male sex, Indians, and Malays (as compared with Chinese). Age >60 years, male sex, high body mass index (≥23.0 kg/m²), hypertriglyceridemia, and diabetes mellitus were proven to be risk predictors for NAFLD.

Evolutionarily derived networks to inform disease pathways

Methods to identify genes or pathways associated with complex diseases are often inadequate to elucidate most risk because they make implicit and oversimplified assumptions about underlying models of disease etiology. These can lead to incomplete or inadequate conclusions. To address this, we previously developed human phenotype networks (HPN), linking phenotypes based on shared biology. However, such visualization alone is often uninterpretable, and requires additional filtering. Here, we expand the HPN to include another method, evolutionary triangulation (ET). ET utilizes the hypothesis that alleles affecting disease risk in multiple populations are distributed consistently with differences in disease prevalence and compares allele frequencies among populations and their relationship to phenotype prevalence. We hypothesized that combining these methods will increase our ability to detect genetic patterns of association in complex diseases. We combined HPN and ET to identify network patterns associated with type 2 diabetes mellitus (T2DM), a leading cause of death worldwide. Fasting glucose, a continuous trait, was used as a proxy for T2DM and differs significantly among continental populations. The combined method identified several diabetes-related traits and several phenotypes related to cardiovascular diseases, for which diabetes is a major risk factor. ET-HPN found more phenotypes related to our target and related phenotypes than the application of either method alone. Not only could we detect phenotype connections related to T2DM, but we also identified phenotypes that are distributed in parallel to it, e.g., amyotrophic lateral sclerosis. Our analyses showed that ET-filtered HPN provides information that neither technique can individually.

Diabetes complications in Sudanese individuals with type 2 diabetes: Overlooked problems in sub-Saharan Africa?

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study is to determine the prevalence of complications of type 2 diabetes across different cities in the country.

METHODS

Individuals with type 2 diabetes, who have been on treatment for DM for at least one year and volunteered to participate, were selected from two diabetes centers in Sudan (Khartoum and Atbara). Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of complications of diabetes.

RESULTS

Four hundred and twenty four individuals with T2DM were included in this study (50.7% males and 49.3% females). Good glycemic control (HbA1c <7) was found in 15.7%. Hypertension was reported in 39.9% and myocardial infarction in 5.9%, while high cholesterol and triglyceride noted in 59.9%, 32.5% respectively. Low HDL was noted in 52.6%. Other complications like peripheral neuropathy, retinopathy and diabetic foot were observed in 68.2%, 72.6% and 12.7% respectively. Factors significantly associated with these complications were longer duration of diabetes (P<0.001), and living in urban areas (P<0.004).

CONCLUSION

High prevalence of complications of type 2 diabetes were observed especially in those with longer duration of diabetes and poor control.

Glycaemic control in Sudanese individuals with type 2 diabetes: Population based study

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study was to determine the prevalence of glycaemic control among individuals with type 2 diabetes across different cities in Sudan.

METHODS

Individuals with type 2 diabetes attending selected diabetes centres in Sudan, who had been on treatment for DM for at least one year and volunteered to participate were included. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and life style characteristics. Lipid profile and glycosylated hemoglobin were tested by calibrated laboratory methods. Blood pressure, Body mass index (BMI) and waist circumference were measured. Chi squared and logistic regression were used as statistical methods.

RESULTS

A total of 387 individuals with T2DM were included in this study (50.4% males and 49.6% females). The glycemic control indicator (HbAIc>7) was poor in 85% of patients. Factors associated with poor glycemic control were prolonged duration of diabetes (p=0.03), high plasma triglyceride (p=0.02), low high density lipoprotein (HDL) level (p=0.04) and low glomerular filtration rate (GFR) (P=0.01). Logistic regression analysis showed that low GFR is independent factor with poor diabetes control.

CONCLUSION

High prevalence of uncontrolled diabetes (85%) is noted in Sudanese individuals with type 2 diabetes.

Prevalence and Risk Factors for Acute Coronary Syndrome Among Sudanese Individuals With Diabetes: A Population-Based Study

Background

Acute coronary syndrome (ACS) is common with diabetes. The aim of this study was to establish prevalence and risk factors for ACS among Sudanese individuals with diabetes mellitus (DM).

Methods

A descriptive cross-sectional study was conducted in Khartoum State and Atabra (North of Sudan). The data collection was performed through pretested questionnaire, in addition to measurement of lipid profile and HbA1c.

Results

Among the 496 respondents, 234 (48.4%) were males and only 15 of them had ACS, while 255 (51.6%) were females and 12 had ACS. Therefore, the prevalence of ACS was 5.44% (95% confidence interval (CI): 3.45-7.44%). The unadjusted risk factors for ACS were age (P = 0.0008864), duration of DM (P = 0.01105) and presence of hypertension (P = 0.0006021). The presence of albuminuria, gender, and body mass index (BMI) was not associated with ACS. In addition, parameters like HbA1c, high-density lipoprotein (HDL), triglyceride and low-density cholesterol (LDL) were also not associated with ACS. Logistic regression analysis showed that duration of diabetes (odds ratio (OR) for below 5 years' history of DM = 0.175 (95% CI for OR: 0.180 - 0.835), P = 0.04051) and hypertension (OR = 2.462 (95% CI for OR: 1.007 - 6.500), P = 0.039) were absolute risk factors for ACS.

Conclusion

The prevalence of ACS is estimated to be 5.44%. ACS in Sudanese individuals with DM was associated with hypertension, increase in age and increase in duration of DM.

Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "non-alcoholic fatty liver disease" and "non-alcoholic steatohepatitis", in addition to "prevalence and risk factors for NAFLD", with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?

BACKGROUND

Diabetic foot ulceration (DFU) is a major health problem across the globe. The objective of this study is to determine the prevalence of DFU and its associated risk factors in Sudanese individuals with diabetes.

METHODS

Three hundred and ten individuals with type 2 diabetes, who have been on treatment for DM for at least 1 year and volunteered to participate, were enrolled in this study. Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of DFU.

RESULTS

The prevalence of DFU was found to be 18.1% in this cohort (95% CI: 13.78-22.34%). Among different metabolic variants like hypertension, albuminuria, retinopathy, neuropathy, HbA1c, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride, only duration of diabetes was significantly associated with DFU (P<0.0018) as shown by logistic regression statistical analysis. Even after adjusting for all other potential risk factors, living with diabetes for more than 10 years is associated with an increase in the diabetic foot probability by 3.16 folds (95% CI: 052-10.48 folds increase), P=0.006. The adjusted effect for living with diabetes for more than 20 years on the diabetic foot complication probability is an increase by 1.73 folds (95% CI: 0.39-4.37 folds increase), P=0.005. However, living with diabetes for more than 5 years had a non-significant adjusted effect on diabetic foot probability.

CONCLUSIONS

Prevalence of diabetic foot ulcer was 18.1% and the risk of development of diabetic foot ulcer is increased with duration of diabetes more than 10 years.

Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is emerging as a public health issue worldwide and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). However, there was a great disparity across studies in the estimated prevalence of NAFLD in T2DM patients. This meta-analysis, therefore, aimed to estimate the pooled prevalence of NAFLD in T2DM patients.

METHODS

Electronic databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, and Wanfang were searched using MeSH terms to identify relevant studies. Eligibility assessment and data extraction were conducted independently by 2 investigators and a meta-analysis was performed to synthesize the data. Heterogeneity was evaluated using the Cochran Q test and quantified using the I statistic. Publication bias was assessed using both the Begg and Egger tests. Subgroup analyses were performed to identify the possible sources of heterogeneity.

RESULTS

Twenty-four studies involving 35,599 T2DM patients were included in this meta-analysis, of which 20,264 were identified with NAFLD. A high degree of heterogeneity (I = 99.0%, P < .001) was observed among the eligible studies, with the reported prevalence ranging from 29.6% to 87.1%. The pooled prevalence of NAFLD in T2DM patients, by a random-effects model, was 59.67% (95% confidence interval: 54.31-64.92%). Sensitivity was low and both the Begg test and Egger test showed low possibility of publication bias. Subgroup analyses indicated that the prevalence of NAFLD in T2DM patients differed by gender, obesity, hypertension, dyslipidemia, coronary heart disease, and chronic kidney disease.

CONCLUSIONS

The high pooled prevalence of NAFLD in T2DM patients found in this study significantly underscores the need for early assessment of NAFLD and the importance of strengthening the management of NAFLD in T2DM patients.

Obesity among Sudanese adults with diabetes: a population-based survey

BACKGROUND

The aim of this study was to determine the prevalence of obesity among Sudanese individuals with diabetes.

METHODS

Demographic and clinical data from 1,337 individuals with type 2 diabetes were collected using a pretested, standardized, interviewer administered questionnaire. Subjects were recruited from three states namely Khartoum, Northern and River Nile States. Anthropometric measurements including body weight, height and waist circumference were determined using standardized techniques and calibrated equipment.

RESULTS

Total of 1,337 subjects with type 2 diabetes from Khartoum and North of Sudan were enrolled in this study and completed the questionnaires; the results showed that prevalence of obesity among individuals with diabetes was found to be 24.5%, with a higher rate of obesity in females than males (29.2% versus 18.1%). The prevalence of central obesity was also higher in women (43.6%) than men (21.8%). The prevalence of overweight was 39.9%. The overall prevalence of overweight and obesity was 64.4%. Obesity was associated with age, sex and blood pressure. While central obesity was associated with an increase in age, female sex and hypertension. Logistic regression analysis showed that female sex and hypertension are absolute risk factors for both obesity and central obesity.

CONCLUSIONS

The prevalence of obesity was 24.5% and overweight was 39.9% among Sudanese individuals with diabetes and more among women than men. Obesity and central obesity were significantly associated with female sex and hypertension.

Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Africa and worldwide. The prevalence of diabetes is expected to increase at alarming rate in Africa. Its estimated that around 20 million Africans are now living with diabetes, comprising a challenge for health systems at present and in the future. The aim of the present study was to determine the prevalence of undiagnosed and diagnosed DM and impaired glucose tolerance (IGT) in adult urban communities of the River Nile State (RNS), north Sudan.

METHODS

The present study was a cross-sectional community-based study in which participants were randomly selected from the four main cities of the RNS, on a house-to-house basis. Blood glucose was tested and all participants completed a questionnaire to obtain demographic, clinical and social data. Blood pressure and anthropometric measures were also recorded.

RESULTS

In all, 954 adults (518 females; 54.3%; mean [±SD] age 39.5 ± 16.7 years; range 18-90 years) participated in the survey. The overall prevalence of DM was 19.1% (182/954), whereas that of IGT was 9.5% (91/954). Among the diabetic group, 125 (68.7%) had known diabetes, whereas 57 (31.3%) were newly diagnosed during the study. Increasing age, a family history of diabetes, central obesity, abnormal body mass index, and hypertension were significant risk factors for DM.

CONCLUSIONS

There is high prevalence of DM and glucose intolerance in the urban population of the RNS. Screening for diabetes in individuals with any feature of metabolic syndrome is recommended.