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Díaz LA, Villota-Rivas M, Barrera F, Lazarus JV, Arrese M. The burden of liver disease in Latin America. Ann Hepatol 2024; 29:101175. [PMID: 37922988 DOI: 10.1016/j.aohep.2023.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
Liver disease poses a substantial burden in Latin America. This burden is primarily attributed to a high level of alcohol consumption and the increasing prevalence of risk factors associated with metabolic dysfunction-associated steatotic liver disease (MASLD), such as sedentary lifestyles, easy access to ultra-processed foods, obesity, and type 2 diabetes mellitus. These epidemiological trends are cause for concern, especially considering that there are significant challenges in addressing them due to disparities in access to liver disease screening and care. In this article, we aim to provide an overview of the current situation regarding liver disease in Latin America. We also discuss recent multinational proposals designed to address the growing MASLD burden via its integration into existing non-communicable diseases policies, at both local and global levels. Additionally, we emphasize the urgent need to establish effective public health policies that target both MASLD risk factors and excessive alcohol consumption. Furthermore, we discuss the development of liver transplantation programs, areas for improvement in medical education and research capabilities, and how the fostering of extensive collaboration among all stakeholders is crucial for addressing liver disease in the region.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francisco Barrera
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, United States; Global NASH Council, Washington DC, United States
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile; Global NASH Council, Washington DC, United States.
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Zazueta A, Valenzuela-Pérez L, Ortiz-López N, Pinto-León A, Torres V, Guiñez D, Aliaga N, Merino P, Sandoval A, Covarrubias N, Pérez de Arce E, Cattaneo M, Urzúa A, Roblero JP, Poniachik J, Gotteland M, Magne F, Beltrán CJ. Alteration of Gut Microbiota Composition in the Progression of Liver Damage in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Int J Mol Sci 2024; 25:4387. [PMID: 38673972 PMCID: PMC11050088 DOI: 10.3390/ijms25084387] [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] [Received: 12/13/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 04/28/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a complex disorder whose prevalence is rapidly growing in South America. The disturbances in the microbiota-gut-liver axis impact the liver damaging processes toward fibrosis. Gut microbiota status is shaped by dietary and lifestyle factors, depending on geographic location. We aimed to identify microbial signatures in a group of Chilean MASLD patients. Forty subjects were recruited, including healthy controls (HCs), overweight/obese subjects (Ow/Ob), patients with MASLD without fibrosis (MASLD/F-), and MASLD with fibrosis (MASLD/F+). Both MASLD and fibrosis were detected through elastography and/or biopsy, and fecal microbiota were analyzed through deep sequencing. Despite no differences in α- and β-diversity among all groups, a higher abundance of Bilophila and a lower presence of Defluviitaleaceae, Lachnospiraceae ND3007, and Coprobacter was found in MASLD/F- and MASLD/F+, compared to HC. Ruminococcaceae UCG-013 and Sellimonas were more abundant in MASLD/F+ than in Ow/Ob; both significantly differed between MASLD/F- and MASLD/F+, compared to HC. Significant positive correlations were observed between liver stiffness and Bifidobacterium, Prevotella, Sarcina, and Acidaminococcus abundance. Our results show that MASLD is associated with changes in bacterial taxa that are known to be involved in bile acid metabolism and SCFA production, with some of them being more specifically linked to fibrosis.
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Affiliation(s)
- Alejandra Zazueta
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile;
| | - Lucía Valenzuela-Pérez
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Nicolás Ortiz-López
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Araceli Pinto-León
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Verónica Torres
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Danette Guiñez
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Nicolás Aliaga
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Pablo Merino
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
| | - Alexandra Sandoval
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Natalia Covarrubias
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Edith Pérez de Arce
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Máximo Cattaneo
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Alvaro Urzúa
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Juan Pablo Roblero
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Jaime Poniachik
- Unit of Gastroenterology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile; (D.G.); (A.S.); (N.C.); (E.P.d.A.); (M.C.); (A.U.); (J.P.R.); (J.P.)
| | - Martín Gotteland
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Fabien Magne
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile;
| | - Caroll Jenny Beltrán
- Laboratory of Immuno-Gastroenterology, Section of Gastroenterology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile; (L.V.-P.); (N.O.-L.); (A.P.-L.); (V.T.); (N.A.); (P.M.)
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Aguirre-Villarreal D, Servin-Rojas M, Sánchez-Cedillo A, Chávez-Villa M, Hernandez-Alejandro R, Arab JP, Ruiz I, Avendaño-Castro KP, Matamoros MA, Adames-Almengor E, Diaz-Ferrer J, Rodriguez-Aguilar EF, Paez-Zayas VM, Contreras AG, Alvares-da-Silva MR, Mendizabal M, Oliveira CP, Navasa M, García-Juárez I. Liver transplantation in Latin America: reality and challenges. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100633. [PMID: 38058662 PMCID: PMC10696109 DOI: 10.1016/j.lana.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.
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Affiliation(s)
- David Aguirre-Villarreal
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Maximiliano Servin-Rojas
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aczel Sánchez-Cedillo
- Department of Surgery, Hospital General de Mexico Dr. Eduardo Liceaga, Ciudad de Mexico, Mexico
| | - Mariana Chávez-Villa
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Roberto Hernandez-Alejandro
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Departament of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l’Université de Montréal (CHUM), Canada
| | | | - Maria A. Matamoros
- Centro de Trasplante Hepatico y Cirugía Hepatobiliar, San Jose, Costa Rica
| | | | - Javier Diaz-Ferrer
- Department of Hepatology, Hospital Nacional Edgardo Rebagliati, Lima, Perú
| | | | | | - Alan G. Contreras
- Transplant Surgery, Intermountain Transplant Clinic, Salt Lake City, UT, USA
| | - Mario R. Alvares-da-Silva
- GI/Liver Unit, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Claudia P. Oliveira
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Miquel Navasa
- Liver Transplant Unit, Hepatology Service, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio García-Juárez
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
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Goble S, Akambase J, Prieto J, Balderramo D, Ferrer JD, Mattos AZ, Arrese M, Carrera E, Groothuismink ZMA, Oliveira J, Boonstra A, Debes JD. MBOAT7 rs641738 Variant Is Not Associated with an Increased Risk of Hepatocellular Carcinoma in a Latin American Cohort. Dig Dis Sci 2023; 68:4212-4220. [PMID: 37684433 PMCID: PMC10570183 DOI: 10.1007/s10620-023-08104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The rs641738 C > T single-nucleotide polymorphism of MBOAT7 has been associated with hepatocellular carcinoma (HCC) and nonalcoholic fatty liver disease (NAFLD). Latin Americans have high rates of HCC and NAFLD, but no assessment between MBOAT7 and HCC has been performed in this population. AIMS We provide the first assessment of the impact of MBOAT7 on HCC risk in Latin Americans. METHODS Patients were prospectively recruited into the ESCALON network, designed to collect samples from Latin American patients with HCC in 6 South American countries (Argentina, Ecuador, Brazil, Chile, Peru, and Colombia). A European cohort and the general Hispanic population of gnomAD database were included for comparison. Associations between HCC and MBOAT7 were evaluated using logistic regression. RESULTS In total, 310 cases of HCC and 493 cases of cirrhosis without HCC were assessed. The MBOAT7 TT genotype was not predictive of HCC in Latin Americans (TT vs CC OR adjusted = 1.15, 95% CI 0.66-2.01, p = 0.610) or Europeans (TT vs CC OR adjusted = 1.20, 95% CI 0.59-2.43, p = 0.621). No significant association was noted on subgroup analysis for NAFLD, viral hepatitis, or alcohol-related liver disease. The TT genotype was increased in the NAFLD-cirrhosis cohort of Latin Americans compared to a non-cirrhotic NAFLD cohort (TT vs CC + CT OR = 2.75, 95% CI 1.10-6.87, p = 0.031). CONCLUSION The rs631738 C > T allele of MBOAT7 was not associated with increased risk of HCC in Latin Americans or Europeans. An increase in the risk of cirrhosis was noted with the TT genotype in Latin Americans with NAFLD.
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Affiliation(s)
| | | | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestives, Bogotá, Colombia
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | | | - Angelo Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Marco Arrese
- Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Enrique Carrera
- Departamento de Gastroenterologia y Hepatologia, Hospital Eugenio Espejo, Quito, Ecuador
| | - Zwier M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeffrey Oliveira
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jose D Debes
- Hennepin Healthcare, Minneapolis, MN, USA.
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Medicine, University of Minnesota, Mayo Memorial Building, MMC 250, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
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