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Kamga Wouambo R, Panka Tchinda G, Kagoue Simeni LA, Djouela Djoulako PD, Yateu Wouambo CI, Tamko Mella GF, Tchoumi Leuwat EP, Bello D, Fokam J. Anti-hepatitis C antibody carriage and risk of liver impairment in rural-Cameroon: adapting the control of hepatocellular carcinoma for resource-limited settings. BMC Infect Dis 2023; 23:875. [PMID: 38093205 PMCID: PMC10717920 DOI: 10.1186/s12879-023-08880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. METHODS A facility-based observational study was conducted from July-August 2021 among individuals attending the "St Monique" Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p < 0.05 considered statistically significant. RESULTS Out of 306 eligible participants (negative for HBsAg and HIVAb) enrolled, the mean age was 34.35 ± 3.67 years. 252(82.35%) were female and 129 (42.17%) were single. The overall HCVAb sero-positivity was 15.68%(48/306), with 17.86% (45/252) among women vs. 5.55%(3/54) among men [OR (95%CI) = 3.69(2.11-9.29),p = 0.04]. HCVAb Carriage was greater among participants aged > 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p < 0.000] and in multipartnership [26.67%(12/45)vs.13.79%(36/261) monopartnership, OR (95%CI) = 2.27(1.07-4.80),p = 0.03]. The liver impairment rate (abnormal ALT+AST levels) was 30.39%(93/306), with 40.19%(123/306) of abnormal ALT alone. Moreover, the burden of Liver impairment was significantly with aged> 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p < 0.000). Interestingly, the burden of liver impairment (abnormal AST + ALAT) was significantly higher in HCVAb positive (62.5%, 30/48) versus HCVAb negative (24.42%, 63/258) participants, OR: 3.90 [1.96; 7.79], p = 0.0001. CONCLUSIONS In this rural health facility, HCVAb is highly endemic and the burden of liver impairment is concerning. Interestingly, HCVAb carriage is associated with abnormal liver levels of enzyme (ALT/AST), especially among the elderly populations. Hence, in the absence of nuclei acid testing, ALT/AST are relevant sentinel markers to screen HCVAb carriers who require monitoring/care for HCV-associated hepatocellular carcinoma in RLS.
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Affiliation(s)
- Rodrigue Kamga Wouambo
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon.
| | - Gaelle Panka Tchinda
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Luc Aime Kagoue Simeni
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Department of Microbiology, Faculty of Health Science, University of Buea, Buea, Cameroon
| | - Paule Dana Djouela Djoulako
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Ghislaine Flore Tamko Mella
- Laboratory of Fundamental Virology, Centre for Research on Emerging and Reemerging Diseases (CREMER), Yaounde, Cameroon
| | | | - Djoda Bello
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Joseph Fokam
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Younossi ZM, Zelber-Sagi S, Henry L, Gerber LH. Lifestyle interventions in nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2023; 20:708-722. [PMID: 37402873 DOI: 10.1038/s41575-023-00800-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a dynamic chronic liver disease that develops in close association with metabolic irregularities. Between 2016 and 2019, the global prevalence among adults was reported as 38% and among children and adolescents it was about 10%. NAFLD can be progressive and is associated with increased mortality from cardiovascular disease, extrahepatic cancers and liver complications. Despite these numerous adverse outcomes, no pharmacological treatments currently exist to treat nonalcoholic steatohepatitis, the progressive form of NAFLD. Therefore, the main treatment is the pursuit of a healthy lifestyle for both children and adults, which includes a diet rich in fruits, nuts, seeds, whole grains, fish and chicken and avoiding overconsumption of ultra-processed food, red meat, sugar-sweetened beverages and foods cooked at high heat. Physical activity at a level where one can talk but not sing is also recommended, including leisure-time activities and structured exercise. Avoidance of smoking and alcohol is also recommended. Policy-makers, community and school leaders need to work together to make their environments healthy by developing walkable and safe spaces with food stores stocked with culturally appropriate and healthy food items at affordable prices as well as providing age-appropriate and safe play areas in both schools and neighbourhoods.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA.
- Inova Medicine, Inova Health System, Falls Church, VA, USA.
| | | | - Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
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Anand A, Shalimar, Arora U, Asadullah M, Shivashankar R, Biswas S, Vaishnav M, Aggarwal A, Kandasamy D, Kondal D, Rautela G, Peerzada A, Grover B, Amarchand R, Nayak B, Sharma R, Ramakrishnan L, Prabhakaran D, Krishnan A, Tandon N. ABDA Score: A Non-invasive Model to Identify Subjects with Fibrotic Non-alcoholic Steatohepatitis in the Community. J Clin Exp Hepatol 2023; 13:742-752. [PMID: 37693275 PMCID: PMC10482999 DOI: 10.1016/j.jceh.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH) are prevalent in the community, especially among those with metabolic syndrome. Patients with fibrotic NASH are at increased risk of liver-related-events. Currently available non-invasive tests have not been utilized for screening for fibrotic NASH among the community. We aimed to develop a screening tool for fibrotic NASH among community members. Methods We included two large cohorts aimed at assessing cardiovascular disease among community members. Fibrotic NASH was defined using the FibroScan-aspartate aminotransferase score of ≥0.67 that identifies ≥F2 fibrosis and a non-alcoholic fatty liver disease activity score ≥4 with a specificity of 90%. Metabolic parameters, biochemical tests and anthropometry were used to develop a multivariate model. Results The derivation cohort (n = 1660) included a population with a median age 45 years, 42.5% males, metabolic syndrome in 66% and 2.7% (n = 45) with fibrotic NASH. Multivariate analysis identified the four significant variables (Age, body mass index , Diabetes and alanine aminotransferas levels) used to derive an ABDA score. The score had high diagnostic accuracy (the area under receiver-operating characteristic curve, 0.952) with adequate internal validity. An ABDA score ≥-3.52 identified fibrotic NASH in the derivation cohort with a sensitivity and specificity of 88.9% and 88.3%. The score was validated in a second cohort (n = 357) that included 21 patients (5.9%) with fibrotic NASH, where it demonstrated a high area under receiver-operating characteristic curve (0.948), sensitivity (81%) and specificity (89.3%). Conclusions ABDA score utilizes four easily available parameters to identify fibrotic NASH with high accuracy in the community.
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Affiliation(s)
- Abhinav Anand
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Umang Arora
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Md Asadullah
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Shivashankar
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Arnav Aggarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Ariba Peerzada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Bhanvi Grover
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Baibaswata Nayak
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Niriella MA, Ediriweera DS, Withanage MY, Darshika S, De Silva ST, Janaka de Silva H. Prevalence and associated factors for non-alcoholic fatty liver disease among adults in the South Asian Region: a meta-analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 15:100220. [PMID: 37614359 PMCID: PMC10442973 DOI: 10.1016/j.lansea.2023.100220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 08/25/2023]
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease worldwide. We estimated the prevalence and predefined associated factors for NAFLD among South-Asian adults. Methods We searched PubMed and included descriptive, epidemiological studies with satisfactory methodology, reporting the prevalence of NAFLD with ultrasound. Two authors screened and extracted data independently. Gender, urban/rural settings, general population and individuals with metabolic diseases (MetD) stratified the analysis. In addition, a random-effects meta-analysis of the prevalence and effect sizes of associations of NAFLD was performed. Findings Twenty-two publications were included after the quality assurance process. The difference in the NAFLD prevalence between the general population and people with MetD was found to be statistically significant (Q = 15.8, DF = 1, P < 0.001). The pooled overall prevalence of NAFLD in the general population was 26.9% (95% CI: 18.9-35.8%) with high heterogeneity. The prevalence was similar among men and women (Q = 0.06, DF = 1, P = 0.806). The NAFLD prevalence in the rural communities was 22.6% (95% CI: 13.6-33.1%), and the prevalence in urban communities was 32.9% (95% CI: 22.8-43.8%) and the difference was not statistically significant (Q = 1.92, DF = 1, P = 0.166). The pooled overall prevalence of NAFLD in patients with MetD was 54.1% (95% CI: 44.1-63.9%) with high heterogeneity. The pooled overall prevalence of NAFLD in the non-obese population was 11.7% (95% CI: 7.0-17.3%). The pooled prevalence of non-obese NAFLD in the NAFLD population was 43.4% (95% CI: 28.1-59.4%). Meta-analysis of binary variables showed that NAFLD in the South Asian population was associated with diabetes mellitus, hypertension, dyslipidaemia, general obesity, central obesity and metabolic syndrome. Gender was not associated with NAFLD. Interpretation The overall prevalence of NAFLD among adults in South Asia is high, especially in those with MetD, and a considerable proportion is non-obese. In the South Asian population, NAFLD was associated with diabetes mellitus, hypertension, dyslipidaemia, general obesity, central obesity, and metabolic syndrome. Funding None.
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Affiliation(s)
- Madunil Anuk Niriella
- Faculty of Medicine, Department of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | - Selani Darshika
- Faculty of Medicine, Department of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Anton MC, Shanthi B, Sridevi C. Prevalence of Non-Alcoholic Fatty Liver Disease in Urban Adult Population in a Tertiary Care Center, Chennai. Indian J Community Med 2023; 48:601-604. [PMID: 37662140 PMCID: PMC10470578 DOI: 10.4103/ijcm.ijcm_437_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/12/2023] [Indexed: 09/05/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common liver diseases among the Indian population. The predisposing factors for NAFLD are diet, lifestyle modifications, and lack of exercise. There is a paucity of research on NAFLD in the South Indian population. Hence, the present study aimed to assess the prevalence of NAFLD among the urban adult population in Chennai. Material and Methods This analytical cross-sectional study was conducted in General Medicine outpatient departments at a tertiary care center in Chennai. The study included 510 non-alcoholic adults (both male and female) aged between 21 and 40 years. Ultrasonography was performed to rule out fatty liver in all participants. All the results obtained were statistically analyzed using SPSS software version 22.0. The frequency was given in percentage. Results The proportion of participants who screened positive for NAFLD was 61.5%. The participants with higher body mass index (BMI) were found to be significantly 23.09 times higher risk of developing NAFLD. An increase in age was also found to be a predictor of NAFLD. This study also supports that males are more prone to develop NAFLD and are at a 1.59% higher risk of developing the disease than females. Conclusion Fatty liver has become one of the common non-communicable diseases in India, the high prevalence of NAFLD in the present study supports it. Therefore, people should have regular screening and diagnosis to rule out fatty liver disease. Proper diet patterns and exercise must be followed to prevent fatty liver.
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Affiliation(s)
- Mary Chandrika Anton
- Department of Biochemistry, Bhaarath Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - B. Shanthi
- Department of Biochemistry, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Chaganti Sridevi
- Department of Biochemistry, Prathima Relief Institute of Medical Sciences, Warangal, Telangana, India
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