Prevalence of and risk factors for non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt

Objective

Limited literature has examined the epidemiology of non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt, a country with one of the highest obesity rates globally. We assessed the prevalence of steatosis and fibrosis among college students in Egypt.

Design

In this cross-sectional study, we recruited students unaware of having fatty liver via a call-for-participation at a private university in the Dakahlia governorate of Egypt. Primary outcomes were the prevalence of steatosis as determined by the controlled attenuation parameter component of transient elastography and fibrosis as determined by the liver stiffness measurement component of transient elastography. Secondary outcomes were clinical parameters and socioeconomic factors associated with the presence and severity of steatosis and fibrosis.

Results

Of 132 participants evaluated for the study, 120 (91%) were included (median (IQR) age, 20 (19–21) years; 65 (54.2%) female). A total of 38 participants (31.6%) had steatosis, among whom 22 (57.9%) had S3 (severe) steatosis. There was a higher risk for steatosis in persons with overweight (adjusted OR 9.67, 95% CI (2.94 to 31.7, p<0.0001) and obesity (adjusted OR 13.87, 95% CI 4.41 to 43.6, p<0.0001) compared with lean persons. Moreover, higher level of parental education was associated with progressing steatosis stages (S1–S3). Six (5%) participants had transient elastography values equivalent to F2–F3 fibrosis (four with F2 fibrosis (≥7.9 kPa), and two with F3 fibrosis (≥8.8 kPa)).

Conclusion

In this cohort of college students in Egypt, around 1 in 3 had steatosis, and 1 in 20 had moderate-to-advanced fibrosis, an established risk factor for hepatic and extrahepatic morbidity and mortality. These data underscore the urgency to address the silent epidemic of NAFLD among young adults in the Middle East-North Africa region.

Dairy Consumption and Cardiometabolic Risk Factors in Patients with Type 2 Diabetes and Overweight or Obesity during Intensive Multidisciplinary Weight Management: A Prospective Observational Study

Dairy products are integral parts of healthy diets; however, their association with cardiometabolic (CM) health among patients with type 2 diabetes (T2D) undergoing weight management is debated. We examined the relationship between dairy consumption and CM biomarkers in 45 subjects with T2D and obesity (mean age 56 ± 9 yrs, 40% female) enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program. After the IMWM program (intervention phase), subjects were followed for 12 weeks (maintenance phase). We stratified subjects based on initial average dairy consumption into infrequent (IFR), less-frequent (LFR), and frequent (FR) consumers. Outcomes were assessed at baseline, 12, and 24 weeks. There were no differences between tertiles at baseline except for higher total energy intake among FR compared with IFR. HbA1c changes showed no association with dairy consumption at 12 or 24 weeks. FR Females achieved greater weight loss at 12 weeks compared with IFR peers (-4.5 kg; 95%CI: -5.5, -3.5). There was a trend towards lower HDL-C with increasing dairy consumption during the intervention phase. In subjects with T2D and overweight or obesity, dairy consumption during weight management is not associated with HbA1c changes but with lower HDL-C and with higher magnitude of weight loss among females.

The role of adipokines in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a complication of pregnancy that is characterized by impaired glucose tolerance with onset or first recognition during pregnancy. The reported prevalence of GDM varies between 0.6% and 20% of pregnancies depending on screening method, gestational age and the population studied. GDM is characterized by pancreatic β-cell function that is insufficient to meet the body's insulin needs. Available evidence suggests that β-cell defects in GDM result from the same spectrum of causes that underline hyperglycemia in general, including autoimmune disease, monogenic causes and insulin resistance. Adipokines are proteins secreted from the adipocytes and are believed to have a metabolic influence. Our review suggests that, in GDM, various adipokines, mainly leptin and adiponectin, are dysregulated. These two adipokines might have both prognostic and pathophysiological significance in this disease.

Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review

BACKGROUND

Over the past few years, there has been a worldwide significant increase in the incidence of type II diabetes mellitus with both increase in morbidity and mortality. Controlling diabetes through life style modifications, including diet and exercise has always been the cornerstone in diabetes management. Increasing evidence suggests that the Mediterranean diet could be of benefit in diseases associated with chronic inflammation, including metabolic syndrome, diabetes, obesity as well as atherosclerosis, cancer, pulmonary diseases, and cognition disorders As a matter of fact, a number of studies addressed the relationship between Mediterranean diet and diabetes control. The result of these studies was conflicting. Some were able to elicit a protective role, while others showed no added benefit. As a result; we decided to conduct a systematic review to have a better understanding of the relationship between adherence to Mediterranean diet and diabetes control.

METHODS

A systematic review was conducted on the effect of Mediterranean diet in diabetes control and cardiovascular risk modification as well as the possible mechanism through which this diet might exhibit its beneficial role. We did a comprehensive search of multiple electronic databases such as Medline, Google Scholars, PubMed, and the Cochrane central register data until May 2014. We included cross-sectional, prospective, and controlled clinical trials that looked at the associations between Mediterranean diet and indices of diabetes control such HbA1c, fasting glucose, and homeostasis model assessment, in addition to cardiovascular and peripheral vascular outcomes.

OUTCOME/CONCLUSION

Most of the studies showed favorable effects of Mediterranean diet on glycemic control and CVD, although a certain degree of controversy remains regarding some issues, such as obesity. Important methodological differences and limitations in the studies make it difficult to compare results, thus further longer term studies are needed to evaluate the long-term efficacy of the Mediterranean diet along with the possibility of explaining its mechanism.

A favorable effect of hydroxychloroquine on glucose and lipid metabolism beyond its anti-inflammatory role

Hydroxychloroquine (HCQ), a commonly used antimalarial drug in rheumatic diseases, has shown favorable metabolic effects on both glucose control and lipid profiles. We describe a case of a young woman with type 1 diabetes whose glycemic control was optimized with the introduction of HCQ as a treatment for her Sjogren syndrome in addition to a subtle yet measurable improvement in her lipid profile. An increasing body of evidence supports the beneficial impacts of HCQ in various ancillary conditions, including diabetes mellitus and dyslipidemia. However, mechanisms of action responsible for these effects remain ill-defined and may include alterations in insulin metabolism and signaling through cellular receptors. These favorable metabolic effects of HCQ and further understanding of underlying mechanisms may provide an additional rational for its use in rheumatic diseases, conditions associated with an elevated cardiovascular risk.

Effect of glucagon-like peptide-1 receptor agonists in patients with psoriasis

Glucagon-like peptide-1 (GLP-1) agonists are a class of drugs used for the treatment of type 2 diabetes mellitus. GLP-1 is released in response to meal intake; these classes of drugs enhance glucose-dependent insulin secretion and exhibit other antihyperglycemic effects following their release into the circulation from the gut. Psoriasis is a chronic skin condition affecting approximately 2% of the Western population. It is considered to be an autoimmune disease that involves the Th1 pathway and is associated with metabolic syndrome and its components, such as obesity, diabetes, and hypertension. We have reviewed reports in the literature that indicate a beneficial anti-inflammatory effect of GLP-1 in patients with diabetes or who have insulin resistance and psoriasis.