Prevalence of Ultrasound-diagnosed Non Alcoholic Fatty Liver Disease Among Rural Indigenous Population in Malaysian and Its Association With Biochemical and Anthropometric Measures

Main Article Content

Abdul Sattar AK
Subapriya Suppiah
Ramlah Mohamad Ibrahim
Nurul Nadiah Mohamed Nasir
Norafida Bahari
Hasyma Abu Hassan
Suraini Mohammad Saini
Idris Ibrahim
Mohd Hazeman Zakaria
Rozi Mahmud

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease world- wide, especially in the Western world and Asia-Pacific regions. This study was designed to determine the prevalence of NAFLD detected by sonographic assessment among the rural indigenous population in Peninsula Malaysia and its association with anthropometric and biochemical factors. Methods: A cross-sectional survey was carried out from January 2014-February 2016. Subjects were recruited among indigenous peninsula Malaysia population in rural villages, aged ³18 years old. The survey was questionnaire-based followed by anthropometric and blood parame- ters measurements. All subjects underwent abdominal ultrasound assessment to screen for the presence of NAFLD. Semi-quantitative visual grading was performed to assess for mild, moderate or severe NAFLD. Results: A total of 270 subjects underwent the screening program (mean age 43.3 ±14.0 years). Approximately 53 subjects (19.6 %) were identified with NAFLD. Of those with NAFLD, approximately 83% had moderate grade of fatty liver and the remainder were diagnosed with mild grade. NAFLD was closely associated with age, body mass index (BMI), central obesity, hypertension, total cholesterol (TC), triglyceride/high density lipoprotein-cholesterol (TG/HDL-C) ratio. On multivariate logistic regression, a high BMI (>23.0 kg/m2), central obesity, and raised TG/HDL-C ratio were indepen- dent risk factors for developing NAFLD. Conclusion: This pioneer study defines the prevalence of NAFLD among rural indigenous population in Peninsula Malaysia. Lifestyle-related diseases, such as NAFLD can affect both rural and urban communities with equal severity. High BMI, central obesity, and elevated TG/HDL-C ratio were independent risk factors for developing NAFLD.

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AK, A. S., Suppiah, S., Mohamad Ibrahim, R., Mohamed Nasir, N. N., Bahari, N., Abu Hassan, H., Mohammad Saini, S., Ibrahim, I., Zakaria, M. H., & Mahmud, R. (2021). Prevalence of Ultrasound-diagnosed Non Alcoholic Fatty Liver Disease Among Rural Indigenous Population in Malaysian and Its Association With Biochemical and Anthropometric Measures. Malaysian Journal of Medicine and Health Sciences, 17(3), 88–97. Retrieved from http://mjmhsojs.upm.edu.my/index.php/mjmhs/article/view/414
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References

Ozturk, Z. A., & Kadayifci, A. Insulin sensitizers for the treatment of non-alcoholic fatty liver disease. World Journal of Hepatology. 2014; 6(4): 199-06.

Diehl, A., Goodman, Z., & Ishak, K. Alcohollike liver disease in nonalcoholics: a clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology. 1988; 95(4): 1056-62.

Ludwig, J., Viggiano, T. R., McGill, D. B., & Oh, B. J. Nonalcoholic steatohepatitis: Mayo clinic experiences with a hitherto unnamed disease. Mayo Clinic Proceedings. 1980; 55(7): 434-8.

Li, N., Zhang, G., Zhang, J., Jin, D., Li, Y., & Liu, T. Non-alcoholic fatty liver disease is associated with progression of arterial stiffness. Nutrition, Metabolism and Cardiovascular Diseases. 2015; 25(2): 218-23.

Cave M, Deaciuc I, Mendez C, Song Z, Joshi-Barve S, Barve S, et al. Nonal¬coholic fatty liver disease: predisposing factors and the role of nutrition. J Nutr Biochemist. 2007; 18 (3): 184-95.

Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M. Preva¬lence of fatty liver in a general population of Okinawa, Japan. Jpn J Med. 1988; 27 (2): 142-9.

Park Sh, Jeon Wk, Kim Sh, Kim Hj, Park Di, Cho Yk, et al. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. Journal of gastroenterology and hepatology. 2006; 21 (1): 138-43.

Shen L, Fan JG, Shao Y, Zeng MD, Wang JR, Luo GH, et al. Prevalence of nonalcoholic fatty liver among administrative officers in Shanghai: an epidemiological survey. World Journal of Gastroenterology: 2003; 9(5): 1106-1110.

Fan Jg, Zhu J, Li Xj, Chen L, Lu Ys, Li L, et al. Fatty liver and the metabolic syndrome among Shanghai adults. Journal of gastroenterology and hepatology. 2005; 20(12):1825-32.

Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. Clinical, biochemical and histological profile of nonalcoholic steatohepatitis. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology. 2001;20 (5):183-6.

Chen CH, Huang MH, Yang JC, Nien CK, Yang CC, Yeh YH, et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. Journal of clinical gastroenterology. 2006;40(8):745-52.

Goh SC, Ho EL, Goh KL. Prevalence and risk factors of non-alcoholic fatty liver disease in a multiracial suburban asian population in Malaysia. Hepatology International. 2013; 7(2): 548-54.

Lee S, Jin Kim Y, Yong Jeon T, Hoi Kim H, Woo Oh S, Park Y, et al. Obesity is the only independent factor associated with ultrasound-diagnosed non- alcoholic fatty liver disease: a cross-sectional case-control study. Scandinavian journal of gastroenterology. 2006; 41(5):566-72.

Suppiah S, Chow LR, Sazali NS, Hassan HA. Non-alcoholic Fatty Liver Disease in Metabolic Syndrome Patients in Serdang Hospital: Quantification by Contrast-Enhanced Computed Tomography. Malaysian Journal of Medicine and Health Sciences. 2016; 12(1):9-18.

Tchelepi H, Ralls PW, Radin R, Grant E. Sonography of diffuse liver disease. Journal of Ultrasound in Medicine. 2002; 21(9):1023-32.

World Health Organisation (WHO), Interna¬tional Association for the Study of Obesity, International Obesity Task Force (IOTF). The Asia-Pacific perspective: Redefining obesity and its treatment. Sydney: Health Communications, 2000.

Khammas ASA, Abu Hassan H, Mohamad Ibrahim R, Mohamad Nasir NN, Bahari N, et al. Sonographic assessment of renal size and its correlation with anthropometric measures among indigenous population in peninsular Malaysia. Malaysian Journal of Medicine and Health Sciences. 2020;16(4): 138-45.

National Cholesterol Education Program (NCEP): Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III) final report (2002). Circulation, 106, 3143.

Ministry of Health (MOH) Malaysia. Malaysia clinical practice guideline on management of type II diabetes mellitus. 4th ed. Kuala Lumpur: MOH, 2009.

Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease: A road less travelled. Indian Journal of Endocrinology and Metabolism. 2013; 17(6): 990-5.

Farrell GC, Chitturi S, Lau GK, Sollano JD. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia– Pacific region: Executive summary. Journal of gastroenterology and hepatology. 2007; 22(6): 775-7.

Gerstenmaier JF, Gibson RN. Ultrasound in chronic liver disease. Insights into Imaging. 2014; 5(4): 441-55.

Ekstedt M, Franzén LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, et al. Long-term follow- up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006; 44(4): 865-73.

Maheshwari A, Thuluvath PJ. Cryptogenic cirrhosis and NAFLD: are they related? The American journal of gastroenterology. 2006; 101(3), 664-8.

Page JM, Harrison SA.. Nash and HCC. Clinics in liver disease. 2009; 13(4): 631-47.

Chitturi S, Farrell GC, Hashimoto E, Saibara T, Lau GK, Sollano JD. Non-alcoholic fatty liver disease in the Asia–Pacific region: Definitions and overview of proposed guidelines. Journal of Gastroenterology and Hepatology. 2007; 22(6): 778-87.

Li N, Zhang GW, Zhang JR, Jin D, Li Y, Liu T. Non-alcoholic fatty liver disease is associated with progression of arterial stiffness. Nutrition, Metabolism and Cardiovascular Diseases. 2015; 25(2): 218-23.

Wah-Kheong C, Khean-Lee G. Epidemiology of a fast emerging disease in the asia-pacific region: Non-alcoholic fatty liver disease. Hepatology International. 2013; 7(1): 65-71.

Chan WK, Tan AT, Vethakkan SR, Tah PC, Vijayananthan A, Goh KL. Non-alcoholic fatty liver disease in diabetics–prevalence and predictive factors in a multiracial hospital clinic population in Malaysia. Journal of gastroenterology and hepatology. 2013; 28(8): 1375-83.

Cheah WL, Lee PY, Chang CT, Mohamed HJ, Wong SL. Prevalence of ultrasound diagnosed non- alcoholic fatty liver disease among rural indigenous community of Sarawak and its association with biochemical and anthropometric measures. Southeast Asian Journal of Tropical Medicine and Public Health. 2013; 44(2): 309-17.

Hallsworth K, Thoma C, Moore S, Ploetz T, Anstee QM, Taylor R, et al. Non-alcoholic fatty liver disease is associated with higher levels of objectively measured sedentary behaviour and lower levels of physical activity than matched healthy controls. Frontline Gastroenterology. 2015; 6 (1): 444-51

Lv WS, Sun RX, Gao YY, Wen JP, Pan RF, Li L, et al. Nonalcoholic fatty liver disease and microvascular complications in type 2 diabetes. World Journal of Gastroenterology. 2013; 19(20): 3134-42.

Rampal L, Rampal S, Khor GL, Zain AM, Ooyub SB, Rahmat RB, et al. A national study on the prevalence of obesity among 16,127 Malaysians. Asia Pacific journal of clinical nutrition. 2007;16(3): 561-6.

Lau K, Lorbeer R, Haring R, Schmidt CO, Wallaschofski H, Nauck M, The association between fatty liver disease and blood pressure in a population-based prospective longitudinal study. Journal of hypertension. 2010; 28(9), 1829-35.

Liao XH, Cao X, Liu J, Xie XH, Sun YH, Zhong BH. Prevalence and features of fatty liver detected by physical examination in Guangzhou. World Journal of Gastroenterology. 2013; 19(32): 5334-9.

Park HY, Jhun BW, Jeong HJ, Chon HR, Koh WJ, Suh GY, et al. The Complex Association of Metabolic Syndrome and Its Components with Computed Tomography–Determined Emphysema Index. Metabolic syndrome and related disorders. 2015; 13(3): 132-9.

Lee L, Alloosh M, Saxena R, Van Alstine W, Watkins BA, Klaunig JE, et al. Nutritional model of steatohepatitis and metabolic syndrome in the ossabaw miniature swine. Hepatology. 2009; 50(1): 56-67.

DeFilippis AP, Blaha MJ, Martin SS, Reed RM, Jones SR, Nasir K, et al. Nonalcoholic fatty liver disease and serum lipoproteins: The Multi-ethnic study of atherosclerosis. Atherosclerosis. 2013; 227(2): 429-36.

Wu KT, Kuo PL, Su SB, Chen YY, Yeh ML, Huang CI, et al. Nonalcoholic fatty liver disease severity is associated with the ratios of total cholesterol and triglycerides to high-density lipoprotein cholesterol. Journal of clinical lipidology. 2016; 10(2): 420-5.

Quispe R, Manalac RJ, Faridi KF, Blaha MJ, Toth PP, Kulkarni KR, et al. Relationship of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to the remainder of the lipid profile: The very large database of lipids-4 (VLDL-4) study. Atherosclerosis. 2015; 242(1): 243-50.

Loomba R, Abraham M, Unalp A, Wilson L, Lavine J, Doo E, et al. Association between diabetes, family history of diabetes, and risk of nonalcoholic steatohepatitis and fibrosis. Hepatology. 2012; 56(3): 943-51.

Cheng HY, Wang HY, Chang WH, Lin SC, Chu CH, Wang TE, et al. Nonalcoholic fatty liver disease: Prevalence, influence on age and sex, and relationship with metabolic syndrome and insulin resistance. International Journal of Gerontology. 2013; 7(4): 194-8.

Cheng HY, Wang HY, Chang WH, Lin SC, Chu CH, Wang TE, et al. Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: Is metabolic syndrome the culprit? Arab Journal of Gastroenterology. 2015; 16(2), 54-58

Ma H, Xu C, Xu L, Yu C, Miao M, Li Y. Independent association of HbA1c and nonalcoholic fatty liver disease in an elderly Chinese population. BMC gastroenterology. 2013; 13(1), 1-6

Fan JG, Zhu J, Li XJ, Chen L, Li L, Dai F, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. Journal of hepatology. 2005; 43(3), 508-14

Sen A, Kumar J, Misra RP, Uddin M, Shukla PC. Lipid profile of patients having non-alcoholic fatty liver disease as per ultrasound findings in north indian population: A retrospective observational study. Journal of Medical & Allied Sciences. 2013; 3(2), 59-62

Williamson RM, Perry E, Glancy S, Marshall I, Gray C, Nee LD, et al.. The use of ultrasound to diagnose hepatic steatosis in type 2 diabetes: Intra-and interobserver variability and comparison with magnetic resonance spectroscopy. Clinical Radiology. 2011; 66(5), 434-39.