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

Spearman, C Wendy; Afihene, Mary; Betiku, Omolade; Bobat, Bilal; Cunha, Lina; Kassianides, Chris; Katsidzira, Leolin; Mekonnen, Hailemichael Desalegn; Ocama, Ponsiano; Ojo, O. O.; Paruk, Imran; Tzeuton, Christian; Sonderup, Mark

doi:10.1016/s2468-1253(21)00275-2

Cited by 30 publications

(27 citation statements)

References 121 publications

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“…Fatty liver refers to abnormal lipid accumulation in the parenchymal cells of the liver ( 16 ). NAFLD is defined as liver steatosis of more than 5% unrelated to other causes such as alcohol intake, intake of certain drugs, or other established liver disease ( 17 ). NASH is considered the progressive form of NAFLD and is characterized by liver steatosis, inflammation, hepatocellular injury and different degrees of fibrosis ( 3 ).…”

Section: Methodsmentioning

confidence: 99%

Changes in the global, regional, and national burdens of NAFLD from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

Wang

Zhu

et al. 2022

Front. Nutr.

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BackgroundUnderstanding the burdens and trends of non-alcoholic fatty liver disease (NAFLD) is necessary for developing effective intervention strategies. In this study, Global Burden of Disease (GBD) 2019 study data were extracted and analyzed to elucidate trends of NAFLD.MethodsThe prevalence, incidence, disability-adjusted life year (DALY), and death rates of NAFLD in geographic populations worldwide from 1990 to 2019 were extracted from the GBD 2019 study data. The global temporal trend of NAFLD from 1990 to 2019 was evaluated using estimated annual percentage changes (EAPCs) and age-standardized rates.ResultsGlobally, between 1999 and 2019, the age-standardized prevalence rate of NAFLD increased, with EAPCs of 0.77 [95% CI (0.69, 0.85)], whereas the DALY and Death rates decreased, with EAPCs of –0.82 [95% CI (–0.92, –0.71)], and –0.67 [95% CI (–0.76, –0.58)], respectively. Geographically, the age-standardized prevalence rate showed the most serious upward trend in high-income North America with an EAPC of 0.98 [95% CI (0.95, 1.02)], and the age-standardized incidence rate showed an upward trend in Central Asia with an EAPC of 3.17 [95% CI (2.2, 2.49)]. The most significant upward trend of DALY and death rates appeared in Eastern Europe, with EAPCs of 4.06 [95% CI (3.31, 4.82)], and 3.36 [95% CI (2.77, 3.96)], respectively. At the country level, the age-standardized rates showed an upward trend in Armenia, Belarus, and Republic of Korea. Regarding age groups, the percentage change of prevalence was the highest in the 40 to 44 group [0.29 (0.26, 0.34)] from 1990 to 2019; the percentage change of incidence was the highest in the 85 to 89 group [0.46 (0.12, 0.71)] from 1990 to 2019; the percentage change of DALY was the highest in the 80 to 84 group [0.25 (0.11, 0.39)] from 1990 to 2019; and the percentage change of death rate was the highest in the 15 to 19 group [0.36 (0.17, 0.60)] from 1990 to 2019. The percentage change of prevalence of liver cancer due to NASH was the highest in the group of 85 to 89, whereas those of incidence, DALY, and death were the highest in the group above 95 from 1990 to 2019. Regarding the sociodemographic index (SDI), the highest age-standardized prevalence, incidence, and Death rates of NAFLD occurred in middle-SDI countries, and the highest DALY rates of NAFLD occurred in low-SDI countries.ConclusionGlobal NAFLD burdens have increased since 1990. Our findings provide a reference for policymakers to reduce the burden of NAFLD, especially in middle and low-SDI countries.

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Section: Methodsmentioning

confidence: 99%

Changes in the global, regional, and national burdens of NAFLD from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

Wang

Zhu

et al. 2022

Front. Nutr.

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“…[5] There are scarce data on NAFLD in populations living with HIV in sub-Saharan Africa, although rates of obesity, hypertension, dyslipidemia, and impaired glucose tolerance and diabetes are rising in the region. [6,7] Two studies from South Africa investigated selected patients with HIV who had undergone a liver biopsy for various care indications and reported liver steatosis in 19% and 28%, respectively. [8,9] In three studies from Western Africa, the prevalence of liver steatosis by liver ultrasound scan ranged between 13% and 28%.…”

Section: Introductionmentioning

confidence: 99%

Liver steatosis and fibrosis in people with human immunodeficiency virus in West Africa and the relationship with hepatitis B virus coinfection

et al. 2022

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There is a heavy burden of liver disease in West Africa. While the role of hepatitis B virus (HBV) infection is well recognized, less is known about the contributing role of liver steatosis and how the two interact in the context of human immunodeficiency virus (HIV) infection. Adults with HIV in Ghana underwent FibroScan measurements to determine prevalence of liver steatosis (expressed as controlled attenuation parameter [CAP]) and fibrosis (expressed as liver stiffness [LS]). We explored contributing factors in linear regression models, including demographics, lifestyle characteristics, medical history, HIV and HBV status, and measurements of metabolic syndrome.Among 329 adults (72.3% women; median age, 47 years), 322 (97.9%) were on antiretroviral therapy (median duration, 8.9 years). CD4 counts were preserved (median, 619 cells/mm 3 ); plasma HIV RNA was fully suppressed in 162 (50.3%) of the treated participants. Cigarette smoking, excessive alcohol consumption, and use of traditional or herbal remedies were uncommon (6.1%, 1.8%, 3.3%, respectively). Largely undiagnosed metabolic syndrome was detected in 87 (26.4%) participants. We obtained readings indicative of

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“…In Africa, the estimated NAFLD prevalence for the general population is also likely to be very high, given the rising prevalence of obesity and type 2 diabetes. Thus, well‐designed epidemiological studies that screen for NAFLD in the general population are needed to assess the true paediatric NAFLD prevalence 30 . These geographic differences may reflect a lingering cultural impact on dietary habits despite economic globalisation, with increasing consumption of refined sugars, foods and additives that add calories 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, well-designed epidemiological studies that screen for NAFLD in the general population are needed to assess the true paediatric NAFLD prevalence. 30 These geographic differences may reflect a lingering cultural impact on dietary habits despite economic globalisation, with increasing consumption of refined sugars, foods and additives that add calories. 31 We suspect that variation in ethnicities, lifestyle, employment status, educational level, community socio-economic status (income) and access to healthcare and subspecialty care may all be associated with the prevalence of NAFLD through various pathways.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis: global prevalence, trend and forecasting of non‐alcoholic fatty liver disease in children and adolescents, 2000–2021

Rui

et al. 2022

Aliment Pharmacol Ther

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Summary Background NAFLD is increasing in children. Aims To determine the recent trend and forecast the future global prevalence of paediatric NAFLD Methods We searched PubMed, Embase, Web of Science and Cochrane library databases from inception to 1 May 2021 for studies of children and adolescents (≤21 years) with NAFLD. Obesity was defined with weight at ≥95th percentile and overweight as 85th to <95th percentile as per the Center for Disease Control BMI‐for‐age percentile cut‐offs. Results From 3350 titles and abstracts, we included 74 studies (276,091 participants) from 20 countries/regions. We included 14 studies in the general NAFLD prevalence analysis, yielding an overall prevalence of 7.40% (95% CI: 4.17–12.81) regardless of the diagnostic method, and 8.77% (95% CI: 3.86–18.72) by ultrasound. Among continents with more than one study, the prevalence of NAFLD was 8.53% (95% CI: 5.71–12.55) for North America, 7.01% (95% CI: 3.51–13.53) for Asia, and 1.65% (95% CI: 0.97–2.80) for Europe. NAFLD prevalence regardless of the diagnostic method was 52.49% (95% CI: 46.23–58.68, 9159 participants) and 39.17% (95% CI: 30.65–48.42, 5371 participants) among obese and overweight/obese participants, respectively. For the general population, trend analysis from 2000 to 2017 indicates an increasing global prevalence of paediatric NAFLD from 4.62% to 9.02% at a yearly increase of 0.26%, whereas forecast analysis predicts a prevalence of 30.7% by 2040. Conclusion The prevalence of paediatric NAFLD varies by region and is 52.49% overall among the obese population and 7.40% in the general population. It is predicted to reach 30.7% by 2040.

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

Cited by 30 publications

References 121 publications

Changes in the global, regional, and national burdens of NAFLD from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

Changes in the global, regional, and national burdens of NAFLD from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

Liver steatosis and fibrosis in people with human immunodeficiency virus in West Africa and the relationship with hepatitis B virus coinfection

Meta‐analysis: global prevalence, trend and forecasting of non‐alcoholic fatty liver disease in children and adolescents, 2000–2021

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