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      The Prevalence of Non-alcoholic Fatty Liver Disease and Diabetes Mellitus in an Iranian Population

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          Abstract

          BACKGROUND

          Type II diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD.

          METHODS

          In this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran (N=6143). The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin.

          RESULTS

          In men, the prevalence (95% confidence interval) of T2DM was 5.34% (4.35%-6.34%) and 15.06% (13.12%-17.00%) in individuals without and with NAFLD, respectively (p <0.001). In women without NAFLD, the prevalence was 8.27% (6.83%-9.71%) while in the presence of NAFLD, the prevalence was 27.21% (24.59%-29.83%), (p <0.001). In univariate analysis, the chance of having T2DM was 3.700 (3.130-4.380) times more in patients with NAFLD compared with subjects without NAFLD (p<0.001). This chance was reduced (Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001) after removing the effects of other variables.

          CONCLUSION

          The prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM.

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          Insulin resistance: a metabolic pathway to chronic liver disease.

          Elisabetta Bugianesi, Arthur McCullough, Giulio Marchesini (2005)
          Insulin resistance (IR) is the pathophysiological hallmark of nonalcoholic fatty liver disease (NAFLD), one of the most common causes of chronic liver disease in Western countries. We review the definition of IR, the methods for the quantitative assessment of insulin action, the pathophysiology of IR, and the role of IR in the pathogenesis of chronic liver disease. Increased free fatty acid flux from adipose tissue to nonadipose organs, a result of abnormal fat metabolism, leads to hepatic triglyceride accumulation and contributes to impaired glucose metabolism and insulin sensitivity in muscle and in the liver. Several factors secreted or expressed in the adipocyte contribute to the onset of a proinflammatory state, which may be limited to the liver or more extensively expressed throughout the body. IR is the common characteristic of the metabolic syndrome and its related features. It is a systemic disease affecting the nervous system, muscles, pancreas, kidney, heart, and immune system, in addition to the liver. A complex interaction between genes and the environment favors or enhances IR and the phenotypic expression of NAFLD in individual patients. Advanced fibrotic liver disease is associated with multiple features of the metabolic syndrome, and the risk of progressive liver disease should not be underestimated in individuals with metabolic disorders. Finally, the ability of insulin-sensitizing, pharmacological agents to treat NAFLD by reducing IR in the liver (metformin) and in the periphery (thiazolidinediones) are discussed.
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            Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography.

            Henry Lik-Yuen Chan, Angel Mei-Ling Chim, Jennifer Ong … (2012)
            Knowledge of the epidemiology of non-alcoholic fatty liver disease (NAFLD) is incomplete because liver biopsy cannot be performed on the general population to assess disease severity. New non-invasive tests allow accurate and safe assessment in healthy individuals. The aim of this study was to examine the prevalence of NAFLD and advanced fibrosis in the general Hong Kong Chinese population. Subjects were recruited from the community by random selection from the government census database. Liver fat and fibrosis were assessed by proton-magnetic resonance spectroscopy and transient elastography, respectively. Overall, 264 of 922 (28.6%) subjects had intrahepatic triglyceride content ≥5%. Excluding 12 subjects with significant alcohol consumption, the population prevalence of NAFLD was 27.3% (95% CI 24.5% to 30.2%). Each component of the metabolic syndrome increased the risk of fatty liver in a dose-dependent manner (prevalence of 4.5% in subjects without any component and 80.0% in those with all five components). 8 (3.7%) patients with fatty liver had liver stiffness ≥9.6 kPa, a level suggestive of advanced fibrosis. Body mass index and alanine aminotransferase level were independent factors associated with liver stiffness. Together with other clinical prediction scores, the estimated prevalence of advanced fibrosis in patients with fatty liver in the community was <10%. Compared with non-drinkers, modest drinkers (<10 g per day) did not have higher risk of fatty liver after adjustment for demographic and metabolic factors. The liver stiffness was 4.7±1.9 kPa in modest drinkers and 4.6±1.7 kPa in non-drinkers (p=0.54). NAFLD is found in over a quarter of the general adult Chinese population, but the proportion of patients with advanced fibrosis is low. Modest alcohol consumption does not increase the risk of fatty liver or liver fibrosis.
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              Prevalence of Depression among University Students: A Systematic Review and Meta-Analysis Study

              Diana Sarokhani, Ali Delpisheh, Yousef VEISANI … (2013)
              Introduction. Depression is one of the four major diseases in the world and is the most common cause of disability from diseases. The aim of this study is to estimate the prevalence of depression among Iranian university students using meta-analysis method. Materials and Methods. Keyword depression was searched in electronic databases such as PubMed, Scopus, MAGIran, Medlib, and SID. Data was analyzed using meta-analysis (random-effects model). Heterogeneity of studies was assessed using the I 2 index. Data was analyzed using STATA software Ver.10. Results. In 35 studies conducted in Iran from 1995 to 2012 with sample size of 9743, prevalence of depression in the university students was estimated to be 33% (95% CI: 32–34). The prevalence of depression among boys was estimated to be 28% (95% CI: 26–30), among girls 23% (95% CI: 22–24), single students 39% (95% CI: 37–41), and married students 20% (95% CI: 17–24). Metaregression model showed that the trend of depression among Iranian students was flat. Conclusions. On the whole, depression is common in university students with no preponderance between males and females and in single students is higher than married ones.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Middle East J Dig Dis
                Journal ID (iso-abbrev): Middle East J Dig Dis
                Journal ID (publisher-id): Middle East J Dig Dis
                Journal ID (publisher-id): MEJDD
                Title: Middle East Journal of Digestive Diseases
                Publisher: Iranian Association of Gastroerterology and Hepatology
                ISSN (Print): 2008-5230
                ISSN (Electronic): 2008-5249
                Publication date (Print): April 2017
                Volume: 9
                Issue: 2
                Pages: 86-93
                Affiliations
                1Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
                2Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
                3Department of Virology, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                [* ] Corresponding Author: Farhad Zamani, MD Professor of Medicine, Department of Gastroenterology, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran. Tel: + 98 2188940489 fax: + 98 2182141201 zamani.farhad@ 123456gmail.com
                Article
                DOI: 10.15171/mejdd.2017.56
                PMC ID: 5471107
                PubMed ID: 28638584
                SO-VID: 281f8a7d-29bf-462c-a722-33b71e698e4b
                Copyright © © 2017 by Middle East Journal of Digestive Diseases
                License:

                This work is published by Middle East Journal of Digestive Diseases as an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-sa/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.

                History
                Date received : 26 November 2016
                Date accepted : 28 February 2017
                Page count
                Figures: 1, Tables: 3, References: 40, Pages: 8
                Categories
                Subject: Original Article

                Keywords: non-alcoholic fatty liver disease,diabetes mellitus,non-communicable disease,prevalence,iran
                Data availability:
                Keywords: non-alcoholic fatty liver disease, diabetes mellitus, non-communicable disease, prevalence, iran

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