Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community

BACKGROUND: Liver disease continues to be a major cause of morbidity and mortality in sub-Saharan Africa, including Nigeria, due to the high endemicity of viral hepatitis B. However non-alcoholic fatty liver disease may be an important contributory factor. The impact of fatty liver disease in our region has not been evaluated. AIM: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD) among a population of diabetic (DM) subjects attending the endocrine clinic of LASUTH compared with non-diabetic subjects; ascertain other contributing factors and compare the occurrence of the metabolic syndrome in subjects with and without NAFLD. METHODOLOGY: Consecutive patients who satisfy the study criteria were enrolled. An investigator- administered questionnaire was used to determine symptoms of liver disease, followed by physical examination to obtain anthropometric indices as well as signs of liver disease. Abdominal scan was performed to determine radiologic evidence of fatty liver and fasting blood samples were collected from for the measurement of fasting lipid profile, glucose, liver biochemistry and serology for hepatitis B and C markers. RESULTS: One hundred and fifty subjects, mean age 56 years (standard deviation = 9, range 20-80 yr) and gender ratio (F: M) of 83:67(55%:45%), were recruited. 106 were diabetics and 44 non-diabetics. The overall prevalence of NAFLD amongst all study subjects was 8.7%. The prevalence rate of NAFLD was higher in the DM cases than in the Control subjects but this difference was not statistically significant (9.5 vs. 4.5%, p = 0.2). Only one of the subjects with fatty liver disease had elevated transaminase levels (steatohepatitis) and also had type 2 DM. Central obesity as measured by waist circumference (WC) and SGPT levels were significantly higher in people with fatty liver. The mean body mass index (BMI) of diabetic and non-diabetic patients was similar (31 vs. 30 kg/m(2)). The prevalence of the metabolic syndrome was higher in the subjects with NAFLD than in those without fatty liver disease but this difference was not statistically significant (p = 0.8). CONCLUSION: Non-alcoholic fatty liver disease is present in Africa but is less than what one would expect based on American and European studies.