B-Mode Ultrasound Grading of Cryptogenic Steatotic Liver Disease and Association with the Level of Sun Exposure in Zaria, Nigeria: A Case-Control Study.
Main Article Content
Keywords
B-mode ultrasound, Grading, Cryptogenic Steatotic Liver Disease, Sun exposure
Abstract
Background: Cryptogenic Steatotic Liver Disease (CSLD) is a novel subject where the liver has significant steatosis but without a known cause or abnormal cardiometabolic risk factors. Its aetiology and associations with sunlight exposure remain underexplored, particularly in Nigeria. CSLD is a growing public health concern in Nigeria, characterized by its potential progression to severe liver complications such as cirrhosis and liver cancer, posing significant health risks. This study aimed to determine the association between CSLD and the level of sun exposure.
Methodology: This case-control study involved 181 healthy subjects with CSLD and an equal number of normal subjects without CSLD as controls. This made for a total number of 362 subjects. They were recruited into the study consecutively as they emerged after clinical, laboratory, and imaging screenings. A liver ultrasound scan was done using a 3.5MHz frequency transducer to screen for the steatotic liver. The severity of liver steatosis was evaluated by ultrasound bright liver scores (BLS). A daily sun exposure score based on our local pattern was calculated using the information from the administered questionnaire. The data were analyzed with GraphPad Prism software version 6.
Results: the median (IQR) age of CSLD and control groups were 44.0 (28.5 - 54.0) and 44.0 (30.0 - 55.0) years. Wilcoxon matched pairs signed rank comparison test showed no significant difference in the ages of the two study groups (p = 0.5578), indicating age matching of the study participants. There was a significant association (χ2 = 59.03, df = 18, p< 0.0001) between age and development of CSLD. One hundred and eighty-one study subjects with CSLD comprised 83 (45.8%) males and 98 (54.1%) females.
The median (IQR) values of the control group's sun exposure score differed significantly from those of the CSLD groups (p = 0.0001) for all categories (mild, moderate, severe steatosis). A multivariate logistic regression analysis model, weighted by years of age and sex, revealed that low sunlight exposure is a significant independent risk factor.
Conclusion: The study shows that limited sun exposure is significantly associated with developing CSLD among Nigerians in Zaria. There is also a significant independent risk factor.
References
2. Rinella, M. E., Lazarus, J. V., Ratziu, V., Francque, S. M., Sanyal, A. J., Kanwal, F., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986.
3. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67:328–57
4. https://web.standford.edu/~kcobb/hrp261/lecture8.ppt.
5. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67:328–57
6. Lupsor-Platon M, Stefanescu H, Mursan D. Non-invasive assessment of liver steatosis using ultrasound methods. Medical Ultrasonography. 2014; 16(3):236-245.
7. Sham L, Yeh EA, Magalhaes S, Para EJ, Gozdzik A. Evaluation of fall sun exposure score in predicting vitamin D status in young Canadian adults, and the influence of ancestry. Journal of Photochemistry & Photobiology B: Biology. 2016;145:25-29.
8. Hanwell HC, Vieth R, Cole DC, Scillitani A, Modoni S. Sun exposure questionnaire predicts circulating 25-hydroxyvitamin D concentrations in Caucasian hospital workers in Southern Italy. The Journal of Steroid Biochemistry and Molecular Biology. 2010; 121:334-337.
9. Williams CD, Stengel J, Asike MI. Prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis among a largely middle-aged population utilising ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124-131.
10. Caballeria L, Pera G, Auladell MA. Prevalence and factors associated with the presence of non-alcoholic fatty liver disease in an adult population in Spain. European Journal of Gastroenterology & Hepatology. 2010; 21:24-32.
11. Kim MK, Ahn CW, Nam JS, Kang S, Park JS, Kim KR et al. Association between non-alcoholic fatty liver disease and coronary artery calcification in postmenopausal women. Menopause. 2015; 22(12):1323-1327.
12. Hamaguchi M, Takeda N, Kojima T,Ohbora A,Kato T, Sarui H et al. Identification of individuals with non-alcoholic fatty liver disease by the diagnostic criteria for the metabolic syndrome. World Journal of Gastroenterology. 2012;18:1508-16.
13. Musso G, Cassader M, Rosina F, Gambino R. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis randomized trials. Diabetologia 2012; 55:885–904.
14. Holick M.F. (2007). Vitamin D deficiency. The New England Journal of Medicine. 357:266-281.
15. Targher, G., Bertolini, L., Scala, L., et al. Serum 25-hydroxyvitamin D levels and NAFLD: A retrospective analysis in a large cohort of adults. Journal of Hepatology. 2015;62(1):48–55.
16. Wang, R., Li, J., Guo, H., et al. Association between vitamin D and NAFLD in adults: A meta-analysis. Nutrients. 2019;11(2): 286.
17. Gorman, S., Khazdouz, M., & Halliday, G. M. Ultraviolet radiation suppresses obesity and symptoms of metabolic syndrome independently of vitamin D in mice fed a high-fat diet. Endocrinology. 2018;159(4):1800–1813.
18. Bellan, M., Aimaretti, G., & Marzullo, P. Effects of vitamin D deficiency on non-alcoholic fatty liver disease: A systematic review. Advances in Therapy. 2020;37(10):4517–4534.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.