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. 2021 Oct;8(1):e000780.
doi: 10.1136/bmjgast-2021-000780.

Prevalence of and risk factors for non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt

Shaheen Tomah  1   2 , Osama Hamdy  3   2 , Megahed M Abuelmagd  4 , Attia H Hassan  5 , Naim Alkhouri  6 , Marwa R Al-Badri  3   2 , Hannah Gardner  3 , Ahmed H Eldib  3   2 , Elsayed A Eid  5
Affiliations

Prevalence of and risk factors for non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt

Shaheen Tomah et al. BMJ Open Gastroenterol. 2021 Oct.

Abstract

Objective: Limited literature has examined the epidemiology of non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt, a country with one of the highest obesity rates globally. We assessed the prevalence of steatosis and fibrosis among college students in Egypt.

Design: In this cross-sectional study, we recruited students unaware of having fatty liver via a call-for-participation at a private university in the Dakahlia governorate of Egypt. Primary outcomes were the prevalence of steatosis as determined by the controlled attenuation parameter component of transient elastography and fibrosis as determined by the liver stiffness measurement component of transient elastography. Secondary outcomes were clinical parameters and socioeconomic factors associated with the presence and severity of steatosis and fibrosis.

Results: Of 132 participants evaluated for the study, 120 (91%) were included (median (IQR) age, 20 (19-21) years; 65 (54.2%) female). A total of 38 participants (31.6%) had steatosis, among whom 22 (57.9%) had S3 (severe) steatosis. There was a higher risk for steatosis in persons with overweight (adjusted OR 9.67, 95% CI (2.94 to 31.7, p<0.0001) and obesity (adjusted OR 13.87, 95% CI 4.41 to 43.6, p<0.0001) compared with lean persons. Moreover, higher level of parental education was associated with progressing steatosis stages (S1-S3). Six (5%) participants had transient elastography values equivalent to F2-F3 fibrosis (four with F2 fibrosis (≥7.9 kPa), and two with F3 fibrosis (≥8.8 kPa)).

Conclusion: In this cohort of college students in Egypt, around 1 in 3 had steatosis, and 1 in 20 had moderate-to-advanced fibrosis, an established risk factor for hepatic and extrahepatic morbidity and mortality. These data underscore the urgency to address the silent epidemic of NAFLD among young adults in the Middle East-North Africa region.

Keywords: hepatic fibrosis; nonalcoholic steatohepatitis; obesity.

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Conflict of interest statement

Competing interests: ST reports consulting for Research America and stock ownership in Amarin corp. outside the submitted work. NA is on advisory board/review panel for 89Bio, Echosens, Fibronostics, Gilead, Intercept, Novo Nordisk, Perspectum, Pfizer and Zydus, received grant/research support from 89Bio, Akero, Bristol Myers Squibb, Galectin, Genentech, Gilead, Intercept, Ionis, Madrigal, Metacrine, NGM Bio, Novo Nordisk, Pfizer, Viking and Zydus, and is speaker for AbbVie, Alexion, Echosens, Gilead, and Intercept. OH reports consultation to Abbott Nutrition, Merck Serono and Sanofi Aventis, received research support from Novo-Nordisk, Eli Lilly, National Dairy Council, and Gilead, and is on the advisory board of L-Nutra and Twin. He is also shareholder of Heathimation Inc. MA, AH, MA-B, HG, AE and EAE have no disclosures relevant to this work.

Figures

Figure 1
Figure 1
Body mass index categories across steatosis stages. Percentages represent the proportion of obese participants in each stage. N=120.
See this image and copyright information in PMC

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