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Gantzel RH, Bagge CN, Villadsen GE, Rex KF, Grønbæk H, Pedersen ML. The prevalence and disease course of autoimmune liver diseases in Greenland. Int J Circumpolar Health 2024; 83:2327693. [PMID: 38465864 DOI: 10.1080/22423982.2024.2327693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024] Open
Abstract
Autoimmune liver diseases are rare serious diseases causing chronic inflammation and fibrosis in the liver parenchyma and bile ducts. Yet, the prevalence and burden of autoimmune liver diseases are largely unexplored in Arctic native populations. We investigated the prevalence and management of autoimmune liver diseases in Greenland using nationwide cross-sectional register data and subsequent medical chart reviews validating diagnoses and extracting liver histology examinations and medical treatments. The overall prevalence of autoimmune liver diseases in Greenland was 24.6 per 100,000 (95% CI: 14.7-41.3). This was based on 7 patients with autoimmune hepatitis (AIH) (12.3 per 100,000), 3 patients with primary biliary cholangitis (PBC) (5.3 per 100,000), 4 patients with AIH/PBC overlap disease (7.0 per 100,000), and no patients with primary sclerosing cholangitis. All diagnoses were confirmed by liver histology examinations. Medical treatments adhered to internal recommendations and induced complete remission in most patients with AIH, and complete or partial remission in 1 patient with PBC and 3 patients with AIH/PBC overlap disease. One patient had established cirrhosis at the time of diagnosis, while 2 patients progressed to cirrhosis. In conclusion, the prevalence of autoimmune liver diseases was lower in Greenland than in Scandinavia and among Alaska Inuit.
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Affiliation(s)
- Rasmus Hvidbjerg Gantzel
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Medicine, Regional Hospital Gødstrup, Herning, Denmark
| | - Carina Nørskov Bagge
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Gerda Elisabeth Villadsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Muhammad AG, Hansen FO, Gantzel RH, Rex KF, Villadsen GE, Grønbæk H, Pedersen ML. Non-alcoholic fatty liver disease in patients with type 2 diabetes in Greenland: a register-based cross-sectional study. Int J Circumpolar Health 2022; 81:2065755. [PMID: 35440282 PMCID: PMC9037206 DOI: 10.1080/22423982.2022.2065755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide due to its close association to the metabolic syndrome of type 2 diabetes mellitus (T2DM), obesity and insulin resistance. However, the prevalence and severity of NAFLD in Greenland remain unexplored. We aimed to estimate the prevalence of liver steatosis and fibrosis among Greenlanders and Danes with T2DM living in Greenland using biochemical surrogate markers. We included 1409 Greenlanders and 182 Danes with T2DM in this register-based cross-sectional study. Greenlanders had higher BMI and plasma lipid levels and lower HbA1c levels compared with Danes (p<0.05). Their median alanine aminotransferase (ALAT) levels were similar. However, more Greenlanders had elevated ALAT levels (20.5% vs. 11.5%, p<0.05). Greenlanders had lower FIB-4 scores than Danes, 0.91 (IQR: 0.66–1.27) vs. 0.97 (IQR: 0.78–1.34), without difference in FIB-4 score categories (p=0.27). The prevalence of advanced fibrosis was low in both populations (1.7–2.6%). In conclusion, Greenlanders with T2DM had better glycaemic control despite higher BMI and plasma lipids. A larger proportion of Greenlanders had elevated plasma ALAT levels, while FIB-4 scores were lower than Danes. These findings suggest that Greenlanders with T2DM may be less likely to develop liver complications than Danes with T2DM in Greenland.
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Affiliation(s)
- Abdullah Ghassan Muhammad
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Frederik Orm Hansen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Rasmus Hvidbjerg Gantzel
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Gerda Elisabeth Villadsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland.,Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Rex KF, Krarup HB, Laurberg P, Andersen S. Liver biochemistry and associations with alcohol intake, hepatitis B virus infection and Inuit ethnicity: a population-based comparative epidemiological survey in Greenland and Denmark. Int J Circumpolar Health 2016; 75:29528. [PMID: 26928535 PMCID: PMC4772703 DOI: 10.3402/ijch.v75.29528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Hepatitis B virus (HBV) infection is common in Arctic populations and high alcohol intake has been associated with an increased risk of a number of diseases. Yet, a description of the influence of alcohol intake in persons with HBV infection on liver biochemistry is lacking. Objective We aimed to describe the association between reported alcohol intake and liver biochemistry taking into account also HBV infection, ethnicity, Inuit diet, body mass index (BMI), gender and age in an Arctic population. Design and methods Population-based investigation of Inuit (n=441) and non-Inuit (94) in Greenland and Inuit living in Denmark (n=136). Participants filled in a questionnaire on alcohol intake and other life style factors. Blood samples were tested for aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, albumin, hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. We also performed physical examinations. Results Participation rate was 95% in Greenland and 52% in Denmark. An alcohol intake above the recommended level was reported by 12.9% of non-Inuit in Greenland, 9.1% of Inuit in East Greenland, 6.1% of Inuit migrants and 3.4% of Inuit in the capital of Greenland (p=0.035). Alcohol intake was associated with AST (p<0.001) and GGT (p=0.001), and HBV infection was associated with ALP (p=0.001) but not with AST, GGT, bilirubin or albumin in the adjusted analysis. Inuit had higher AST (p<0.001), GGT (p<0.001) and ALP (p=0.001) values than non-Inuit after adjustment for alcohol, diet, BMI and HBV exposure. Ethnic origin modified the association between alcohol and AST, while HBV infection did not modify the associations between alcohol and liver biochemistry. Conclusions Non-Inuit in Greenland reported a higher alcohol intake than Inuit. Ethnic origin was more markedly associated with liver biochemistry than was alcohol intake, and Greenlandic ethnicity modified the effect of alcohol intake on AST. HBV infection was slightly associated with ALP but not with other liver biochemistry parameters.
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Affiliation(s)
- Karsten Fleischer Rex
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.,Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark;
| | - Henrik Bygum Krarup
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Andersen
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.,Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
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Børresen ML, Andersson M, Wohlfahrt J, Melbye M, Biggar RJ, Ladefoged K, Panum I, Koch A. Hepatitis B prevalence and incidence in Greenland: a population-based cohort study. Am J Epidemiol 2015; 181:422-30. [PMID: 25721415 DOI: 10.1093/aje/kwu287] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Greenland remains a highly endemic area for hepatitis B virus (HBV) infection. This is in sharp contrast to other modern societies, such as Denmark. To address this discrepancy, we investigated the natural history of HBV infection in Greenland by estimating the age-specific incidence of HBV infection, the proportion of chronic carriers, and the rates of hepatitis B surface antigen seroclearance. In total, 8,879 Greenlanders (16% of the population) from population-based surveys conducted in 1987 and 1998 were followed through March 2010. Data on HBV status were supplemented by HBV test results from all available HBV registries in Greenland to determine changes in HBV status over time. Incidence rates of HBV infection and hepatitis B surface antigen seroclearance were estimated after taking into account interval censoring. The incidence of HBV infection in 5-14-year-old subjects was less than 1 per 100 person-years and peaked at 5 per 100 person-years in persons 15-24 years of age. Overall, 17.5% of persons infected in adulthood were estimated to become chronic carriers. HBV is primarily transmitted in adolescence and adulthood in Greenland. In contrast to what is observed in most other populations, HBV-infected adults in Greenland have a high risk of progressing to chronic HBV carriage. This phenomenon might explain how the high rate of infection is maintained in Greenland.
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Nøjgaard C, Johansen JS, Bjerregaard P, Bojesen SE, Becker U. Plasma YKL-40 in Inuit and Danes. Alcohol Alcohol 2014; 50:11-7. [PMID: 25332349 DOI: 10.1093/alcalc/agu072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS The aim of the present study was to investigate whether there are differences in plasma levels of YKL-40 between Inuit in Greenland and in Denmark and in Danes, as well as to study the relationship between alcohol intake, plasma YKL-40 and other factors in Inuit. METHODS Plasma YKL-40 levels were measured on 1645 people from The Greenland Population Study (a cross-sectional population study of Inuit from Denmark and West Greenland) and were compared with the plasma YKL-40 levels of 8899 people from The Copenhagen City Heart Study (a population-based, prospective study of the Danish general population). RESULTS The plasma concentrations of YKL-40 were significantly (P = 0.001) lower in Inuit living in Greenland (median 46 µg/l, range 10-2164, n = 1164) compared with the plasma YKL-40 levels of Inuit living in Denmark (median 63 µg/l, range 20-2827, n = 481) and of Danes living in Denmark (median 55 µg/l, range 10-2909, n = 8899). In Inuit, increased alcohol intake was significantly associated with increased plasma YKL-40 levels (P < 0.001), and high plasma YKL-40 levels were associated with high values of alkaline phosphatase and low values of albumin. Smoking, gender and bilirubin were not associated with the plasma YKL-40 level. High levels of YKL-40 and alcohol were associated with where people lived. CONCLUSION The plasma concentrations of YKL-40 are significantly lower in Inuit living in Greenland than Inuit and Danes living in Denmark. A number of factors, including different alcohol intake patterns, nutrition and genes may play a role in these findings.
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Affiliation(s)
- Camilla Nøjgaard
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Julia S Johansen
- Departments of Medicine and Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stig E Bojesen
- Department of Clinical Biochemistry, Copenhagen University Hospital Herlev, Herlev, Denmark The Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Ulrik Becker
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Scott JD, Garland N. Chronic liver disease in Aboriginal North Americans. World J Gastroenterol 2008; 14:4607-15. [PMID: 18698674 PMCID: PMC2738784 DOI: 10.3748/wjg.14.4607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 05/28/2008] [Accepted: 06/04/2008] [Indexed: 02/06/2023] Open
Abstract
A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.
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Krarup HB, Andersen S, Madsen PH, Okkels H, Hvingel BH, Laurberg P. Benign course of long-standing hepatitis B virus infection among Greenland Inuit? Scand J Gastroenterol 2008; 43:334-43. [PMID: 18266176 DOI: 10.1080/00365520701712198] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Chronic hepatitis B virus (HBV) infection can present in different ways, from inactive carrier to liver failure or cancer. The role of the virus subtype is controversial. The purpose of this study was to characterize HBV infection in detail and its impact on general health, body-build and liver biochemistry. MATERIAL AND METHODS The study comprised a population-based cohort of Inuit exposed to HBV 3-7 decades ago in the capital in West Greenland, a coastal town and four settlements in rural East Greenland. Participants included 95% of the invited Inuit: 229 men, 205 women, aged 50-69 years. RESULTS Only 25% of the participants had never had HBV infection. HBsAg was positive in 86 participants (20.0%), more being found positive in rural East Greenland than in the city in West Greenland (28.9% versus 2.7%; p < 0.001). HBV-DNA was positive in 61 of those with median HBV-DNA 40,000 copies/ml. HBV genotype could be determined in 52: 47 participants had genotype B, 4 genotype D, and 1 had both B and D. At sequencing, genotype B resembled subtype Bj, but with more than 5% diversity in the C-gene it could be a new subtype B. Pre-core mutation was found in 55 of 56 participants investigated. None of the participants had signs of liver disease, and HBV infection did not influence body-build or liver biochemistry. CONCLUSIONS More than 75% of participants had a marker of present or previous HBV infection but the infection seemed dormant. The majority harbored a special variant of genotype B that might be a new subtype giving a relatively benign disease. The role of detailed subtyping of HBV for prognostic evaluation should be investigated in more detail.
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Affiliation(s)
- Henrik Bygum Krarup
- Department of Clinical Biochemistry, Aalborg Hospital, Aarhus University Hospital, Denmark.
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