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De Silva ST, Niriella MA, Ediriweera DS, Kottahachchi D, Kasturiratne A, de Silva AP, Dassanayaka AS, Pathmeswaran A, Wickramasinghe R, Kato N, de Silva HJ. Incidence and risk factors for metabolic syndrome among urban, adult Sri Lankans: a prospective, 7-year community cohort, follow-up study. Diabetol Metab Syndr 2019; 11:66. [PMID: 31428204 PMCID: PMC6694684 DOI: 10.1186/s13098-019-0461-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/08/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MetS) is a clustering of abdominal obesity, diabetes and prediabetes, high cholesterol and high blood pressure, that confers an increased risk of cardiovascular disease. There is limited data on incidence of MetS from South Asia. This study investigated incidence and risk factors for new onset MetS in an urban adult Sri Lankan population. METHODS Subjects (selected by age-stratified random sampling from the Ragama Medical Officer of Health area) were screened initially in 2007 (35-64 years) and re-evaluated in 2014 (42-71 years). On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, and biochemical/serological tests. MetS was diagnosed on International Diabetes Federation (IDF-2006) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using body impedance method. Incidence and factors at baseline, associated with new onset MetS, were investigated among those who presented for re-evaluation. RESULTS 2985 (99.1%) [1636 (54.8%) women (54.8%); median age (IQR) 53 (47-59) years] from the initial cohort in 2007 had complete data. 2148 (71.9%) [1237 (57.6%) women; median age (IQR) 60 (54-66) years] attended follow-up. 949 of them [701 (73.9%) women; median age (IQR) 60 (54-65) years] had MetS (prevalence 47.2%, 95% CI 45.0-49.4%). Of 1246 who did not have MetS in 2007, 265 [178 (67.1%) women, median age (IQR) 57 (51-64) years] had developed MetS after 7 years (annual incidence 3.5% (95% CI 2.4-4.5%). Females (OR = 4.9, 95% CI 3.4-7.4), BMI > 23 kg/m2 in 2007 (OR = 1.6 per unit increase, 95% CI 1.5-1.7), weight gain (by 2-5% OR = 2.0, 95% CI 1.1-3.5; by > 5% OR = 2.2, 95% CI 1.4-3.4), and increase in waist circumference (by 2-5% OR = 7.0, 95% CI 4.0-12.2; by > 5% OR = 13.4, 95% CI 8.3-22.4) from baseline and presence of non-alcoholic fatty liver disease (NAFLD) in 2007 (OR = 1.70, 95% CI 1.04-2.76) were associated new onset MetS. Those with MetS had abnormal VFP and TBF in 2014 [P < 0.001]. CONCLUSION In this study, annual incidence of MetS was 3.5%. Female gender, BMI > 23 kg/m2 and NAFLD in 2007 and increase in weight and waist circumference from baseline were significantly associated with new onset MetS. Obesity was the best predictor of future MetS.
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Affiliation(s)
- Shamila T. De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Madunil A. Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Dileepa S. Ediriweera
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
| | - Dulani Kottahachchi
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
| | - Arjuna P. de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Anuradha S. Dassanayaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Arunasalam Pathmeswaran
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
| | - Rajitha Wickramasinghe
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
| | - N. Kato
- National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
| | - H. Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
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Niriella MA, Kasturiratne A, Pathmeswaran A, De Silva ST, Perera KR, Subasinghe SKCE, Kodisinghe SK, Piyaratna TACL, Vithiya K, Dassanayaka AS, De Silva AP, Wickramasinghe AR, Takeuchi F, Kato N, de Silva HJ. Lean non-alcoholic fatty liver disease (lean NAFLD): characteristics, metabolic outcomes and risk factors from a 7-year prospective, community cohort study from Sri Lanka. Hepatol Int 2018; 13:314-322. [PMID: 30539516 DOI: 10.1007/s12072-018-9916-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION While patients with non-alcoholic fatty liver disease (NAFLD) are mostly overweight or obese, some are lean. METHODS In a community-based follow-up study (baseline and follow-up surveys performed in 2007 and 2014), we investigated and compared the clinical characteristics, body composition, metabolic associations and outcomes, and other risk factors among individuals with lean (BMI < 23 kg/m2) NAFLD, non-lean (BMI ≥ 23 kg/m2) NAFLD and those without NAFLD. To investigate associations of selected genetic variants, we performed a case-control study between lean NAFLD cases and lean non-NAFLD controls. RESULTS Of the 2985 participants in 2007, 120 (4.0%) had lean NAFLD and 816 (27.3%) had non-lean NAFLD. 1206 (40.4%) had no evidence of NAFLD (non-NAFLD). Compared to non-lean NAFLD, lean NAFLD was commoner among males (p < 0.001), and had a lower prevalence of hypertension (p < 0.001) and central obesity (WC < 90 cm for males, < 80 cm for females) (p < 0.001) without prominent differences in the prevalence of other metabolic comorbidities at baseline survey. Of 2142 individuals deemed as either NAFLD or non-NAFLD in 2007, 704 NAFLD individuals [84 lean NAFLD, 620 non-lean NAFLD] and 834 individuals with non-NAFLD in 2007 presented for follow-up in 2014. There was no difference in the occurrence of incident metabolic comorbidities between lean NAFLD and non-lean NAFLD. Of 294 individuals who were non-NAFLD in 2007 and lean in both 2007 and 2014, 84 (28.6%) had developed lean NAFLD, giving an annual incidence of 4.1%. Logistic regression identified the presence of diabetes at baseline, increase in weight from baseline to follow-up and a higher educational level as independent risk factors for the development of incident lean NAFLD. NAFLD association of PNPLA3 rs738409 was more pronounced among lean individuals (one-tailed p < 0.05) compared to the whole cohort sample. CONCLUSION Although lean NAFLD constitutes a small proportion of NAFLD, the risk of developing incident metabolic comorbidities is similar to that of non-lean NAFLD. A PNPLA3 variant showed association with lean NAFLD in the studied population. Therefore, lean NAFLD also warrants careful evaluation and follow-up.
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Affiliation(s)
- Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka.
| | - A Kasturiratne
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - A Pathmeswaran
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - S T De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - K R Perera
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - S K C E Subasinghe
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - S K Kodisinghe
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - T A C L Piyaratna
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - K Vithiya
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - A S Dassanayaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - A P De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - A R Wickramasinghe
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
| | - F Takeuchi
- National Center for Global Health and Medicine, Tokyo, Japan
| | - N Kato
- National Center for Global Health and Medicine, Tokyo, Japan
| | - H J de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P O Box 6, Ragama, GQ, 11010, Sri Lanka
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Niriella MA, Pathmeswaran A, De Silva ST, Kasturiratna A, Perera R, Subasinghe CE, Kodisinghe K, Piyaratna C, Rishikesawan V, Dassanayaka AS, De Silva AP, Wickramasinghe R, Takeuchi F, Kato N, de Silva HJ. Incidence and risk factors for non-alcoholic fatty liver disease: A 7-year follow-up study among urban, adult Sri Lankans. Liver Int 2017; 37:1715-1722. [PMID: 28544258 DOI: 10.1111/liv.13478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study investigated incidence and risk factors for NAFLD among an adult cohort with 7-year follow-up. METHODS The study population (age-stratified random sampling, Ragama MOH area) was screened initially in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and NAFLD was also performed. RESULTS Out of 2985 of the original cohort, 2148 (72.0%) attended follow-up (1238 [57.6%] women; mean-age 59.2 [SD-7.6] years) in 2014, when 1320 (61.5%) were deemed NAFLD subjects. Out of 778 who initially did not have NAFLD and were not heavy drinkers throughout follow-up, 338 (43.4%) (221 [65.4%] women, mean-age 57.8 [SD-8.0] years) had developed NAFLD after 7-years (annual incidence-6.2%). Central obesity (OR=3.82 [95%-CI 2.09-6.99]), waist increase >5% (OR=2.46 [95%-CI 1.20-5.05]) overweight (OR=3.26 [95%-CI 1.90-5.60]), weight gain 5%-10% (OR=5.70 [95%-CI 2.61-12.47]), weight gain >10% (OR=16.94 [95%-CI 6.88-41.73]), raised plasma triglycerides (OR=1.96 [95%-CI 1.16-3.29]) and diabetes (OR=2.14 [95%-CI 1.13-4.06]), independently predicted the development of incident NAFLD in multivariate analysis. The updated genetic association study (1362-cases, 392-controls) showed replicated association (P=.045, 1-tailed) with NAFLD at a candidate locus: PNPLA3 (rs738409). CONCLUSIONS In this community cohort study, the annual incidence of NAFLD was 6.2%. Incident NAFLD was associated with general and central obesity, raised triglycerides and diabetes, and showed a tendency of association with PNPLA3 gene polymorphisms.
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Affiliation(s)
| | | | | | | | - Ruwan Perera
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | | | - Chathura Piyaratna
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | | | | | | | - Fumihiko Takeuchi
- National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
| | - Norihiro Kato
- National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
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De Hewavisenthi SJS, Dassanayaka AS, De Silva HJ. Clinical, biochemical and histological characteristics of a Sri Lankan population of non-alcoholic steatohepatitis (NASH) patients. Ceylon Med J 2009; 50:113-6. [PMID: 16252575 DOI: 10.4038/cmj.v50i3.1429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-alcoholic steatohepatitis (NASH) is common and can progress to cirrhosis. It has been regarded as a 'disease of affluence' and there are only a few reports from developing countries. OBJECTIVE To describe the clinical, biochemical, and histological characteristics of a cohort of NASH patients in Sri Lanka, and to determine their short term outcome following modifications of lifestyle. METHOD Patients who had a liver biopsy for investigation of raised hepatic enzymes were assessed during the period May 1999 - May 2003. Patients who had an alcohol intake of over 40 g/week were excluded. Detailed clinical and biochemical data of patients with histologically confirmed NASH were compiled. Histological grading and staging was done using the Brunt system. The patients were advised on lifestyle modifications and the control of diseases known to be associated with NASH. They were followed up at 3 -monthly intervals. RESULTS During the study period liver biopsies were performed on 296 patients and 100 ( 35.1%) were diagnosed as having NASH. (Men = 79, Mean age 37.2 years, SD 10.6). Risk factors for NASH included diabetes mellitus (55%), obesity (52%), hyperlipidaemia (54%), a family history of risk factors (66%) and a high dietary fat intake (66%). However, 44.3% of men and 33.3% of women were not overweight. The histological grading and staging of 80 biopsies showed Grade 1 in 31 (38.8%), Grade 2 in 29 (36.3%), Grade 3 in 20 (25%), Stage 1 in 57 (71.3%) Stage 2 in 13 (16.3%), Stage 3 in 2 (2.5%) and Stage 4 in 8 (10%). In 55/91 (60.4%) patients who were followed up for a median of 2.5 years (range 1-4 years) the serum transaminases returned to normal in a median of 7 months (range 3-14 months). CONCLUSION The clinical, biochemical and histological features of NASH patients in our series are similar to that reported in western countries. However "lean males" accounted for a significant proportion. In the short term a majority of patients showed improvement in serum transaminases with lifestyle modification.
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