Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) refers to a range of conditions caused by the accumulation of fat in individuals that consume an insignificant amount of alcohol. NAFLD is becoming one of the major causes of chronic liver disease world wide. The main aim of this study was to determine the prevalence and associated factors of NAFLD in the Buea Regional Hospital

Materials and method: A cross-sectional study involving 122 participants with obesity that consume minute amounts of alcohol. Participants ages ranged from 24-60 years. After consent was gotten from the participants, their blood pressure, waist circumference, weight and height ere measured and body mass index (BMI) calculated. Following an 8-12 hours fast, serum triglycerides and gamma glumatyl transferase (GGT) levels were measured by spectrophotometry. A p-value ≤ 0.05 was considered statistically significant.

Results: The prevalence of NAFLD was 84.4% (76.65. Participants who were classified as overweight, obesity class I, class II and class III had a prevalence of 100%, 96.3%, 93.3% and 62.5%. Sex and diabetic status were significantly associated with risk of NAFLD.

Conclusion: The prevalence of NAFLD among study participants was high (84.4%).

CHAPTER ONE

INTRODUCTION

1.1 Background

Nonalcoholic fatty liver disease (NAFLD) refers to a range of conditions caused by the accumulation of fat in individuals who consume an insignificant amount of alcohol. The liver plays an important role in digestion, energy storage and detoxification of the body. A healthy liver has a fat content of less than or equal to 5%. NAFLD can either be of metabolic or genetic origin [1].

When it is metabolic it is associated with obesity, hypertension and insulin resistance hence individuals with Type 2 diabetes and cardiovascular disease are at high risk of suffering from NAFLD. Meanwhile when it is of genetic origin it is caused by variations in the patatin-like phosphate domain containing 3 (PNPLA3) and trans membrane 6 super family member 2 (TM6SF2) [2].

Worldwide, NAFLD is rapidly becoming the most common cause of liver disease especially in the western countries where its prevalence is higher. Globally it has a prevalence of 32.4% with wide geographical variation across the world [3]. Highest prevalence rates mostly ultrasound based has been reported from Middle East and South America (around 30%) whereas the limited number of studies from Africa reports a much lower prevalence (13%) [4].

In Cameroon, Mawo and colleagues in 2020 found a prevalence of 56.1% in patients with type 2 diabetes meanwhile Nga and collaborators in 2022 found a prevalence of 48.9% in patients with metabolic sy[3].

The gold standard for the diagnosis of NAFLD is liver biopsy. The other diagnostic techniques are non-invasive but they only serve as screening tests and cannot be used to confirm that one is suffering from NAFLD. They include blood bio-makers such as serum triglycerides, alanine amino transferase and aspartate amino transferase, cytokeratin 18 and fasting serum insulin. Imaging techniques such as ultrasound are the most commonly used screening tests for NAFLD [5].

NAFLD has two clinical entities.

They include; Nonalcoholic fatty liver (NAFL) and Non-alcoholic Steatohepatitis (NASH). NAFL is generally an asymptotic, benign and non-progressive disease meanwhile NASH is characterized by steatosis, hepatocellular ballooning, lobular inflammation and almost always fibrosis.

As the liver tries to regenerate new cells, NASH progresses to cirrhosis with the hepatocytes replaced by scar tissues of type I collagen produced by stellate cells. Cirrhosis is an end-stage organ failure that require liver transplantation or may lead to hepatocellular carcinoma [6]. There is no standard treatment for NAFLD yet.

When of metabolic origin, the underlying condition is properly managed by taking medications like anti diabetics, vitamins and supplements if necessary. Living a healthier lifestyle is also advised [5].

1.2 Problem Statement

NAFLD is a range of conditions caused by the accumulation of fats in the liver of individuals that consume an insignificant amount of alcohol. Globally it has become one of the leading causes of chronic liver disease.

It ranges from nonalcoholic fatty liver to nonalcoholic steatohepatitis which progresses to fibrosis, cirrhosis and death eventually. Hence for better management and effective treatment, early diagnosis will aid early intervention.

1.3 Objectives

1.3.1 General Objectives

The main aim of this study is to determine the prevalence of non-alcoholic fatty liver disease in Buea Regional hospital.

1.3.2 Specific Objectives

1. To compare serum triglyceride levels among obese patients at the Buea Regional Hospital (BRH)
2. To compare serum gamma-glutamyl transferase levels among obese patients at the BRH
3. To estimate the prevalence of non-alcoholic fatty liver disease among obese patients at the BRH
4. To identify the factors associated with non-alcoholic fatty liver disease in obese patients at the BRH.

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