Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System

Mohamed H Ahmed, Sufian K Noor, Sarra O Bushara, Nazik Elmalaika Husain, Wadie M Elmadhoun, Ibrahim A Ginawi, Meissa M Osman, Abdalhafeez O Mahmoud, Ahmed O Almobarak, Mohamed H Ahmed, Sufian K Noor, Sarra O Bushara, Nazik Elmalaika Husain, Wadie M Elmadhoun, Ibrahim A Ginawi, Meissa M Osman, Abdalhafeez O Mahmoud, Ahmed O Almobarak

Abstract

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "non-alcoholic fatty liver disease" and "non-alcoholic steatohepatitis", in addition to "prevalence and risk factors for NAFLD", with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

Keywords: Africa; Fatty liver; Lipid profile.

References

    1. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330–344. doi: 10.1038/nrgastro.2013.41.
    1. Ahmed MH, Barakat S, Almobarak AO. Nonalcoholic fatty liver disease and cardiovascular disease: has the time come for cardiologists to be hepatologists? J Obes. 2012;2012:483135.
    1. Rocha R, Cotrim HP, Carvalho FM, Siqueira AC, Braga H, Freitas LA. Body mass index and waist circumference in non-alcoholic fatty liver disease. J Hum Nutr Diet. 2005;18(5):365–370. doi: 10.1111/j.1365-277X.2005.00634.x.
    1. Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes. 2013;2013:839275.
    1. Kim HJ, Kim HJ, Lee KE, Kim DJ, Kim SK, Ahn CW, Lim SK. et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med. 2004;164(19):2169–2175. doi: 10.1001/archinte.164.19.2169.
    1. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005;42(1):44–52. doi: 10.1002/hep.20734.
    1. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM. et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40(6):1387–1395. doi: 10.1002/hep.20466.
    1. Adams LA, Harmsen S, St Sauver JL, Charatcharoenwitthaya P, Enders FB, Therneau T, Angulo P. Nonalcoholic fatty liver disease increases risk of death among patients with diabetes: a community-based cohort study. Am J Gastroenterol. 2010;105(7):1567–1573. doi: 10.1038/ajg.2010.18.
    1. Williamson RM, Price JF, Glancy S, Perry E, Nee LD, Hayes PC, Frier BM. et al. Prevalence of and risk factors for hepatic steatosis and nonalcoholic Fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes Care. 2011;34(5):1139–1144. doi: 10.2337/dc10-2229.
    1. Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, Day C. et al. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007;30(5):1212–1218. doi: 10.2337/dc06-2247.
    1. Chan WK, Tan AT, Vethakkan SR, Tah PC, Vijayananthan A, Goh KL. Non-alcoholic fatty liver disease in diabetics - prevalence and predictive factors in a multiracial hospital clinic population in Malaysia. J Gastroenterol Hepatol. 2013;28(8):1375–1383. doi: 10.1111/jgh.12204.
    1. Lv WS, Sun RX, Gao YY, Wen JP, Pan RF, Li L, Wang J. et al. Nonalcoholic fatty liver disease and microvascular complications in type 2 diabetes. World J Gastroenterol. 2013;19(20):3134–3142. doi: 10.3748/wjg.v19.i20.3134.
    1. Ferreira VS, Pernambuco RB, Lopes EP, Morais CN, Rodrigues MC, Arruda MJ, Silva LM. et al. Frequency and risk factors associated with non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Arq Bras Endocrinol Metabol. 2010;54(4):362–368. doi: 10.1590/S0004-27302010000400004.
    1. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593–608. doi: 10.1016/j.jhep.2012.12.005.
    1. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43(8):617–649. doi: 10.3109/07853890.2010.518623.
    1. Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Stal P, Kechagias S, Hultcrantz R. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–1554. doi: 10.1002/hep.27368.
    1. Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis. 2004;24(1):3–20. doi: 10.1055/s-2004-823098.
    1. de Marco R, Locatelli F, Zoppini G, Verlato G, Bonora E, Muggeo M. Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care. 1999;22(5):756–761. doi: 10.2337/diacare.22.5.756.
    1. Konfortion J, Coupland VH, Kocher HM, Allum W, Grocock MJ, Jack RH. Time and deprivation trends in incidence of primary liver cancer subtypes in England. J Eval Clin Pract. 2014;20(4):498–504. doi: 10.1111/jep.12188.
    1. Ladep NG, Khan SA, Crossey MM, Thillainayagam AV, Taylor-Robinson SD, Toledano MB. Incidence and mortality of primary liver cancer in England and Wales: changing patterns and ethnic variations. World J Gastroenterol. 2014;20(6):1544–1553. doi: 10.3748/wjg.v20.i6.1544.
    1. Stickel F, Hellerbrand C. Non-alcoholic fatty liver disease as a risk factor for hepatocellular carcinoma: mechanisms and implications. Gut. 2010;59(10):1303–1307. doi: 10.1136/gut.2009.199661.
    1. Ertle J, Dechene A, Sowa JP, Penndorf V, Herzer K, Kaiser G, Schlaak JF. et al. Non-alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis. Int J Cancer. 2011;128(10):2436–2443. doi: 10.1002/ijc.25797.
    1. Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology. 2010;51(5):1820–1832. doi: 10.1002/hep.23594.
    1. Basaranoglu M, Najjar SM, Demirbag AE, Senturk H. Significant cohort of non-alcoholic fatty liver disease with portal vein thrombosis in transplant waiting list. World J Hepatol. 2016;8(7):376–384. doi: 10.4254/wjh.v8.i7.376.
    1. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, Ahmed A. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–555. doi: 10.1053/j.gastro.2014.11.039.
    1. Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011;141(4):1249–1253. doi: 10.1053/j.gastro.2011.06.061.
    1. Quillin RC 3rd, Wilson GC, Sutton JM, Hanseman DJ, Paterno F, Cuffy MC, Paquette IM. et al. Increasing prevalence of nonalcoholic steatohepatitis as an indication for liver transplantation. Surgery. 2014;156(4):1049–1056. doi: 10.1016/j.surg.2014.06.075.
    1. Agopian VG, Kaldas FM, Hong JC, Whittaker M, Holt C, Rana A, Zarrinpar A. et al. Liver transplantation for nonalcoholic steatohepatitis: the new epidemic. Ann Surg. 2012;256(4):624–633. doi: 10.1097/SLA.0b013e31826b4b7e.
    1. Burra P, Germani G. Orthotopic liver transplantation in non-alcoholic fatty liver disease patients. Rev Recent Clin Trials. 2014;9(3):210–216. doi: 10.2174/1574887109666141216105224.
    1. Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, Hultcrantz R. et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med. 2014;11(7):e1001680. doi: 10.1371/journal.pmed.1001680.
    1. Hamad AA, Khalil AA, Connolly V, Ahmed MH. Relationship between non-alcoholic fatty liver disease and kidney function: a communication between two organs that needs further exploration. Arab J Gastroenterol. 2012;13(4):161–165. doi: 10.1016/j.ajg.2012.06.010.
    1. Muhidin SO, Magan AA, Osman KA, Syed S, Ahmed MH. The relationship between nonalcoholic fatty liver disease and colorectal cancer: the future challenges and outcomes of the metabolic syndrome. J Obes. 2012;2012:637538. doi: 10.1155/2012/637538.
    1. Ahmed MH, Ali A. Nonalcoholic fatty liver disease and cholesterol gallstones: which comes first? Scand J Gastroenterol. 2014;49(5):521–527. doi: 10.3109/00365521.2014.894119.
    1. Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14(5):417–431. doi: 10.1111/obr.12020.
    1. Kew MC. Obesity as a cause of hepatocellular carcinoma. Ann Hepatol. 2015;14(3):299–303.
    1. Akala FA, El-Saharty S. Public-health challenges in the Middle East and North Africa. Lancet. 2006;367(9515):961–964. doi: 10.1016/S0140-6736(06)68402-X.
    1. Kruger FC, Daniels C, Kidd M, Swart G, Brundyn K, Van Rensburg C, Kotze MJ. Non-alcoholic fatty liver disease (NAFLD) in the Western Cape: a descriptive analysis. S Afr Med J. 2010;100(3):168–171. doi: 10.7196/SAMJ.1422.
    1. Maziak W. Health in the middle East. BMJ. 2006;333(7573):815–816. doi: 10.1136/bmj.39006.478796.80.
    1. Onyekwere CA, Ogbera AO, Balogun BO. Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community. Ann Hepatol. 2011;10(2):119–124.
    1. Ramezani-Binabaj M, Motalebi M, Karimi-Sari H, Rezaee-Zavareh MS, Alavian SM. Are women with polycystic ovarian syndrome at a high risk of non-alcoholic Fatty liver disease; a meta-analysis. Hepat Mon. 2014;14(11):e23235. doi: 10.5812/hepatmon.23235.
    1. Sohrabpour A, Rezvan H, Amini-Kafiabad S, Dayhim M, Merat S, Pourshams A. Prevalence of nonalcoholic steatohepatitis in Iran: a population based study. Middle East J Dig Dis. 2010;2(1):14–19.
    1. Almobarak AO, Barakat S, Khalifa MH, Elhoweris MH, Elhassan TM, Ahmed MH. Non alcoholic fatty liver disease (NAFLD) in a Sudanese population: What is the prevalence and risk factors? Arab J Gastroenterol. 2014;15(1):12–15. doi: 10.1016/j.ajg.2014.01.008.
    1. Almobarak AO, Barakat S, Suliman EA, Elmadhoun WM, Mohamed NA, Abobaker IO, Noor SK. et al. Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: Is metabolic syndrome the culprit? Arab J Gastroenterol. 2015;16(2):54–58. doi: 10.1016/j.ajg.2015.06.001.
    1. Zatu MC, van Rooyen JM, Loots du T, Greeff M, Schutte AE. A comparison of the cardiometabolic profile of black South Africans with suspected non-alcoholic fatty liver disease (NAFLD) and excessive alcohol use. Alcohol. 2015;49(2):165–172. doi: 10.1016/j.alcohol.2014.11.002.
    1. Matsha TE, Macharia M, Yako YY, Erasmus RT, Hassan MS, Kengne AP. Gamma-glutamyltransferase, insulin resistance and cardiometabolic risk profile in a middle-aged African population. Eur J Prev Cardiol. 2014;21(12):1541–1548. doi: 10.1177/2047487313501967.
    1. Mahmoud AA, Bakir AS, Shabana SS. Serum TGF-beta, Serum MMP-1, and HOMA-IR as non-invasive predictors of fibrosis in Egyptian patients with NAFLD. Saudi J Gastroenterol. 2012;18(5):327–333. doi: 10.4103/1319-3767.101132.
    1. Ahmed AM, Hassan MS, Abd-Elsayed A, Hassan H, Hasanain AF, Helmy A. Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic Hepatitis C virus infection. Saudi J Gastroenterol. 2011;17(4):245–251. doi: 10.4103/1319-3767.82578.
    1. Alkassabany YM, Farghaly AG, El-Ghitany EM. Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt. Arab J Gastroenterol. 2014;15(2):76–81. doi: 10.1016/j.ajg.2014.05.002.
    1. El-Karaksy HM, El-Raziky MS, Fouad HM, Anwar GM, El-Mougy FM, El-Koofy NM, El-Hennawy AM. The value of different insulin resistance indices in assessment of non-alcoholic fatty liver disease in overweight/obese children. Diabetes Metab Syndr. 2015;9(2):114–119. doi: 10.1016/j.dsx.2013.10.008.
    1. El-Koofy NM, El-Karaksy HM, Mandour IM, Anwar GM, El-Raziky MS, El-Hennawy AM. Genetic polymorphisms in non-alcoholic fatty liver disease in obese Egyptian children. Saudi J Gastroenterol. 2011;17(4):265–270. doi: 10.4103/1319-3767.82582.
    1. el-Karaksy HM, el-Koofy NM, Anwar GM, el-Mougy FM, el-Hennawy A, Fahmy ME. Predictors of non-alcoholic fatty liver disease in obese and overweight Egyptian children: single center study. Saudi J Gastroenterol. 2011;17(1):40–46. doi: 10.4103/1319-3767.74476.
    1. Kelishadi R, Abtahi SH, Qorbani M, Heshmat R, Esmaeil Motlagh M, Taslimi M, Aminaee T. et al. First national report on aminotransaminases' percentiles in children of the Middle East and North Africa (MENA): the CASPIAN-III Study. Hepat Mon. 2012;12(11):e7711. doi: 10.5812/hepatmon.7711.
    1. El-Koofy N, El-Karaksy H, El-Akel W, Helmy H, Anwar G, El-Sayed R, El-Hennawy A. Ultrasonography as a non-invasive tool for detection of nonalcoholic fatty liver disease in overweight/obese Egyptian children. Eur J Radiol. 2012;81(11):3120–3123. doi: 10.1016/j.ejrad.2012.06.020.
    1. Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, Shah SR. et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009;57:205–210.
    1. Assy N, Kaita K, Mymin D, Levy C, Rosser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis Sci. 2000;45(10):1929–1934. doi: 10.1023/A:1005661516165.
    1. Basaranoglu M, Basaranoglu G, Sabuncu T, Senturk H. Fructose as a key player in the development of fatty liver disease. World J Gastroenterol. 2013;19(8):1166–1172. doi: 10.3748/wjg.v19.i8.1166.
    1. Neuschwander-Tetri BA, Ford DA, Acharya S, Gilkey G, Basaranoglu M, Tetri LH, Brunt EM. Dietary trans-fatty acid induced NASH is normalized following loss of trans-fatty acids from hepatic lipid pools. Lipids. 2012;47(10):941–950. doi: 10.1007/s11745-012-3709-7.
    1. Basaranoglu M, Basaranoglu G, Bugianesi E. Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surg Nutr. 2015;4(2):109–116.
    1. Boza C, Riquelme A, Ibanez L, Duarte I, Norero E, Viviani P, Soza A. et al. Predictors of nonalcoholic steatohepatitis (NASH) in obese patients undergoing gastric bypass. Obes Surg. 2005;15(8):1148–1153. doi: 10.1381/0960892055002347.
    1. Haentjens P, Massaad D, Reynaert H, Peeters E, Van Meerhaeghe A, Vinken S, Poppe K. et al. Identifying non-alcoholic fatty liver disease among asymptomatic overweight and obese individuals by clinical and biochemical characteristics. Acta Clin Belg. 2009;64(6):483–493. doi: 10.1179/acb.2009.084.
    1. Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600–606. doi: 10.1016/j.jhep.2006.06.013.
    1. Colicchio P, Tarantino G, del Genio F, Sorrentino P, Saldalamacchia G, Finelli C, Conca P. et al. Non-alcoholic fatty liver disease in young adult severely obese non-diabetic patients in South Italy. Ann Nutr Metab. 2005;49(5):289–295. doi: 10.1159/000087295.
    1. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg. 2003;138(11):1240–1244. doi: 10.1001/archsurg.138.11.1240.
    1. Adams LA, Angulo P. Treatment of non-alcoholic fatty liver disease. Postgrad Med J. 2006;82(967):315–322. doi: 10.1136/pgmj.2005.042200.
    1. Boutayeb A, Lamlili ENM, Boutayeb W, Maamri A, Ziyyat A, Ramdani N. The rise of diabetes prevalence in the Arab region. Open Journal of Epidemiology. 2012;2:55–60. doi: 10.4236/ojepi.2012.22009.
    1. Al Khalaf MM, Eid MM, Najjar HA, Alhajry KM, Doi SA, Thalib L. Screening for diabetes in Kuwait and evaluation of risk scores. East Mediterr Health J. 2010;16(7):725–731.
    1. Noor SK, Bushara SO, Sulaiman AA, Elmadhoun WM, Ahmed MH. Undiagnosed diabetes mellitus in rural communities in Sudan: prevalence and risk factors. East Mediterr Health J. 2015;21(3):164–170. doi: 10.26719/2015.21.3.164.
    1. Elmadhoun WM, Noor SK, Ibrahim AA, Bushara SO, Ahmed MH. Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study. J Diabetes. 2016;8(6):839–846. doi: 10.1111/1753-0407.12364.
    1. Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, Safaie A. et al. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care. 2008;31(1):96–98. doi: 10.2337/dc07-0959.
    1. Abebe SM, Berhane Y, Worku A, Assefa A. Diabetes mellitus in North West Ethiopia: a community based study. BMC Public Health. 2014;14:97. doi: 10.1186/1471-2458-14-97.
    1. Alsheikh-Ali AA, Omar MI, Raal FJ, Rashed W, Hamoui O, Kane A, Alami M. et al. Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study. PLoS One. 2014;9(8):e102830. doi: 10.1371/journal.pone.0102830.
    1. International diabetes federation/Africa ( ) accessed 13/2/2016.
    1. Julia H. Goedecke, Courtney L. Jennings, Estelle V. Lambertc - chronic diseases of lifestyle in South Africa since 1995 - 2005 ( )
    1. Motala AA, Esterhuizen T, Pirie FJ, Omar MA. The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community. Diabetes Care. 2011;34(4):1032–1037. doi: 10.2337/dc10-1921.
    1. Fikru Tesfaye, Peter Byass, Stig Wall. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic Biomed central. .
    1. Cohen MP, Stern E, Rusecki Y, Zeidler A. High prevalence of diabetes in young adult Ethiopian immigrants to Israel. Diabetes. 1988;37(6):824–828. doi: 10.2337/diab.37.6.824.
    1. Tran A, Gelaye B, Girma B, Lemma S, Berhane Y, Bekele T, Khali A. et al. Prevalence of metabolic syndrome among working adults in ethiopia. Int J Hypertens. 2011;2011:193719. doi: 10.4061/2011/193719.
    1. International diabetes federation. .
    1. Egyptians are the fattest Africans, says WHO. Egypt independent. .
    1. Aboul Ella NA, Shehab DI, Ismail MA, Maksoud AA. Prevalence of metabolic syndrome and insulin resistance among Egyptian adolescents 10 to 18 years of age. J Clin Lipidol. 2010;4(3):185–195. doi: 10.1016/j.jacl.2010.03.007.
    1. International diabetes federation. .
    1. .
    1. Gyakobo M, Amoah AG, Martey-Marbell DA, Snow RC. Prevalence of the metabolic syndrome in a rural population in Ghana. BMC Endocr Disord. 2012;12:25. doi: 10.1186/1472-6823-12-25.
    1. International diabetes federation. .
    1. Kumah DB, Akuffo KO, Abaka-Cann JE, Affram DE, Osae EA. Prevalence of overweight and obesity among students in the Kumasi Metropolis. J Nutr Metab. 2015;2015:613207. doi: 10.1155/2015/613207.
    1. Aljohani NJ. Metabolic syndrome: Risk factors among adults in Kingdom of Saudi Arabia. J Family Community Med. 2014;21(3):170–175. doi: 10.4103/2230-8229.142971.
    1. Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F, Kamgar M. et al. Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health. 2009;9:167. doi: 10.1186/1471-2458-9-167.
    1. Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey. Public Health Nutr. 2008;11(3):246–251. doi: 10.1017/S1368980007000262.
    1. Azizi F, Salehi P, Etemadi A, Zahedi-Asl S. Prevalence of metabolic syndrome in an urban population: tehran lipid and glucose study. Diabetes Res Clin Pract. 2003;61(1):29–37. doi: 10.1016/S0168-8227(03)00066-4.
    1. Al-Sharafi BA, Gunaid AA. Prevalence of obesity in patients with type 2 diabetes mellitus in yemen. Int J Endocrinol Metab. 2014;12(2):e13633. doi: 10.5812/ijem.13633.
    1. Gunaid AA. Obesity, overweight and underweight among adults in an urban community in Yemen. East Mediterr Health J. 2012;18(12):1187–1193.
    1. Bamashmoos MA, Al Serouri AW. Metabolic syndrome among obese patients attending the medical clinics of the three teaching hospitals at Sana's City, Yemen. Funct Foods Health Dis. 2011;1(6):214–221.
    1. Shera AS, Basit A, Fawwad A, Hakeem R, Ahmedani MY, Hydrie MZ, Khwaja IA. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Prim Care Diabetes. 2010;4(2):79–83. doi: 10.1016/j.pcd.2010.01.003.
    1. Streib, Lauren (2 August 2007). World's Fattest Countries. Forbes.Basit A.
    1. Basit A, Shera AS. Prevalence of metabolic syndrome in Pakistan. Metab Syndr Relat Disord. 2008;6(3):171–175. doi: 10.1089/met.2008.0005.
    1. Ajlouni K, Khader YS, Batieha A, Ajlouni H, El-Khateeb M. An increase in prevalence of diabetes mellitus in Jordan over 10 years. J Diabetes Complications. 2008;22(5):317–324. doi: 10.1016/j.jdiacomp.2007.01.004.
    1. Alarjan JF, Hindawi OS, Judge LW, Aleyadh ZA, Bellar DM. Prevalence of obesity and behaviors associated with the development of metabolic disease among medical practitioners in Jordan. J Educ Health Promot. 2015;4:17. doi: 10.4103/2277-9531.154036.
    1. Yasein N, Masa'd D. Metabolic syndrome in family practice in Jordan: a study of high-risk groups. East Mediterr Health J. 2011;17(12):943–948.
    1. International Diabetes Federation. IDF Diabetes Atlas. 15th Edition, International Diabetes Federation, Brussels. 2011.
    1. Al Zenki S, Al Omirah H, Al Hooti S, Al Hamad N, Jackson RT, Rao A, Al Jahmah N. et al. High prevalence of metabolic syndrome among Kuwaiti adults - a wake-up call for public health intervention. Int J Environ Res Public Health. 2012;9(5):1984–1996. doi: 10.3390/ijerph9051984.
    1. Chukwuonye, II, Chuku A, John C, Ohagwu KA, Imoh ME, Isa SE, Ogah OS. et al. Prevalence of overweight and obesity in adult Nigerians - a systematic review. Diabetes Metab Syndr Obes. 2013;6:43–47. doi: 10.2147/DMSO.S38626.
    1. international diabetes federation.
    1. .
    1. Adegoke OA, Adedoyin RA, Balogun MO, Adebayo RA, Bisiriyu LA, Salawu AA. Prevalence of metabolic syndrome in a rural community in Nigeria. Metab Syndr Relat Disord. 2010;8(1):59–62. doi: 10.1089/met.2009.0037.
    1. International diabetes federation - .
    1. Baalwa J, Byarugaba BB, Kabagambe EK, Otim AM. Prevalence of overweight and obesity in young adults in Uganda. Afr Health Sci. 2010;10(4):367–373.
    1. Muyanja D, Muzoora C, Muyingo A, Muyindike W, Siedner MJ. High prevalence of metabolic syndrome and cardiovascular disease risk among people with HIV on stable ART in southwestern Uganda. AIDS Patient Care STDS. 2016;30(1):4–10. doi: 10.1089/apc.2015.0213.
    1. Tiffany L.E. Jones. Diabetes Mellitus: the increasing burden of disease in Kenya. South Sudan Medical Journal. .
    1. Kenya - Adult obesity prevalence, female - world data atlas - .
    1. Kaduka LU, Kombe Y, Kenya E, Kuria E, Bore JK, Bukania ZN, Mwangi M. Prevalence of metabolic syndrome among an urban population in Kenya. Diabetes Care. 2012;35(4):887–893. doi: 10.2337/dc11-0537.
    1. Botswana. Adult obesity prevalence, male. .
    1. Botsuana prevalence of diabetes. .
    1. International diabetes federation. .
    1. Grace A Shayo, Ferdinand M Mugusi. Prevalence of obesity and associated risk factors among adults in Kinondoni municipal district, Dar es Salaam Tanzania - Biomed center. .
    1. Kagaruki Gibson B, Kimaro, Godfather D, Mweya Clement N, Kilale Andrew M, Mrisho Ray M, Shao Amani F, Kalinga Akili K, Kahwa Amos M, Ngadaya Esther S, Materu Godlisten S, Mfinanga Sayoki G, Mayige Mary T, Gomez Nelida Virginia, Wang Ronald. Prevalence and risk factors of metabolic syndrome among individuals living with HIV and Receiving Antiretroviral Treatment in Tanzania - EBSCO host connection. .
    1. Ahmed MH, Woodward C, Mital D. Metabolic clinic for individuals with HIV/AIDS: a commitment and vision to the future of HIV services. Cardiovascular Endocrinology. 2017;6:109–112. doi: 10.1097/XCE.0000000000000128.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する