Awareness of Non-Alcoholic Fatty Liver Disease among General Population in KSA: A Cross-Section Study

Authors

  • Eman AbdulAziz Balbaid Consultant Family Medicine, Jeddah university medical Center, Jeddah University, Jeddah, KSA
  • Mousa Faisal Allebdi Senior Registrar Internal medicine, King Fahad Armed Forces Hospital, KSA
  • Fatimah Abdulrazaq Al Zaher General practitioner, Inherited Blood Disease Center, Prince Mohammed Bin Fahad Hospital, KSA
  • Ali Amin Alghassab General practitioner, Emergency Medicine king Khalid Hospital, Saudi Ministry of Health, Hail, KSA
  • Dalal Nasser Alsharif General practitioner, Endocrine & Diabetes Center, Saudi Ministry of Health, Jeddah, KSA
  • Abdullah Ali Alshehri General practitioner, emergency medicine umluj general hospital, tabuk KSA
  • Shahad Ahmed Alsharif Medical intern, Ibn Sina National College for Medical Studies, Jeddah, KSA
  • Wed Salem BinMadhi Medical intern, Ibn Sina National College for Medical Studies, Jeddah, KSA
  • Jana Dhaifallah Algarni Medical intern, Ibn Sina National College for Medical Studies, Jeddah, KSA
  • Nada Mohammed Albariqi Medical intern, Ibn Sina National College for Medical Studies, Jeddah, KSA
  • Abdullah Faisal Alahmari Medical intern, King Khalid University, Aseer, KSA
  • Sayed Mohamed Baqer Ebrahim Medical intern, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
  • Ali Abdulshaheed Ahmed Medical intern, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
  • Amjad Bandar Alenazi Registrar Public Health, GD of Communicable Diseases Control, MOH, Riyadh, KSA
  • Ruqaiyah Abdullah Al Salam Laboratory technician, Dammam regional laboratory, College for International academy for health science, Dammam, KSA

DOI:

https://doi.org/10.63278/10.63278/mme.v31.1

Abstract

Objective: This research aims to determine the Awareness of Non-Alcoholic Fatty Liver Disease among the General Population in KSA.

Methods: This study will employ a cross-sectional design to assess the awareness of Non-Alcoholic Fatty Liver Disease (NAFLD) among the general population in Saudi Arabia. A structured questionnaire will gather data from a representative population sample.

Results: The study included 300 participants. The most frequent gender among them was female (n= 248, 82.6%) and male (n= 52, 17.3%). The most frequent age among study participants was 40 years and more (n= 114, 83%), followed by less than 25 years (n= 59, 19.6%), then 36-40 years (n=50, 16.6%), and 31-35 years (n=40, 16.6%), 25-30 years (n=37, 12.3%). The most frequent educational level among them was university (n=204, 68%), followed by high school (n=48, 16%), and then others (n=28, 9.3%), intermediate school (n=15, 5 The most frequent nationalities among study participants were Saudi (n=252, 84%) and non-Saudi (n=48, 16%). Participants were asked about the diseases of fatty liver. The most frequent inflammation (n=224, 74.7%), followed by swelling (n=43, 14.3%), then injury (n=33, 11%). The source of information about the most common non-alcoholic fatty liver disease was never heard about it (n=117, 33.5%), health professional (n=71, (20.3%), social media (n=59, 16.9%), friend/relative (n=58, 16.6%), a previous study (n= 31(8.8%), and others (n=13, 3.7%).

Conclusion: There are significant relationships between the awareness of Non-Alcoholic Fatty Liver Disease (NAFLD) among the general population and other variables, including age, gender, and educational level.

References

Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol. 2015;13:2062-70.

Machado MV, Diehl AM. Pathogenesis of nonalcoholic steatohepatitis. Gastroenterology. 2016;150:1769-77.

Chitturi S, Farrell GC. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis. 2001;21:27-41.

Fromenty B, Pessayre D. Impaired mitochondrial function in microvesicular steatosis. Effects of drugs, ethanol, hormones and cytokines. J Hepatol. 1997;26:43-53.

Pouwels S, Sakran N, Graham Y, et al. Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss. BMC Endocr Disord. 2022;22:63.

Dixon JB, Bhathal PS, O'Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121:91-100.

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77:1335-47.

Paik JM, Golabi P, Younossi Y, Mishra A, Younossi ZM. Changes in the global burden of chronic liver diseases from 2012 to 2017: the growing impact of NAFLD. Hepatology. 2020;72:1605-16.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123-33.

Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology. 2014;59:2188-95.

Lin X, Xu Y, Pan X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10:14790.

Golabi P, Otgonsuren M, de Avila L, Sayiner M, Rafiq N, Younossi ZM. Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD). Medicine (Baltimore). 2018;97.

Salem V, AlHusseini N, Abdul Razack HI, Naoum A, Sims OT, Alqahtani SA. Prevalence, risk factors, and interventions for obesity in Saudi Arabia: a systematic review. Obes Rev. 2022;23.

Alenezi YM, Harris R, Morling J, Card T. Prevalence of non-alcoholic fatty liver disease (NAFLD) in Saudi Arabia: systematic review and meta-analysis. Cureus. 2023;15.

Alqahtani SA, Paik JM, Biswas R, Arshad T, Henry L, Younossi ZM. Poor awareness of liver disease among adults with NAFLD in the United States. Hepatol Commun. 2021;5:1833-47.

Lazarus JV, Ekstedt M, Marchesini G, et al. A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe. J Hepatol. 2020;72:14-24.

Cleveland ER, Ning H, Vos MB, et al. Low awareness of nonalcoholic fatty liver disease in a population-based cohort sample: the CARDIA study. J Gen Intern Med. 2019;34:2772-8.

Younossi ZM, Henry L, Bush H, Mishra A. Clinical and economic burden of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Clin Liver Dis. 2018;22:1-10.

Alsubaie A, Mohammad S, Alqarni A, et al. Awareness of adult population toward non-alcoholic fatty liver disease in Riyadh, Saudi Arabia. Int J Dev Ctries. 2020;1938:44.

Ghevariya V, Sandar N, Patel K, Ghevariya N, Shah R, Aron J, Anand S. Knowing what's out there: awareness of non-alcoholic fatty liver disease. Front Med (Lausanne). 2014;1:4.

Maurice J, Manousou P. Non-alcoholic fatty liver disease. Clin Med. 2018;18:245–250.

Neuschwander-Tetri BA. Non-alcoholic fatty liver disease. BMC Med. 2017;15:45.

Guo X, Yin X, Liu Z, Wang J. Non-alcoholic fatty liver disease (NAFLD) pathogenesis and natural products for prevention and treatment. Int J Mol Sci. 2022;23:15489.

Teng ML, Ng CH, Huang DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29:0–42.

Powell EE, Wong VW-S, Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;397:2212–2224.

Bambha K, Belt P, Abraham M, et al. Ethnicity and nonalcoholic fatty liver disease. Hepatology. 2012;55:769–780.

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.

Sinn DH, Kang D, Chang Y, et al. Non-alcoholic fatty liver disease and progression of coronary artery calcium score: a retrospective cohort study. Gut. 2017;66:323–329.

Takaki A, Kawai D, Yamamoto K. Multiple hits, including oxidative stress, as pathogenesis and treatment target in non-alcoholic steatohepatitis (NASH). Int J Mol Sci. 2013;14:20704–20728.

Karkucinska-Wieckowska A, Simoes IC, Kalinowski P, et al. Mitochondria, oxidative stress and nonalcoholic fatty liver disease: a complex relationship. Eur J Clin Invest. 2022;52:0.

Nassir F. NAFLD: mechanisms, treatments, and biomarkers. Biomolecules. 2022;12:824.

Liu Q, Bengmark S, Qu S. The role of hepatic fat accumulation in pathogenesis of non-alcoholic fatty liver disease (NAFLD). Lipids Health Dis. 2010;9:42.

Tanase DM, Gosav EM, Costea CF, et al. The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD). J Diabetes Res. 2020;2020:3920196.

Basaranoglu M, Basaranoglu G, Sabuncu T, Sentürk H. Fructose as a key player in the development of fatty liver disease. World J Gastroenterol. 2013;19:1166–1172.

Chen Z, Tian R, She Z, Cai J, Li H. Role of oxidative stress in the pathogenesis of nonalcoholic fatty liver disease. Free Radic Biol Med. 2020;152:116–141.

Robertson G, Leclercq I, Farrell GC. Nonalcoholic steatosis and steatohepatitis. II. Cytochrome P-450 enzymes and oxidative stress. Am J Physiol Gastrointest Liver Physiol. 2001;281:0–9.

Pessayre D, Mansouri A, Fromenty B. Nonalcoholic steatosis and steatohepatitis. V. Mitochondrial dysfunction in steatohepatitis. Am J Physiol Gastrointest Liver Physiol. 2002;282:0–9.

Flamment M, Kammoun HL, Hainault I, Ferré P, Foufelle F. Endoplasmic reticulum stress: a new actor in the development of hepatic steatosis. Curr Opin Lipidol. 2010;21:239–246.

Gentile CL, Frye M, Pagliassotti MJ. Endoplasmic reticulum stress and the unfolded protein response in nonalcoholic fatty liver disease. Antioxid Redox Signal. 2011;15:505–521.

Hetz C, Chevet E, Harding HP. Targeting the unfolded protein response in disease. Nat Rev Drug Discov. 2013;12:703–719.

Engin AB. Obesity and lipotoxicity. Cham: Springer; 2017. What is lipotoxicity? pp. 197–220.

Branković M, Jovanović I, Dukić M, et al. Lipotoxicity as the leading cause of non-alcoholic steatohepatitis. Int J Mol Sci. 2022;23:5146.

Svegliati-Baroni G, Pierantonelli I, Torquato P, et al. Lipidomic biomarkers and mechanisms of lipotoxicity in non-alcoholic fatty liver disease. Free Radic Biol Med. 2019;144:293–309.

Ricchi M, Odoardi MR, Carulli L, et al. Differential effect of oleic and palmitic acid on lipid accumulation and apoptosis in cultured hepatocytes. J Gastroenterol Hepatol. 2009;24:830–840.

Musso G, Cassader M, Paschetta E, Gambino R. Bioactive lipid species and metabolic pathways in progression and resolution of nonalcoholic steatohepatitis. Gastroenterology. 2018;155:282–302.

Younossi ZM, Gramlich T, Liu YC, et al. Nonalcoholic fatty liver disease: assessment of variability in pathologic interpretations. Mod Pathol. 1998;11:560–565.

Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37:1286–1292.

Wieckowska A, Feldstein AE. Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive. Semin Liver Dis. 2008;28:386–395.

Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–1906.

Cobbina E, Akhlaghi F. Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters. Drug Metab Rev. 2017;49:197–211.

Matteoni C, Younossi Z, Gramlich T, Boparai N, Liu Y, Mccullough A. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–1419.

Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–1362.

Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–2474.

Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–1321.

Bedossa P, Poitou C, Veyrie N, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012;56:1751–1759.

Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol. 2003;98:2042–2047.

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328–357.

European Association for the Study of the Liver. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–1402.

Simon TG, Roelstraete B, Sharma R, Khalili H, Hagström H, Ludvigsson JF. Cancer risk in patients with biopsy-confirmed nonalcoholic fatty liver disease: a population-based cohort study. Hepatology. 2021;74:2410–2423.

Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67:1265–1273.

Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–1565.

Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006;43:682–689.

Lazo M, Hernaez R, Bonekamp S, et al. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011;343.

Mantovani A, Scorletti E, Mosca A, Alisi A, Byrne CD. Nonalcoholic fatty liver disease (NAFLD) and risk of incident extra-hepatic cancers: a systematic review and meta-analysis. Metabolism. 2020;111:154315.

Pais R, Giral P, Khan JF, et al. Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol. 2016;65:95–102.

Spengler EK, Loomba R. Recommendations for diagnosis, referral for liver biopsy, and treatment of NAFLD and NASH. Mayo Clin Proc. 2015;90:1233–1246.

Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: facts and figures. JHEP Rep. 2019;1:468–479.

Koutoukidis DA, Astbury NM, Tudor KE, et al. Association of weight loss interventions with changes in biomarkers of nonalcoholic fatty liver disease: a systematic review and meta-analysis. JAMA Intern Med. 2019;179:1262–1271.

Alam S, Mustafa G, Alam M, Ahmad N. Effect of different therapeutic regimens on biochemical improvement of nonalcoholic fatty liver disease. J Clin Exp Hepatol. 2012;2:304–311.

Armstrong MJ, Gaunt P, Aithal GP, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet. 2016;387:679–690.

Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med. 1999;107:450–455.

Promrat K, Longato L, Wands JR, de la Monte SM. Weight loss amelioration of non-alcoholic steatohepatitis (NASH) is associated with altered hepatic histological and molecular markers. Hepatol Int. 2011;5:673–679.

Dickins DS, Sacks D, Sacks GS, et al. Nutrition management in nonalcoholic fatty liver disease: an evidenced-based review. Nutr Clin Pract. 2021;36:737–751.

Abdulfattah AA, Elmakki EE, Maashi BI, Alfaifi BA, Almalki AS, Alhadi NA, Majrabi H, Kulaybi A, Salami A, Hakami FI. Awareness of Non-alcoholic Fatty Liver Disease and Its Determinants in Jazan, Saudi Arabia: A Cross-Sectional Study. Cureus. 2024 Jan;16(1).

Downloads

How to Cite

Eman AbdulAziz Balbaid, Mousa Faisal Allebdi, Fatimah Abdulrazaq Al Zaher, Ali Amin Alghassab, Dalal Nasser Alsharif, Abdullah Ali Alshehri, Shahad Ahmed Alsharif, Wed Salem BinMadhi, Jana Dhaifallah Algarni, Nada Mohammed Albariqi, Abdullah Faisal Alahmari, Sayed Mohamed Baqer Ebrahim, Ali Abdulshaheed Ahmed, Amjad Bandar Alenazi, and Ruqaiyah Abdullah Al Salam. 2024. “Awareness of Non-Alcoholic Fatty Liver Disease Among General Population in KSA: A Cross-Section Study”. Metallurgical and Materials Engineering 30 (4):249-58. https://doi.org/10.63278/10.63278/mme.v31.1.

Issue

Section

Research