Validation of the Fatty Liver Index for identifying non-alcoholic fatty liver disease in a Kenyan population.

BACKGROUND AND AIM: Fatty Liver Index (FLI) is a simple clinical scoring system estimating non-alcoholic fatty liver disease (NAFLD). It is validated in European-descent and Asian populations, but not in sub-Saharan Africans. The aim of this study is to evaluate the validity of the FLI for predicting NAFLD in a population from Kenya. METHODS: Participants were recruited from a community-based study conducted in Kenya. NAFLD was diagnosed using hepatic ultrasonography. Clinical, anthropometrical, biochemical and lifestyle data were obtained. The accuracy and cut-off point of the FLI to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis. RESULTS: A total of 640 participants (94 with NAFLD) were included. Mean age was 37.4 ± 0.4 years and 58.7% were women. Mean body mass index (BMI) was 22.3 ± 0.2 kg/m2 and waist circumference (WC) 79.1 ± 0.4 cm. A total of 15 (2.3%) participants were diagnosed with type 2 diabetes and 65 (10.2%) with obesity (BMI ≥ 30 kg/m2 ). AUROC of FLI for predicting NAFLD was 0.80 (95% CI 0.74-0.85), which was significantly higher compared to individual components gamma-glutamyl transferase and triglycerides (p < 0.05), but not compared to anthropometric parameters BMI (AUROC of 0.83, 95% CI 0.79-0.88) and WC (AUROC of 0.81, 95% CI 0.76-0.87). CONCLUSIONS: FLI is a simple valid scoring system to use in rural and urban Kenyan adults. However, this index might not be superior to BMI or WC to predict NAFLD, and those measurements might therefore be more appropriate in limited settings.

Hepatic steatosis is associated with anthropometry, cardio-metabolic disease risk, sex, age and urbanisation, but not with ethnicity in adult Kenyans.

OBJECTIVE: We aimed to determine the associations of non-alcoholic fatty liver disease (NAFLD) with cardio-metabolic risk factors for diabetes in adult Kenyans. METHODS: A cross-sectional study was undertaken among rural and urban Kenyans of different ethnic origin. Ultrasonography scanning (USS) methods were used for the assessment of hepatic fat accumulation for NAFLD assessment and abdominal fat distribution, and simple anthropometry measurements were performed. All participants underwent a 2-h oral glucose tolerance test, and biochemical, haemodynamic and lifestyle data were obtained. Multivariate logistic regression analyses were used to assess sex, age, residency and ethnic differences in the association between NAFLD and various metabolic parameters. RESULTS: In total, 743 individuals (59.1% women) with a mean age of 38.0 (range 18-68) years participated in the study. Overall, 118 individuals (15.9%) had NAFLD, of whom 94.1% had mild steatosis. Age >40 years was significantly associated with having NAFLD compared with <30 years of age with no difference found in NAFLD between ethnic groups (Luo, Kamba, Maasai). All body composition and clinical measurements were associated with NAFLD (p < 0.045 for OR). CONCLUSION: Finding lower odds for NAFLD in men was unexpected, as was the lack of differences in NAFLD among the ethnic groups, while higher odds for NAFLD with increasing age and in urban vs. rural populations was expected. Especially the sex-specific results warrant further studies in black African populations on biology of body composition for having NAFLD, and whether this translates into insulin resistance and higher risk of diabetes and consequently cardiovascular disease in black African women.

Waist circumference and low high-density lipoprotein cholesterol as markers of cardiometabolic risk in Kenyan adults.

BACKGROUND: Abdominal obesity predict metabolic syndrome parameters at low levels of waist circumference (WC) in Africans. At the same time, the African lipid profile phenotype of low high-density lipoprotein (HDL) cholesterol without concomitant elevated triglyceride levels renders high triglyceride levels detrimental to cardiometabolic health unsuitable for identifying cardiometabolic risk in black African populations. OBJECTIVES: We aimed to identify simple clinical measures for cardiometabolic risk based on WC and HDL in an adult Kenyan population in order to determine which of the two predictors had the strongest impact. METHODS: We used linear regression analyses to assess the association between the two exposure variables WC and HDL with cardiometabolic risk factors including ultrasound-derived visceral (VAT) and subcutaneous adipose tissue (SAT) accumulation, fasting and 2-h venous glucose, fasting insulin, fasting lipid profile, and blood pressure in adult Kenyans (n = 1 370), and a sub-population with hyperglycaemia (diabetes and pre-diabetes) (n = 196). The same analyses were performed with an interaction between WC and HDL to address potential effect modification. Ultrasound-based, semi-quantitative hepatic steatosis assessment was used as a high-risk measure of cardiometabolic disease. RESULTS: Mean age was 38.2 (SD 10.7) (range 17-68) years, mean body mass index was 22.3 (SD 4.5) (range 13.0-44.8) kg/m2, and 57.8% were women. Cardiometabolic risk was found in the association between both WC and HDL and all outcome variables (p<0.05) except for HDL and SAT, fasting and 2-h venous glucose. Additive cardiometabolic risk (WC and HDL interaction) was found for SAT, low-density lipoprotein cholesterol, and triglycerides. No differences in the association between WC and HDL and the outcome variables were found when comparing the full study population and the hyperglycaemia sub-population. Increase in WC and HDL were both associated with hepatic steatosis (OR 1.09, p<0.001, and OR 0.46, p = 0.031, respectively). CONCLUSION: In adult Kenyans, increasing WC identified more cardiometabolic risk factors compared to HDL.

Hemoglobin levels and blood pressure are associated in rural black africans.

OBJECTIVES: The association between blood levels of hemoglobin (B-hgb) and blood pressure (BP) has been widely investigated in Caucasians and Asians but there is a paucity of data in rural black Africans. The objective was to investigate the association between B-hgb and BP in a rural black African population. METHODS: A cross-sectional study was conducted in three districts in Kenya (Bondo, Kitui, and Transmara) with the inclusion of participants aged ≥17 years. Background information, anthropometry, BP, B-hgb, hepatic insulin resistance (HOMA2-IR), standard lipid profile, and oral glucose tolerance test were obtained in each participant. RESULTS: Background characteristics among 1,167 participants showed that anemic and non-anemic participants differed significantly from each other as there were more women, lower body mass index and waist circumference (WC), lower degree of hepatic insulin resistance and plasma cholesterols among the anemic participants. Furthermore, anemic participants had significantly lower systolic and diastolic BP (P < 0.01) but not a significantly different prevalence of hypertension (P = 0.08). Multivariate linear regression models adjusted for-age, sex, plasma total-cholesterol, WC, Log2(HOMA2-IR), ethnicity, and smoking status-revealed that B-hgb (per mmol/l increment) was significantly associated with systolic BP (estimate: 1.18 (0.37-1.98)) and diastolic BP (estimate: 1.06 (0.54-1.57)) (P < 0.01). CONCLUSIONS: B-hgb is associated with BP in rural black Africans.

Food Insecurity and Not Dietary Diversity Is a Predictor of Nutrition Status in Children within Semiarid Agro-Ecological Zones in Eastern Kenya.

Machakos and Makueni counties in Kenya are associated with historical land degradation, climate change, and food insecurity. Both counties lie in lower midland (LM) lower humidity to semiarid (LM4), and semiarid (LM5) agroecological zones (AEZ). We assessed food security, dietary diversity, and nutritional status of children and women. Materials and Methods. A total of 277 woman-child pairs aged 15-46 years and 6-36 months respectively, were recruited from farmer households. Food security and dietary diversity were assessed using standard tools. Weight and height, or length in children, were used for computation of nutritional status. Findings. No significant difference (P > 0.05) was observed in food security and dietary diversity score (DDS) between LM4 and LM5. Stunting, wasting, and underweight levels among children in LM4 and LM5 were comparable as were BMI scores among women. However, significant associations (P = 0.023) were found between severe food insecurity and nutritional status of children but not of their caregivers. Stunting was significantly higher in older children (>2 years) and among children whose caregivers were older. Conclusion. Differences in AEZ may not affect dietary diversity and nutritional status of farmer households. Consequently use of DDS may lead to underestimation of food insecurity in semiarid settings.

Prevalence of metabolic syndrome among an urban population in Kenya.

OBJECTIVE: Developing countries are undergoing an epidemiologic transition accompanied by increasing burden of cardiovascular disease (CVD) linked to urbanization and lifestyle modifications. Metabolic syndrome is a cluster of CVD risk factors whose extent in Kenya remains unknown. The aim of this study was to determine the prevalence of metabolic syndrome and factors associated with its occurrence among an urban population in Kenya. RESEARCH DESIGN AND METHODS: This was a household cross-sectional survey comprising 539 adults (aged ≥18 years) living in Nairobi, drawn from 30 clusters across five socioeconomic classes. Measurements included waist circumference, HDL cholesterol, triacylglycerides (TAGs), fasting glucose, and blood pressure. RESULTS: The prevalence of metabolic syndrome was 34.6% and was higher in women than in men (40.2 vs. 29%; P < 0.001). The most frequently observed features were raised blood pressure, a higher waist circumference, and low HDL cholesterol (men: 96.2, 80.8, and 80%; women: 89.8, 97.2, and 96.3%, respectively), whereas raised fasting glucose and TAGs were observed less frequently (men: 26.9 and 63.3%; women: 26.9 and 30.6%, respectively). The main factors associated with the presence of metabolic syndrome were increasing age, socioeconomic status, and education. CONCLUSIONS: Metabolic syndrome is prevalent in this urban population, especially among women, but the incidence of individual factors suggests that poor glycemic control is not the major contributor. Longitudinal studies are required to establish true causes of metabolic syndrome in Kenya. The Kenyan government needs to create awareness, develop prevention strategies, and strengthen the health care system to accommodate screening and management of CVDs.