Metabolic-associated Fatty Liver Disease as Assessed by the Fatty Liver Index Among Migrant and Non-migrant Ghanaian Populations

Abstract

Background and Aims Metabolic-associated fatty liver disease (MAFLD) is driven by high caloric intake and sedentary lifestyle. Migration towards high income countries may induce these driving factors; yet, the influence of such on the prevalence of MAFLD is clearly understudied. Here, we investigated the Fatty Liver Index (FLI), a proxy of steatosis in MAFLD, after migration of Ghanaian subjects. Methods Cross-sectional data of 5282 rural, urban and migrant participants from the Research on Obesity and Diabetes among African Migrants (also known as RODAM) study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus (T2DM), waist-to-hip ratio, and 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD). Results Both FLI and the proportion with an FLI indicative of MAFLD steatosis (FLI ≥60) were higher in migrants compared with non-migrants. Prevalence of elevated FLI (FLI ≥60) in non-migrant males was 4.2% compared to 28.9% in migrants. For females, a similar gradient was observed, from 13.6% to 36.6% respectively. Compared to rural residents, the odds for a FLI ≥60 were higher in migrants living in urban Europe (odds ratio [OR] 9.02, 95% confidence interval [CI]: 5.02–16.20 for men, and 4.00, 95% CI: 3.00–5.34 for women). Compared to controls, the ORs for FLI ≥60 were 2.43 (95% CI: 1.73–3.41) for male T2DM cases and 2.02 (95% CI: 1.52–2.69) for female T2DM cases. One-unit higher FLI was associated with an elevated (≥7.5%) 10-year ASCVD risk (OR: 1.051, 95% CI: 1.041–1.062 for men, and 1.020, 95% CI: 1.015–1.026 for women). Conclusions FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas, through urban areas, to Europe. Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.

Pathophysiology of type 2 diabetes in sub-Saharan Africans

“…This raises the question as to whether Black Africans are more sensitive to the effects of ectopic fat accumulation than their White European counterparts [36]. A recent study in Ghanaians, using fatty liver index as a proxy for liver fat, showed that the fatty liver index increases with increasing urbanisation and is associated with prevalent type 2 diabetes [41], which supports the latter hypothesis.…”

The Magnitude and Directions of the Associations between Early Life Factors and Metabolic Syndrome Differ across Geographical Locations among Migrant and Non-Migrant Ghanaians—The RODAM Study

“…The combination of early exposure to famine during childhood and adoption of unhealthy behaviors in later life could explain why LHR is inversely associated with MetSyn among migrants. The adoption of unhealthy behaviors upon migration leading to MetSyn is further evidenced by the increase in non-alcoholic fatty liver disease, which is the hepatic manifestation of MetSyn and also results from unhealthy lifestyle factors [35,36].…”

Epidemiology, natural history, and diagnosis of metabolic dysfunction-associated fatty liver disease: a comparative review with nonalcoholic fatty liver disease

“…Currently, data from African countries remain limited. Van Dijk et al 34 carried out a study using the Research on Obesity and Diabetes among African Migrants data set, which includes both individuals from the Ashanti Region in rural and urban Ghana and migrant Ghanaians living in European cities ( n = 5282). The presence of hepatic steatosis was detected using FLI; unfortunately, the MAFLD diagnostic criteria were not applied.…”

“…Elevated FLI values (>60) were found in 4.2%, 16.3%, and 28.9% of men as well as in 13.6%, 32.3%, and 36.6% of women living in rural Ghana, urban Ghana, and Europe, respectively (both p < 0.001). 34 …”

“…Elevated FLI values (>60) were found in 4.2%, 16.3%, and 28.9% of men as well as in 13.6%, 32.3%, and 36.6% of women living in rural Ghana, urban Ghana, and Europe, respectively (both p < 0.001). 34 In 2012, the Australian Diabetes, Obesity, and Lifestyle study included 4747 Australian adults aged between 34 and 97 years who were considered representative of the general population. 35 The authors found that 37% of the study participants met the criteria for MAFLD; among them, the BARD score ruled out advanced fibrosis in 38% of cases.…”