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Abstract
RÉSUMÉ
Contexte et objectif. Les patients atteints de diabète de type 2 (DT2) ont un risque élevé de stéatopathie hépatique non alcoolique (NAFLD). Le but de ce travail était de déterminer les facteurs de risque associés à cette stéatopathie métabolique chez les diabétiques de type 2 en Côte d’Ivoire. Matériels et Méthodes. Étude prospective, multicentrique, transversale et analytique réalisée dans les services d'Hépato-Gastro-Entérologie du CHU de Yopougon, de diabétologie de l'Institut National de Santé Publique et de la polyclinique Farah (Abidjan) du 1er Février au 31 Août 2020. Nous avons inclus 52 patients diabétiques de race noire, âgés de 18 ans et plus, ayant réalisé un Fibroscan/CAP. Résultats. 53,8% des patients avaient une NAFLD ; 57,6% avaient une stéatose supérieure ou égale à S1. En analyse univariée, l’âge inférieur à 45 ans était significativement associé à l’absence de stéatopathie métabolique (p= 0,03) ; l’HTA, l’IMC et l’insulino-résitance étaient significativement associés à la survenue de la NAFLD (p=0,02, p=0,02 et p=0,03 respectivement). En analyse multivariée seule l’élévation des GGT était associée à une stéatopathie (p=0,02). Conclusion. Notre étude a retrouvé une prévalence élevée (53.8%) de la NAFLD dans la population diabétique à Abidjan avec 48,1 % de fibrose hépatique significative.
ABSTRACT
Background/Purpose. Patients with type 2 diabetes (T2D) have high risk of non-alcoholic fatty liver disease (NAFLD). The aim of this work was to determine the risk factors associated with this metabolic steatopathy in type 2 diabetics in Ivory Coast. Materials and Methods. Analytical cross-sectional multicenter study carried out in the Hepato-Gastro-Enterology departments of the Yopougon University Hospital, the diabetology departments of the National Institute of Public Health and the Farah polyclinic (Abidjan) from February 1 to August 31, 2020. We included 52 black diabetic patients, aged 18 and over, having performed a Fibroscan/CAP. Results. 53.8% of patients had NAFLD; 57.6% had steatosis greater than or equal to S1. In univariate analysis, age less than 45 years was significantly associated with the absence of metabolic steatopathy (p = 0.03); hypertension, BMI and insulin resistance were significantly associated with the occurrence of NAFLD (p=0.02, p=0.02 and p=0.03 respectively). In multivariate analysis only the elevation of GGT was statistically associated with steatopathy (p=0.02). Conclusion. Our study found a high prevalence (53.8%) of NAFLD in the diabetic population in Abidjan with 48.1% of significant liver fibrosis.
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References
- LaBrecque D, Abbas Z, Annania F. Stéatose hépatique non alcoolique et stéatohépatite non alcoolique. Juin 2012. World Gastroenterology Organisation Global Guidelines :https://www.worldgastroenterology.org/UserFiles/file/guidelines/nafld-nash-french-2012.pdf.
- Younossi Z, Anstee Q, Marietti M. 2018. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat. Rev. Gastroenterol. Hepatol. 15 (1), 11–20.
- Chang Y, Jung H, Cho J. Metabolically healthy obesity and the development of nonalcoholic fatty liver disease. Am J Gastroenterol 2016; 111:1133–40
- American Diabetes Association. 2019. Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care 42 (Suppl. 1), S13–S28. [consulté le 07/08/2021]. Disponible sur: https://pubmed.ncbi.nlm.nih.gov/30559228/
- Younossi Z, Stepanova M, Afendy M. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011; 9:524-30.
- Sobhonslidsuk, Pulsombat, Kaewdoung. 2015. Non-alcoholic Fatty Liver Disease (NAFLD) and significant hepatic fibrosis defined by non-invasive assessment in patients with type 2 diabetes. Asian Pac. J. Cancer Prev. APJCP 16 (5), 1789–94.
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- Organisation mondiale de la Santé (OMS). Rapport mondial sur le diabète. Le diabète sera la 7e cause de décès dans le monde d'ici à 2030. Genève, Suisse : Organisation mondiale de la Santé ; 2016. https://fr. sputniknews.com/20190820/cote-divoire le-diabete-sera-la-7ecause-de-deces-dans le-monde-dici-a-2030–oms-1041955350. Html
- Wong V, Wong G, Yeung D, Lau T, Chan C, Chim A, et al. Incidence of non-alcoholic fatty liver disease in Hong Kong: a population study with paired proton-magnetic resonance spectroscopy. J Hepatol. 2015;62:182–89.
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- Sporea I, Mare R, Lupușoru R, Sima A, Șirli R, Popescu A, Tima R. 2016. Liver stiffness evaluation by transient elastography in type 2 diabetes mellitus patients with ultrasound-proven steatosis. J. Gastrointest. Liver Dis. 25 (2).
- Amiri D, Koushki M, Motedayen M, Dousti M, Sayehmiri F, Vafaee R, et al. 2017. Type 2 diabetes mellitus and non-alcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterol. Hepatol. from bed to bench 10 (Suppl. 1), S1–S7.
- Quillot D, Böhme P, Ziegler O. La stéato-hépatite non alcoolique : influence de la nutrition, de la physiopathologie au traitement. Post’U 2011 ;35-46.
- Ntagirabiri R, Cikomola J, Baransaka E. Stéatose hépatique lors du syndrome métabolique chez l’adulte noir africain : cas du Burundi, 2014, J. Afr. Hépatol. Gastroentérol.
- Tsuneto A, Hida A, Sera N, Imaizumi M, Ichimaru S, Nakashima E, et al. Fatty liver incidence and predictive variables. Hypertens Res. 2010; 33:638–43.
- Lai L, Wan Y, Vethakkan S, Nik M, Mahadeva S, Chan W. Screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography, Gastroenterol. Hepatol. 2019, 1–8.
- Shahwan M, Khattab A, Khattab M, Jairoun A. Association between abnormal serum hepatic enzymes, lipid levels and glycemic control in patients with type 2 diabetes mellitus, Obes. Med. 2019, 16, 100137.
- Adoueni K, Ankotche A, Azoh A. Prise en charge du patient diabétique en Côte d’Ivoire sur le mode de la decentralisation, elsevier ; diabet ; 2012. P 88
- Fujioka K. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes Obes Metab. 2015; 17:1021–32.
References
LaBrecque D, Abbas Z, Annania F. Stéatose hépatique non alcoolique et stéatohépatite non alcoolique. Juin 2012. World Gastroenterology Organisation Global Guidelines :https://www.worldgastroenterology.org/UserFiles/file/guidelines/nafld-nash-french-2012.pdf.
Younossi Z, Anstee Q, Marietti M. 2018. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat. Rev. Gastroenterol. Hepatol. 15 (1), 11–20.
Chang Y, Jung H, Cho J. Metabolically healthy obesity and the development of nonalcoholic fatty liver disease. Am J Gastroenterol 2016; 111:1133–40
American Diabetes Association. 2019. Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care 42 (Suppl. 1), S13–S28. [consulté le 07/08/2021]. Disponible sur: https://pubmed.ncbi.nlm.nih.gov/30559228/
Younossi Z, Stepanova M, Afendy M. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011; 9:524-30.
Sobhonslidsuk, Pulsombat, Kaewdoung. 2015. Non-alcoholic Fatty Liver Disease (NAFLD) and significant hepatic fibrosis defined by non-invasive assessment in patients with type 2 diabetes. Asian Pac. J. Cancer Prev. APJCP 16 (5), 1789–94.
Kwok, Choi K, Wong. 2016. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut 65, 1359–68.
Organisation mondiale de la Santé (OMS). Rapport mondial sur le diabète. Le diabète sera la 7e cause de décès dans le monde d'ici à 2030. Genève, Suisse : Organisation mondiale de la Santé ; 2016. https://fr. sputniknews.com/20190820/cote-divoire le-diabete-sera-la-7ecause-de-deces-dans le-monde-dici-a-2030–oms-1041955350. Html
Wong V, Wong G, Yeung D, Lau T, Chan C, Chim A, et al. Incidence of non-alcoholic fatty liver disease in Hong Kong: a population study with paired proton-magnetic resonance spectroscopy. J Hepatol. 2015;62:182–89.
Alberti KG, Eckel RH, Grundy SM. International Diabetes Federation Task Force on Epidemiology and Prevention ; National Heart Lung and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the Metabolic Syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart Lung and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640–5.
Sporea I, Mare R, Lupușoru R, Sima A, Șirli R, Popescu A, Tima R. 2016. Liver stiffness evaluation by transient elastography in type 2 diabetes mellitus patients with ultrasound-proven steatosis. J. Gastrointest. Liver Dis. 25 (2).
Amiri D, Koushki M, Motedayen M, Dousti M, Sayehmiri F, Vafaee R, et al. 2017. Type 2 diabetes mellitus and non-alcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterol. Hepatol. from bed to bench 10 (Suppl. 1), S1–S7.
Quillot D, Böhme P, Ziegler O. La stéato-hépatite non alcoolique : influence de la nutrition, de la physiopathologie au traitement. Post’U 2011 ;35-46.
Ntagirabiri R, Cikomola J, Baransaka E. Stéatose hépatique lors du syndrome métabolique chez l’adulte noir africain : cas du Burundi, 2014, J. Afr. Hépatol. Gastroentérol.
Tsuneto A, Hida A, Sera N, Imaizumi M, Ichimaru S, Nakashima E, et al. Fatty liver incidence and predictive variables. Hypertens Res. 2010; 33:638–43.
Lai L, Wan Y, Vethakkan S, Nik M, Mahadeva S, Chan W. Screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography, Gastroenterol. Hepatol. 2019, 1–8.
Shahwan M, Khattab A, Khattab M, Jairoun A. Association between abnormal serum hepatic enzymes, lipid levels and glycemic control in patients with type 2 diabetes mellitus, Obes. Med. 2019, 16, 100137.
Adoueni K, Ankotche A, Azoh A. Prise en charge du patient diabétique en Côte d’Ivoire sur le mode de la decentralisation, elsevier ; diabet ; 2012. P 88
Fujioka K. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes Obes Metab. 2015; 17:1021–32.