Prevalence of abnormal liver tests and liver fibrosis among rural adults in low and middle-income country: A cross-sectional study

Arulraj Ramakrishnan; Ganesan Velmurugan; Aravindh Somasundaram; Sundaresan Mohanraj; Dinakaran Vasudevan; Paari Vijayaragavan; Peter Nightingale; Krishnan Swaminathan; James Neuberger

doi:10.1016/j.eclinm.2022.101553

Prevalence of abnormal liver tests and liver fibrosis among rural adults in low and middle-income country: A cross-sectional study

EClinicalMedicine. 2022 Jul 14:51:101553. doi: 10.1016/j.eclinm.2022.101553. eCollection 2022 Sep.

Authors

Arulraj Ramakrishnan^{1

2}, Ganesan Velmurugan¹, Aravindh Somasundaram², Sundaresan Mohanraj¹, Dinakaran Vasudevan¹, Paari Vijayaragavan², Peter Nightingale³, Krishnan Swaminathan¹, James Neuberger⁴

Affiliations

¹ KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India.
² Liver Unit, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India.
³ Statistician, University Hospital Birmingham, Birmingham, B15 2TH United Kingdom.
⁴ Liver Unit, University Hospital Birmingham, Birmingham, B15 2TH United Kingdom.

Abstract

Background: Liver disease is the only major chronic disease and mortality is increasing. Earlier detection of liver fibrosis can reduce progression to cirrhosis and hepatocellular carcinoma. Many studies have reported an increased prevalence in liver fibrosis among adults in urban regions but there are few data in physically active rural populations without attributable metabolic risk factors. This aim of this study is to investigate the prevalence of abnormal liver functions tests (LFTs) and liver fibrosis among adults in a rural population.

Methods: This cross-sectional study included observations from KMCH-NNCD-II (2017) study (n = 907) from a farming village, Nallampatti, located in South India. We assessed lifestyle (occupation, tobacco use and alcohol consumption using AUDIT-C questionnaire), markers for metabolic diseases (obesity, hypertension, diabetes, hypercholesterolemia), LFTs and markers for hepatitis viruses B and C. 901 participants had transient elastography to assess fibrosis. Participants with abnormal LFTs and significant liver fibrosis (F2-F4) underwent additional liver screening (caeruloplasmin, iron studies and autoimmune hepatitis panel). Multiple logistic regression analyses were performed to understand the association of liver fibrosis with lifestyle and metabolic risk factors after adjustment for co-variates.

Findings: Significant liver fibrosis (F2-F4) was observed in 14.4%, and cirrhosis in 0.8%. There was an association of liver fibrosis with abnormal LFTs but no association between alcohol consumption, viral hepatitis, hepatic liver screening and liver fibrosis. Among metabolic risk factors, no association was observed for hypertension and hypercholesterolemia but diabetes [OR - 3.206 (95% CI: 1.792 - 5.736)], obesity [1.987 (1.341 - 2.944)] and metabolic syndrome [2.539 (1.680 - 3.836)] showed association with significant liver fibrosis (F2-F4) after adjustment for confounding factors.

Interpretation: Our results suggest that the prevalence of liver fibrosis in rural population is similar to urban counterparts. The association of metabolic risk factors with liver fibrosis in physically active rural population warrants further investigations in future studies.

Funding: This study is funded by KMCH Research Foundation, India.

Keywords: Abnormal liver tests; Aetiological screening for abnormal LFT's; Elastography screening; Liver fibrosis; Low and middle income country; Metabolic syndrome; prevalence.