Steatotic liver disease among lean and non-lean individuals in Southern Lao PDR: a cross-sectional study of risk factors

Abstract

Background

Steatotic liver disease (SLD) prevalence is rising worldwide, linked to insulin resistance and obesity. SLD prevalence can surpass 10% even among those with normal weight. In Lao People’s Democratic Republic (Lao PDR), where Opisthorchis viverrini (OV) trematode infection and type 2 diabetes mellitus (T2DM) are common, infection related liver morbidity such as cholangiocarcinoma (CCA) is high, but data on SLD prevalence is lacking. The objective of this study was to estimate the prevalence and explore determinants of SLD in rural southern Lao PDR for lean and non-lean populations.

Method

A cross-sectional community-based study assessed SLD prevalence using abdominal ultrasonography (US). Factors investigated for association with SLD were identified by interview, serological tests (Hepatitis B surface antigen (HBsAg); lipids and HbA1c), anthropometrical measurements, and parasitological assessments (OV infection). Uni- and multivariable logistic regression analyses with SLD as endpoint were conducted separately for lean (body mass index (BMI) <23.0 kg/m²) and non-lean (BMI ≥ 23.0 kg/m²) participants.

Result

2,826 participants were included. SLD prevalence was 27.1% (95% confidence interval (95% CI) 24.0%−30.4%), higher among non-lean (39.8%) than lean individuals (17.4%). Lean individuals with OV infection had a statistically significant association with lower odds of SLD (adjusted odds ratio (aOR) 0.49, 95% CI 0.33 − 0.73). T2DM showed a significant positive association with SLD in both lean (aOR 3.58, 95% CI 2.28 − 5.63) and non-lean individuals (aOR 3.31, 95% CI 2.31 − 4.74) while dyslipidemia was significantly associated only in the non-lean group (aOR 1.83, 95% CI 1.09 − 3.07). Females participants exhibited elevated odds of SLD in both lean (aOR 1.43, 95% CI 1.02 − 2.01) and non-lean SLD (aOR 1.50, 95% CI 1.12 − 2.01).

Conclusion

SLD prevalence is notably high among Laotian adults in rural areas, particularly in females and in non-lean individuals. Lean individuals with OV infection exhibited lower SLD prevalence. SLD was more prevalent in individuals with T2DM, independent of BMI. SLD adds to the burden of infection-related liver morbidity in Lao PDR.

Keywords:

• Lao PDR
• steatotic liver disease
• hepatic steatosis
• metabolic dysfunction-associated steatotic liver disease
• type 2 diabetes mellitus
• metabolic diseases
• opisthorchis viverrini
• lipids

Acknowledgments

We thank the contribution of staffs from the Lao Tropical and Public Heaths Institute, Vientiane, Lao PDR, the National Center of Mariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR, The University of Health Science, Vientiane, Lao PDR and the Provincial Health Department of Champasak and Savannakhet. We thank the District Health Office of Khong and Champhone districts for helping in the data collection, Kato-Katz examination, questionnaires administrations, and biospecimens collections. We are grateful for the study participants and authorities at all levels for their supports and contribution to our study.

Authors contributions

AH performed data collection activities, developed and conducted data analysis, and wrote an original draft. PS performed data collection and coordinated the research activity. KK helped to develop the study design and objectives, carried out the data collection and ultrasound examinations, and contributed to the critical review and editing of the manuscript. JH provided statistical analysis suggestions and comments for project design and data analysis. SV provided the technical contribution on the ultrasonography. DHP provided study materials, supervised the research activity and final review. SS performed formulation of the research aims, developed the methodology, provided study materials, supervised the research activity; co-drafted the manuscript and performed data analysis, and provided critical review and editing. PO performed formulation of the research aims, developed the methodology, provided study materials, supervised the research activity and provide critical review and editing. NPH performed formulation of the research aims, developed the methodology, provided study materials, developed data analysis, and co-drafted the manuscript.

Disclosure statement

The authors report no conflict of interest

Data availability statement

Data is available upon reasonable request to the corresponding author.

Additional information

Funding

This work was supported by the Swiss National Science Foundation (SNF) and Swiss Development Cooperation (project r4d # IZ07Z0_160930). AH and PS were supported by AFA Foundation, Basel, Switzerland, and SNF NEWTONIAN (project # IZJFZ3_185644). KK and PO received support from the Freie Akademische Gesellschaft, Basel, Switzerland.