Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
13 results
Search Results
Item The association between steatosis and liver damage in transfusion-dependent beta thalassaemia patients(Wiley-Blackwell, 2023) Padeniya, P.; Ediriweera, D.; de Silva, A.P.; Niriella, M.; Premawardhena, A.Non-alcoholic fatty liver disease (NAFLD) is a global health problem. Iron is the leading cause of liver damage in patients with transfusion-dependent thalassaemia (TDT), and data on the contribution of NAFLD to liver damage in TDT is lacking. Forty-five heavily transfused TDT patients who did not have biochemical or ultrasonic evidence of liver cirrhosis were evaluated for effects of iron overload, including the presence of diabetes mellitus, hypogonadism, serum ferritin, R2-MRI-liver, and liver enzymes alanine aminotransferase and aspartate aminotransferase. Liver fibrosis and steatosis were estimated using transient elastography (TE). Nine (20%) patients had significant steatosis (S1), and their body mass index (BMI) and liver fibrosis scores were higher than in patients without significant steatosis (S0) (p = 0.03 and p = 0.004, respectively). On regression analysis, the controlled attenuation parameter (CAP) score (i.e., degree of liver steatosis) was associated only with increasing BMI. The TE score (i.e., degree of liver fibrosis) was associated with increasing age, CAP score, male gender, and presence of diabetes. Neither liver steatosis nor fibrosis showed significant association with the liver iron concentration or iron-related organ damage (hypogonadism). In this cohort of TDT patients, steatosis of the liver, which is associated with increasing BMI, appeared to increase the risk of liver fibrosis.Item Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri Lankan community(BioMed Central, 2017) Rajindrajith, S.; Pathmeswaran, A.; Jayasinghe, C.; Kottahachchi, D.; Kasturiratne, A.; de Silva, S.T.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common problem across the world. We aimed to determine the prevalence of NAFLD and its associations in Sri Lankan adolescents living in an urban Sri Lankan community. METHOD: The study population consisted of the birth cohort of the year 2000, residing in the Ragama Medical Officer of Health area. Socio-demographic and anthropometric data [anthropometric measurements, blood pressure and total body fat distribution] of these adolescents were collected by trained data collectors. Fasting blood sugar, serum insulin, fasting serum lipids and serum alanine aminotransferase (ALT) levels were measured and an abdominal ultrasound was performed. NAFLD was diagnosed on established ultrasound criteria for fatty liver and absent alcohol consumption. RESULTS: The study sample consisted of 499 adolescents [263 (51.8%) girls]. Forty two (8.4%) had NAFLD. NAFLD was significantly associated with being breast fed for less than 4 months (33.3% vs. 17.1 in controls, p = 0.02), higher waist circumference (prevalence risk ratio 83.3/20.3, 4.1, p < 0.0001), higher body mass index (prevalence risk ratio 40.5/4.8, 8.4, p < 0/0001),higher HOMA-IR (3.7 vs. 1.9, p < 0.0001) and high triglycerides (prevalence risk ratio 14.3/5.8, 2.5, p = 0.033). Adolescents with NAFLD also had a higher amount of total body fat (p < 0.001) and subcutaneous fat (p < 0.001) than those without NAFLD. The number of children with metabolic derangements was higher among adolescents with NAFLD than those without (85.8 vs 26.3 in controls, p < 0.0001), but a family history of hypertension, diabetes, myocardial infarction or dyslipidaemia were not. CONCLUSION: Prevalence of NAFLD was high in Sri Lankan adolescents, and was associated with metabolic derangements, especially obesity, insulin resistance and early cessation of breast feeding.Item Lean non-alcoholic fatty liver disease (Lean-NAFLD): characteristics and risk factors from a community cohort follow up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity. However, some NAFLD patients are lean. We assessed the characteristics and risk factors for lean-NAFLD. METHOD: In a community cohort follow up study (initial screening-2007, re-evaluation-2014), NAFLD was established on USS criteria and exclusion of alcohol overuse and secondary causes. Lean (BMI <23 kg/m2) and non-lean (BMI ≥23 kg/m2) NAFLD were compared. The two groups were compared for differences in gender, diabetes, hypertension, hypertriglyceridemia, low-HDL, weight and waist circumference (WC) at baseline. They were also compared for differences in development of incident diabetes, hypertension, hypertriglyceridemia, low-HDL, and change in weight and WC. RESULTS: 678 (69.6%) individuals with NAFLD detected in 2007 presented for follow up in 2014. 78(11.5%) [males-32(41%); mean-age 53.7(SD-7.1) years] were lean and 600(88.5%) [males-191(31.8%); mean-age 52.3(SD-7.5) years] were non-lean. Hypertension (p=0.007) and a smaller WC (<90cm for males, <80cm for females) (p<0.001) were associated with lean-NAFLD. After 7 years, change in BMI was less (p=0.022) among lean-NAFLD. There were no differences in change in WC or incident metabolic co-morbidities. Of those who did not have NAFLD in 2007, 746 developed incident NAFLD in 2014; lean-NAFLD 193/746 (25.9%) [males-100(51.8%); mean age 59.6(SD-7.5)], non-lean-NAFLD 553/746 (74.1%) [males-201(36.3%); mean age 58.2(SD-7.7)]. On logistic regression analysis, presence of diabetes (p=0.002, OR 2.1) and raised WC (p=0.003, OR 1.7) were associated with incident lean-NAFLD. CONCLUSIONS: Among individuals with NAFLD, lean-NAFLD is associated with hypertension and smaller WC. In the community, diabetes and bigger WC predict incident lean-NAFLD.Item Incidence and risk factors for non-alcoholic fatty liver disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyarathna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.INTRODUCTION: In 2007, we reported a 33% prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with PNPLA3(rs738409) gene polymorphism in an urban, adult Sri Lankan population. OBJECTIVES: This study investigated incidence and risk factors for NAFLD after seven years follow-up. METHOD: The study population (42-71-year-olds, selected by age-stratified random sampling from the Ragama MOH area) was screened initially in 2007 and re-evaluated in 2014. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and incident NAFLD was also performed. RESULTS: 2155/2985 (72.2%) of the original cohort attended follow-up [1244-women, 911-men; mean-age 59.2(SD, 7.7) years]. 1322 [839 women; mean-age 58.9 (SD, 7.6) years] had NAFLD. Out of 795 [466 women] who initially did not have NAFLD, 365 [226 women, mean-age 58.6(SD,7.9) years] had developed NAFLD after 7 years (annual incidence-6.6%). Increased waist circumference [p=0.001], BMI>23kg/m2 [p<0.001] and raised plasma triglycerides [p<0.05] independently predicted incident NAFLD. The updated genetic association study (1310 cases, 427 controls) showed borderline association with NAFLD at 2/10 candidate loci: PPP1R3B(rs4240624), PNPLA3(rs738409) (one-tailed p=0.044 and 0.033, respectively). CONCLUSIONS: In this community cohort follow-up study, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of metabolic syndrome, and showed tendency of association with PNPLA3 and PPP1R3B gene polymorphisms.Item Incidence and risk factors for non-alcoholic fatty liver disease: A 7-year follow-up study among urban, adult Sri Lankans(Blackwell Munksgaard, 2017) Niriella, M.A.; Pathmeswaran, A.; de Silva, S.T.; Kasturiratne, A.; Perera, R.; Subasinghe, C.E.; Kodisinghe, K.; Piyaratna, C.; Rishikesawan, V.; Dassanayake, A.S.; de Silva, A.P.; Wickremasinghe, R.; Takeuchi, F.; Kato, N.; de Silva, H.J.BACKGROUND: This study investigated incidence and risk factors for NAFLD among an adult cohort with 7-year follow-up. METHODS: The study population (age-stratified random sampling, Ragama MOH area) was screened initially in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and NAFLD was also performed. RESULTS: Out of 2985 of the original cohort, 2148 (72.0%) attended follow-up (1238 [57.6%] women; mean-age 59.2 [SD-7.6] years) in 2014, when 1320 (61.5%) were deemed NAFLD subjects. Out of 778 who initially did not have NAFLD and were not heavy drinkers throughout follow-up, 338 (43.4%) (221 [65.4%] women, mean-age 57.8 [SD-8.0] years) had developed NAFLD after 7-years (annual incidence-6.2%). Central obesity (OR=3.82 [95%-CI 2.09-6.99]), waist increase >5% (OR=2.46 [95%-CI 1.20-5.05]) overweight (OR=3.26 [95%-CI 1.90-5.60]), weight gain 5%-10% (OR=5.70 [95%-CI 2.61-12.47]), weight gain >10% (OR=16.94 [95%-CI 6.88-41.73]), raised plasma triglycerides (OR=1.96 [95%-CI 1.16-3.29]) and diabetes (OR=2.14 [95%-CI 1.13-4.06]), independently predicted the development of incident NAFLD in multivariate analysis. The updated genetic association study (1362-cases, 392-controls) showed replicated association (P=.045, 1-tailed) with NAFLD at a candidate locus: PNPLA3 (rs738409). CONCLUSIONS: In this community cohort study, the annual incidence of NAFLD was 6.2%. Incident NAFLD was associated with general and central obesity, raised triglycerides and diabetes, and showed a tendency of association with PNPLA3 gene polymorphisms.Item Epidemiology of Non-Alcoholic Fatty Liver Disease (NAFLD) among adults in an urban Sri Lankan community(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2008) Dassanayake, A.S.; Rajindrajith, S.; Kasturiratne, A.; Kalubowila, U.; de Silva, A.P.; Mizoue, T.; Makaya, M.; de Silva, H.J.BACKGROUND - Non-alcoholic fatty liver disease (NAFLD) is increasing in the Asia-Pacific region.NAFLD can progress from simple steatosis, through steatohepatitis to advanced hepatic fibrosis, cirrhosis and hepatoma. Its prevalence in Sri Lanka is not known. OBJECTIVE: To investigate community prevalence and risk factors associated with NAFLD among adults in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: The sample consisted of 2985 randomly selected subjects, 35-65 years old, resident in the Ragama Medical Officer of Health area. NAFLD was diagnosed on ultrasound criteria (presence of 2 out of 3: increased hepatic echogenicity compared to spleen or kidney, blurring of hepatic vasculature, deep attenuation of ultrasound signal), when alcohol intake was <14 units/week for males and <7 units/week for females. Anthropometric and blood pressure (BP) measurements were made; fasting blood glucose and insulin, lipid profile and serum alanine transaminase (ALT) were estimated (normal cutoff values were based on revised ATP III criteria of metabolic syndrome for Asians). RESULTS: 974 (35%) individuals had NAFLD [mean age 52.8 years (SD 7.3), 605 (62.1%) females]. On multivariate analysis, male sex, presence of acanthosis nigricans, central obesity (BMI>25kg/m2 and/or waist circumference >90cm for males, >80cm females), elevated fasting plasma glucose (>100mg/dl),Insulin resistance(HOMA-IR>1), elevated diastolic BP (>85mmHg), elevated plasma triglycerides (>150mg/dl), elevated ALT (> twice the upper limit of normal), and low high density lipoprotein cholesterol (<40mg/dl for men, <50mg/dl for women) were significantly associated with NAFLD. CONCLUSIONS: The prevalence of NAFLD among adults in this urban Sri Lankan community is as high as in western populations. NAFLD is associated with factors that constitute the metabolic syndromeItem Genetic variants of NAFLD in an urban Sri Lankan community(Wiley Blackwell Scientific Publications, 2013) Niriella, M.A.; Kasturiratne, A.; Akiyama, K.; Takeuchi, F.; Isono, M.; Dassanayake, A.S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.OBJECTIVE: Recently, genome-wide association studies (GWAS) have successfully identified loci associated with susceptibility to non-alcoholic fatty liver disease (NAFLD) in populations of European descent. No large-scale genetic studies have been performed thus far in South Asian populations. Therefore, as part of a community-based cohort study in an urban adult population of Sri Lankans, we investigated associations of genetic variants with NAFLD, diagnosed on established ultrasound criteria, and its related phenotypes. METHODS: We selected 10 single nucleotide polymorphisms (SNPs), all previously reported to be associated with NAFLD in populations of European and/or South Asian ancestry, for a case-control replication study. They included loci derived from GWAS [PNPLA3 (rs738409), LYPLAL1 (rs12137855), GCKR (rs780094), PPP1R3B (rs4240624) and NCAN (rs2228603)] plus those from candidate gene studies [APOC3 (rs2854117 and rs2854116), ADIPOR2 (rs767870) and STAT3 (rs6503695 and rs9891119)]. Genotype data of 2988 participants were used for the analysis. RESULTS: A significant NAFLD association was observed for PNPLA3 (rs738409) [OR = 1.25, 95% CI 1.08–1.44, P = 0.003)]; rs738409 was also associated with a trend towards lower serum triglycerides APOC3 variants were significantly (P = 7.3–7.5 × 10–8) associated with higher triglycerides, but not with NAFLD (OR = 0.86). Apart from SNP–lipid associations previously reported at the GCKR, PPP1R3B and NCAN loci, there were no other prominent associations. CONCLUSION: Our data confirm that the PNPLA3 gene variant is significantly associated with NAFLD in the general Sri Lankan population but could not replicate previously reported disease associations at other loci, reinforcing the importance of further large-scale study on genetic variants in diverse populations to better understand the pathophysiology of NAFLD.Item Is Acanthosis Nigricans a useful clinical screening test for non-alcoholic fatty liver disease(NAFLD) in resource poor settings(Elsevier, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.BACKGROUND: Acanthosis nigricans (AN) is an easily detectable papillomatosis and hyperkeratosis of the skin associated with insulin resistance. Insulin resistance is widely accepted as the underlying cause of Non- Alcoholic Fatty Liver Disease (NAFLD). Ultrasonography is the currently accepted tool to screen for NAFLD in the community, but is expensive and needs expertise. OBJECTIVES: To investigate whether AN would be an useful screening test for NAFLD in an adult Sri Lankan population. METHODS: This study was part of a community based investigation −Ragama Health Study (RHS). The study population consisted of 35−64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, clinical examination, liver ultrasound and collection of 10 ml venous blood. NAFLD was diagnosed based on established ultrasound criteria for fatty liver, safe alcohol consumption and absence of serum markers for Hepatitis B and C. AN was identified by the presence of dark, thick, velvety skin in the neck, body folds and creases. Results: 3012 subjects participated in the study. AN was present significantly more frequently among NAFLD patients than normal individuals in both males (37.9% vs. 4.8%, p <0.001) and females (39.8% vs. 5.8%,p<0.001). The sensitivity, specificity, and positive predictive value of AN for NAFLD was 37.9%, 95.2%, 78.0% for males and 39.8%, 94.2%, and 81.3% for females respectively. CONCLUSION: AN is significantly more common in NAFLD than normal individuals. Although AN has a high specificity, it is not an useful test to screen for NAFLD in the community.Item Epidemiology of non- alcoholic fatty liver disease (NAFLD) in an urban Sri Lankan population(Sri Lanka Medical Association, 2008) Dassanayake, A.S.; Rajindrajith, S.; Kasturiratne, A.; Kalubowila, U.; de Silva, A.P.; Mizoue, T.; Makaya, M.; de Silva, H.J.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is increasing in the Asia-Pacific region. NAFLD can progress from simple steatosis, through steatohepatitis to advanced hepatic fibrosis, cirrhosis and hepatoma. Its prevalence in Sri Lanka is not known. Objective: To investigate community prevalence and risk factors associated with NAFLD among adults in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: The sample consisted of 2985 randomly selected subjects, 35-65 years old, resident in the Ragama Medical Officer of Health area. NAFLD was diagnosed on ultrasound criteria (presence of 2 out of 3: increased hepatic echogenicity compared to spleen or kidney, blurring of hepatic vasculature, deep attenuation of ultrasound signal), and when alcohol intake was <14 units/week for males and <7 units/week for females. Anthropometric and blood pressure (BP) measurements were made; fasting blood glucose, lipid profile and serum alanine transaminase (ALT) were estimated (normal cutoff values were based on revised ATP III criteria of metabolic syndrome for Asians). RESULTS: 974(35%) individuals had NAFLD [mean age 52.8 years (SD 7.3), 605 (62.1%) females]. On multivariate analysis, central obesity (BMI>25kg/m2 and/or waist circumference >90cm for males, >80cm females), elevated fasting plasma glucose (>100mg/dl), elevated diastolic BP (>85mmHg), elevated plasma triglycerides (>150mg/dl), elevated ALT (>twice the upper limit of normal), and low high density lipoprotein cholesterol (<40mg/dl for men, <50mg/dl for women) were significantly associated with NAFLD. CONCLUSIONS: The prevalence of NAFLD among adults in this urban Sri Lankan community is as high as in western populations. NAFLD is associated with factors that constitute the metabolic syndrome.Item Prevalence and risk factors for Non-Alcoholic Fatty Liver Disease among an urban aging adult Sri Lankan population – Ragama Health Study 7-year follow up(Sri Lanka Medical Association, 2015) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Priyantha, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, Y.C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: A previous community based study reported a prevalence of 33% for non-alcoholic fatty liver disease (NAFLD) among and urban adult Sri Lankan population. In this follow up study of the same population after 7 years, e reassessed the prevalence and risk factors for NAFLD. METHODS: The study population consisted of 42-71 year old adults, originally selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (<14 units/week for men, <7 units/week for females) and absence of hepatitis B and C markers. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. HbA1c, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as eGFR<60ml/min/1.72m2 (KDIGO/KDOQI classification). RESULTS: of the 2985 original study participants, 2155(72.2%) (1244[57.7%] women, mean age 59.2 years [SD, 7.7]) participated in the present study. 1322 [mean age 58.9 years (SD, 7.6), 483(53.0%) men and 839(67.4%) women] had NAFLD. On multivariate analysis, obesity, abnormal body fat distribution, elevated systolic BP, raised plasma triglycerides, and low HDL were independently associated wth NAFLD. Raised diastolic BP, raised HbA1c, raised ALT and presence of CKD were not associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this aging urban Sri Lankan community has increased over 7 years and is independently associated with constituent features of the metabolic syndrome.