Non Alcoholic Fatty Liver Disease and Its Connection with Diet Habit, Insulin Resistance and ...

128 Pages·2015·1.64 MB·English

Al Azhar University – Gaza
Deanship of Postgraduate Studies
Faculty of Pharmacy
Department of Master of Clinical Nutrition

Non Alcoholic Fatty Liver Disease and Its Connection with
Diet Habit, Insulin Resistance and Dyslipidemia

By
Hana Kamal Saliem Abd ELnabi
Supervisors
Dr. Jehad Hamdan Elhissi Dr. Kanan Mahmoud Alwuhaidi
Assist. Prof. of Public Health Assist. Prof. of Organic Chemistry
C Faculty of Medicine Faculty of Pharmacy
Al-Azhar University-Gaza Al-Azhar University-Gaza

A thesis Submitted in Partial Fulfillment of the Requirements for the Degree
of Master in Clinical Nutrition

Gaza-Palestine
February, 2015

I
Non Alcoholic Fatty Liver Disease and Its Connection with Diet
Habit, Insulin Resistance and Dyslipidemia

II
Al Azhar University – Gaza
Deanship of Postgraduate Studies
Faculty of Pharmacy
Department of Master of Clinical Nutrition

Non Alcoholic Fatty Liver Disease and Its Connection with Diet Habit, Insulin
Resistance and Dyslipidemia

By
Hana Kamal Saliem Abd ELnabi

This thesis was defended successfully on / / 2015 Approved by

Signature Committee Members

Dr. Jehad H. Elhissi -----------------
Dr. Kanan M. Alwuhaidi -----------------
Dr. Samir M. Radi -----------------
Dr. Mohammed Q. Shbair -----------------

III
اىُيمُ وَ ذٍ دِ سْ ٍَ وِّ مُ ذَ ْْ ػِ ٌْ نُ َزََْصِ اوزُ خُ ًَ دَ َآ ٍَِْث بََ" ًىبؼر الله هبق
َِ ُِفشِ سْ َُ ىْ ا تُّ حِ َُ لََ ُهَِّّإ اىُفشِ سْ ُر لََ وَ اىُثشَ شْ اوَ
) 31: فاشػلأا حسىس)

IV
Declaration

I hereby declare that this submission is my work and that, to the best of my knowledge and
belief. It contains neither material previously published or written by another person nor
material which to a substantial extent has been accepted for the award of another degree at
university or other institute except where due acknowledgement has been in the text.

Signature:
Name: Hana Abd Elnabi
Date: February, 2015

V
Dedication

To my beloved Prophet Mohammad (Peace Be Upon Him)
To prisoners in Israeli jails
To my parents
To my brothers and sisters
To my friends
To all those who helped me get to this important moment of my life,

I dedicated this work.

VI
Acknowledgment

I would like to express my deepest gratitude to all individuals concerned in this research. First
and foremost, I offer my sincerest gratitude and many thanks to my academic supervisors,
both, Dr. Jehad Elhissi and Dr. Kanan Alwuhaidi for valuable help in completing this study,
for kind supervision, and encouragement.
A lot of thanks and gratitude to Dr. Danuta Sukkar for her continuous and enormous help,
precious advices and interest towards this study.
I want to express my sincere thanks and appreciation to Dr. Saleh Elmqaid, the Director of
the Department of x- ray at Al Naser hospital for support given throughout this work.
I would like to offer many thanks to all doctors in ultrasound centers of governmental
hospitals for their help.
I address many thanks and appreciation to Mr. Hassan Altibi and laboratory personnel in
Central Blood Bank Society for facilitating and performing with high professionalism the
laboratory analysis in this study, and for their support.
Finally, thanks to all the study participants who cooperate by answering the questionnaire;
without their contribution, this work would never have been done.

Hana Abd Elnabi

VII
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is closely linked with obesity and
insulin resistance. Dietary patterns and nutrients are the important contributors to the
development and treatment of NAFLD.
Objectives: This study was conducted to identify the effect of diet and dietary habits in
occurrence of NAFLD, to reveal the connection of NAFLD with insulin resistance, to clarify
the connection between NAFLD and dyslipidemia and to raise dietary recommendations and
advices to mitigate NAFLD.
Methodology: A retrospective case-control study was conducted at ultrasound centers at
governmental hospitals in Gaza Strip. The study consisted of 55 cases of NAFLD and 55 age
matched controls. Data collection was done by direct methods that included fasting blood
sugar, lipid profile, liver enzymes and hepatitis B surface antigen, and indirect methods
through a structured interview questionnaire.
Results: Concerning dietary factors, intake of fast food, sweets, soft drinks and high intake of
carbohydrates and fats were positively correlated with NAFLD (P value= 0.001 for each).
About biochemical tests, high serum levels of Aspartate Aminotransferase (AST) and high
Fasting blood sugar (FBS) were positively correlated with NAFLD (P value = 0.001 for both),
while low High-density lipoprotein cholesterol (HDL-C) levels were inversely correlated with
NAFLD (P value= 0.02). Other factors were positively associated with NAFLD such as:
hypertension (36.4% of cases versus 16.4% of controls [P value= 0.02]), Diabetes mellitus (
25.5% of cases versus 3.6% of controls [P value= 0.01]), hyperlipidemia ( 40% of cases and
none of controls [P value= 0.001]), and obesity ( 80% of cases compared to 25.5% of controls
[ P value =0.001]). About lifestyle, 76.4% of cases were physically inactive versus 54.5% of
controls (P value= 0.01).
Conclusion: Many risk factors including a diet high in carbohydrates (such as sweets and soft
drinks) and fats. Diabetes mellitus, hyperlipidemia and obesity may be associated with the
development of NAFLD.
Recommendation: For health providers is recommended performing serum transaminases
level and liver ultrasound in patients with obesity, Diabetes and hyperlipidemia for early
detection of NAFLD.
Key words: Non-Alcoholic Fatty Liver Disease, Diabetes Mellitus, Obesity, Hyperlipidemia,
Gaza Strip.
V III
خُثشؼىا خغيىبث صخيَىا
ًذىا ٍف ُىهذىا خجسّ عبفرساو شنسىا ضشٍو ءازغىا ػَْث هزقلاػو ٍىىحنىا شُغ ٍْهذىا ذجنىا ضشٍ
خساسذىا صخيٍ
ِٓ خ١ئازغٌا داٌّٛاٚ غبّٔلأا ْإ .ٓ١ٌٛغٔلأا خِٚبمِ ٚ خّٕغٌا غِ ك١صٚ ًىشث ػجرش٠ ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ
.ضشٌّا طلاػ بع٠أ ٚ ضشٌّا سٛطرٚ سٚذؾٌ خٌّّٙا ةبجعلأا
ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ سٚذؽ ٟف خ١ئازغٌا دادبؼٌاٚ ٟئازغٌا َبظٌٕا ش١صأر ٍٝػ فشؼزٌٍ خعاسذٌا ٖز٘ ذ٠شعأ :فاذهلأا
ذجىٌا ضشِ ٓ١ث خللاؼٌا ؼ١ظٛزٌ ,ٓ١ٌٛغٔلأا خِٚبمِٚ ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ ٓ١ث خللاؼٌا ٓػ فشىزٌ , ٌٟٛؾىٌا
.ضشٌّا از٘ ِٓ ف١فخزٌٍ ؼئبصٌٕاٚ خ١ئازغٌا دب١صٛزٌا غفشٌ ,ْٛ٘ذٌا خجغٔ عبفرسا ٚ ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا
: خساسذىا خُخبهٍْ
.حضغ عبطل ٟف خ١ِٛىؾٌا دب١فشزغٌّا ٟف خ١رٛصٌا قٛف دبعٌّٛا ضواشِ ٟف ٟؼعس شصأث ذ٘اٛشٌاٚ دلابؾٌا خعاسد ذ٠شعأ
ك٠شغ ٓػ دبٔب١جٌا غّع ُر ذلٚ .ػثاٛعٌا ِٓ 55 ٚ ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ٝظشِ ِٓ خٌبؽ 55 ِٓ خعاسذٌا ذٔٛىرٚ
ٟئبثٌٛا ذجىٌا ةبٙزٌاٚ ذجىٌا فئبظٚ ,َذٌا ٟف ْٛ٘ذٌا ٜٛزغِ ,َذٌا ٟف شىغٌا ٜٛزغِ ً١ٍؾر ذٍّش ٟزٌا حششبجٌّا ت١ٌبعلأا
.ٓ١وسبشٌّا غِ حششبجٌّا دلاثبمٌّبث دبٔبجزعلاا يلاخ ِٓ حششبجِ ش١غ ت١ٌبعأٚ
ِٓ حش١جو دب١ّو يٚبٕرٚ خ٠صبغٌا دبثٚششٌّا , دب٠ٍٛؾٌا ,خؼ٠شغٌا دبجعٌٛا يٚبٕر ,خ١ئازغٌا ًِاٛؼٌبث كٍؼز٠ بّ١ف :حئبزْىا
,)ُِٕٙ ًىٌ 0.001 خ١ئبصؽإ خٌلاد( ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ غِ ب١ثبغ٠ا بغبجرسا ذطجرسا ْٛ٘ذٌا ٚ داسذ١٘ٛثشىٌا
ذجىٌا ضشِ غِ ٟثبغ٠إ ًىشث خطجرشِ ذٔبو َذٌا ٟف شىغٌا ٜٛزغِ عبفرساٚ )AST( عبفرسا ,خ١ئب١ّ١وٛ١جٌا داسبجزخلاا يٛؽ
ضشِ غِ ب١غىػ ػجرشِ ذٔبو )HDL-C( ضبفخٔا ْأ ٓ١ؽ ٟف ,)بِّٕٙ ًىٌ 0.00 خ١ئبصؽإ خٌلاد( ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا
ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ غِ خ١ثبغ٠ئث ٜشخأ ًِاٛػ ذطجرسا .) 0.02 خ١ئبصؽإ خٌلاد) ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا
٪25.5( ٞشىغٌا ءادٚ ,) 0.02 خ١ئبصؽإ خٌلاد) ػثاٛعٌا ِٓ ٪16.4 ًثبمِ دلابؾٌا ِٓ ٪36.4( َذٌا ػغظ عبفرسا :ًضِ
ِٓ ذؽأ لا ٚ دلابؾٌا ِٓ ٪40( ْٛ٘ذٌا خجغٔ عبفرسا ,) 0.01 خ١ئبصؽإ خٌلاد( ػثاٛعٌا ِٓ ٪3.6 ًثبمِ دلابؾٌا ِٓ
(0.001 خ١ئبصؽإ خٌلاد( ػثاٛعٌا ِٓ ٪25.5 غِ خٔسبمٌّبث دلابؾٌا ِٓ ٪80( خّٕغٌاٚ )0.001خ١ئبصؽإ خٌلاد( ػثاٛعٌا
. (0.01 خ١ئبصؽإ خٌلاد( ػثاٛعٌا ِٓ ٪54.5 ًثبمِ ب١ٔذث ػ١شٔ ش١غ دلابؾٌا ِٓ ٪76.4 ,حب١ؾٌا ػٌّٕ خجغٌٕبث
داسذ١٘ٛثشىٌبث خ١ٕغٌا خ٠زغلأا ِٓ خ١ٌبػ دب١ّو يٚبٕر هٌر ٟف بّث حذ٠ذػ ضشٌّا ازٙث خثبصلإٌ شطخٌا ًِاٛػ :خصلاخىا
ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ ش٠ٛطر غِ خطجرشِ خّٕغٌاٚ ْٛ٘ذٌا ,ٞشىغٌا ءاد .ْٛ٘ذٌاٚ )خ٠صبغٌا دبثٚششٌّاٚ دب٠ٍٛؾٌا( ًضِ
.ٌٟٛؾىٌا
ْٛٔبؼ٠ ٓ٠زٌا ٝظشٌٍّ ذجىٌٍ خ١رٛصٌا قٛف دبعٌّٛاٚ ذجىٌا دبّ٠ضٔإ خؼثبزّث ٝصٛ٠ خ١ؾصٌا دبِذخٌا ِٟذمٌّ :دبُصىزىا
..ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ ٓػ شىجٌّا فشىٌٍ ْٛ٘ذٌا خجغٔ عبفرساٚ ٞشىغٌاٚ ,خّٕغٌا ِٓ
.حضغ عبطل ,ْٛ٘ذٌا حدب٠ص ,خّٕغٌا ,ٞشىغٌا ءاد , ٌٟٛؾىٌا ش١غ ٟٕ٘ذٌا ذجىٌا ضشِ :دبَينىا حُربفٍ

IX
Table of Contents
Declaration ............................................................................................................................. V
Dedication ............................................................................................................................. VI
Acknowledgment ................................................................................................................ VII
Abstract .............................................................................................................................. VIII
خعاسذٌا صخٍِ ............................................................................................................................ IX
List of tables ....................................................................................................................... XIV
List of Annexes .................................................................................................................. XVI
Abbreviations .................................................................................................................... XVII
Chapter 1 ................................................................................................................................. 1
Introduction ............................................................................................................................. 1
1.1 Overview ....................................................................................................................... 1
1.2 Goal and Objectives ....................................................................................................... 3
1.2.1 Goal ......................................................................................................................... 3
1.2.2 Objectives ............................................................................................................... 3
1.3 Research Hypothesis...................................................................................................... 3
1.4 Research Problem .......................................................................................................... 3
1.5 Significance of the Study ............................................................................................... 3
1.6 Context of Study ............................................................................................................ 3
1.6.1 Geographic and Demographic Context ................................................................... 3
1.6.2 Socio-economic Context ......................................................................................... 4
1.6.3 Health Service Context ........................................................................................... 5
1.7 Operational Definitions ................................................................................................. 6
1.7.1 Anthropometric measures ....................................................................................... 6
1.7.2 Body Mass Index (BMI) ......................................................................................... 6
1.7.3 Daily intake of fats and oils (servings/day) ............................................................ 6
1.7.4 Physical activity (PA) ............................................................................................. 6
1.7.5 Serum Total Cholesterol (TC) ................................................................................ 7
1.7.6 Serum High- Density Lipoprotein Cholesterol (HDL-C) ....................................... 7
1.7.7 Serum Low- Density Lipoprotein Cholesterol (LDL-C) ........................................ 7
Chapter 2 ................................................................................................................................. 8
Literature Review .................................................................................................................... 8
2.1 Non-alcoholic Fatty Liver Disease- Overview .............................................................. 8
X