Features of metabolic associated fatty liver disease in the CENTRAL ASIAN population in low and high altitude

Background There is insufficient knowledge about the course of metabolically associated fatty liver disease (MAFLD) in Asian populations living at different altitudes. It has been hypothesized that chronic hypoxia in high altitude conditions may have a protective effect against the development of fatty liver disease.

Aim To study the course of MAFLD in lean and obese patients living in the conditions of low and high mountains of Kyrgyzstan.

Material and Methods An open comparative study of patients with MAFLD (n= 338) living in low mountains (Bishkek, height above sea level–750-800 m, n=137, with Diabetes mellitus 2 (DM2), n= 68, without DM2 n= 69) and high mountains (At-Bashy district, Naryn region, height above sea level–2046-2300 m, n=201, with DM2 n=64, without DM2 – n=137 ) of Kyrgyzstan was carried out.The average age of the patients was 58± 0.7 years. The ratio of women and men in low mountains group was 53.3% and 46.7%, respectively, in high mountains group – 71% and 29%. The analyzed group included outpatients from June 2019 to June 2021.The anthropometric parameters and biochemical parameters of blood were determined. Liver fibrosis index was calculated using the FIB Score.The study was approved by the local ethics committee of the Scientific and Production Association "Preventive Medicine" of the Ministry of Health of the Kyrgyz Republic (conclusion No. 6 dated October 08, 2019).The study was conducted within the framework of the project “Etiopathogenetic features and rates of development of non-alcoholic fatty liver disease (NAFLD) in Kyrgyzstan” (registration number MZN/TK-2020-3).

Results Residents of the high mountains with MAFLD had a lower BMI compared to the lowlanders. Low blood glucose and HbA1c levels are observed in patients with high BMI living in high altitude areas compared with lowlanders, especially in combination with DM2. In the group of obese patients with MAFLD living in highlands, low total cholesterol (TC), low density lipoproteins (LDL) and glomerular filtration rate (GFR) are observed. A high risk of fibrosis was noted in the group of lean patients in both regions. A moderate positive relationship was found between FIB-4 and FINDRISC (r= -0.319, p<0.001) and moderate negative relationship between FINDRISC and fat percentage (r= -0.467, p<0.001).

Conclusion Results indicate that the study of the effect of chronic high-altitude hypoxia on the course of MAFLD requires prospective population-based studies.

Publication History

Article published online:
19 August 2022