Prevalence of Risk Factors for Liver Disease in a Random Population Sample in Southern Germany

Abstract

Background: Chronic liver disease leads to fibrosis and cirrhosis of the liver. This may, in turn, result in chronic liver failure or the development of hepatocellular carcinoma (HCC). Main risk factors for chronic liver disease are viral hepatitis and alcoholism. The present study assessed a randomly selected population in southern Germany for risk factors for chronic liver disease such as fatty liver disease, viral hepatis infection and life-style factors. In addition, the potential association with elevated liver enzymes was investigated.

Methods: A total of 2256 subjects (1182 females, 1074 males), aged 18 − 65 years, participated in the study. Each subject underwent a standardized ultrasound examination, and anthropometric and biochemical assessments. Test subjects were randomly selected from the general population of a town in southwestern Germany. Data were acquired from November to December 2002 without further follow-up.

Results: Several factors were found to be associated with chronic liver disease in the study population. Alcohol consumption > 20 g/d was seen in 18.1 % (n = 409). Metabolic syndrome was diagnosed in 5.9 % (n = 132). The number of people with a BMI greater than 25 kg/m² was 45.1 % (n = 1017). The prevalence of subjects with chronic hepatitis B was 0.7 % (n = 15), that of anti-HCV positive patients, 0.6 % (n = 15). Elevated gGT was seen in 10.4 % (n = 14) of the patients. Prevalence of hepatic steatosis was 25.0 % (n = 564).

Conclusions: Many cases of chronic liver disease could be prevented by healthy nutrition, optimized medical treatment of associated disorders, and prevention strategies such as routine vaccination, in particular, against hepatitis B virus (HBV).

Zusammenfassung

Hintergrund: Chronische Lebererkrankungen führen zur Fibrose und Zirrhose der Leber: Dies kann wiederum zum chronischen Leberversagen oder zur Entwicklung eines hepatozellulären Karzinoms führen (HCC). Hauptrisikofaktoren für chronische Lebererkrankungen sind virale Hepatitis und Alkoholkonsum. In der vorliegenden Studie wurde die Prävalenz von Hepatitis B und C ermittelt sowie Risikofaktoren für chronische Lebererkrankungen wie Fettleber, virale Hepatitis und Lifestyle-Faktoren in einer zufälligen Bevölkerungsstichprobe untersucht.

Methoden: An der Studie nahmen 2256 Probanden (1182 Frauen, 1074 Männer) im Alter von 18 − 65 Jahren teil. Bei allen Probanden wurden standardisierte Ultraschalluntersuchungen und Laboruntersuchungen durchgeführt sowie anthropometrische Größen bestimmt. Die Probanden wurden von November bis Dezember 2002 zufällig aus einer Kleinstadt in Südwestdeutschland ausgewählt.

Ergebnisse: Die Ergebnisse zeigen, dass mehrere Faktoren mit einer chronischen Lebererkrankung assoziiert sind. Insgesamt 18,1 % der Probanden gaben einen Alkoholkonsum von über 20 g/Tag an. Das Metabolische Syndrom wurde bei 5,9 % (n = 132) der Probanden diagnostiziert. Insgesamt 45,1 % (n = 1017) der Teilnehmer hatten einen BMI über 25 kg/m². Die Prävalenz von chronischer Hepatitis B lag bei 0,7 % (n = 15), die von Anti-HCV bei 0,6 % (n = 15). Erhöhte gGT-Werte wurden bei 10,4 % (n = 14) der Probanden beobachtet. Die Prävalenz der Steatosis hepatis betrug 25 % (n = 564).

Schlussfolgerungen: In vielen Fällen könnten chronische Lebererkrankungen durch gesunde Ernährung, durch Präventionsstrategien wie routinemäßige Impfung, insbesondere gegen Hepatitis-B-Virus (HBV), verhindert werden.

Schlüsselwörter

Querschnittsstudien - Ultraschall - Fettleber - Hepatitis B - Hepatitis C

Key words

cross-sectional-studies - ultrasonography - fatty liver - hepatitis B - hepatitis C

^* These authors contributed equally

• References

• 1 Michielsen P, Ho E. Viral hepatitis B and hepatocellular carcinoma. Acta Gastroenterol Belg 2011; 74: 4-8
• 2 Bode JC. Epidemiologie und sozioökonomische Bedeutung der chronischen Lebererkrankungen. In: Goebell H, Hotz J, Farthmann EH. Der chronisch Kranke in der Gastroenterologie. Berlin: Springer; 1984
• 3 Bühringer G, Augustin R, Bergmann E et al. Alkoholkonsum und alkoholbezogene Störungen in Deutschland. In: Schriftenreihe des Bundesministeriums für Gesundheit. Baden-Baden: Nomos-Verlag; 2000: 128
• 4 Hüllinghorst R. Versorgung Abhängigkeitskranker in Deutschland. In: Jahrbuch Sucht 06. Geesthacht: Neuland; 2006
• 5 Ziegler H. German center against the dangers of drug addiction (DHS). Organization of the aid to addicts in the Federal Republic of Germany and work of the German Center against Addiction. Fortschr Med 1980; 98: 555-556 , 583
• 6 Epidemiologisches Bulletin des Robert-Koch-Institutes. Zur Situation bei wichtigen Infektionskrankheiten in Deutschland: Virushepatitis B, C, und D im Jahr 2002. Epidemiol Bulletin 2004; 2: 11-20
• 7 Rantala M, van de Laar MJ. Surveillance and epidemiology of hepatitis B and C in Europe – A review. Euro Surveill 2008; 13: 1-8
• 8 Vermehren J, Schlosser B, Domke D et al. High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany: a prospective screening analysis of 28,809 patients. PLoS One 2012; 7
• 9 Poethko-Müller C, Zimmermann R, Hamouda O et al. Epidemiology of hepatitis A, B, and C among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 707-715
• 10 Cornberg M, Razavi HA, Alberti A et al. A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel. Liver Int 2011; 31 (Suppl. 02) 30-60
• 11 Hollinger FB, Liang TJ. Hepatitis B Virus. In: Knipe DM, et al. (eds) Fields Virology, 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001: 2971-3036
• 12 Perz JF, Armstrong GL, Farrington LA et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45: 529-538
• 13 Browning JD, Szczepaniak LS, Dobbins R et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: 1387-1395
• 14 Bedogni G, Miglioli L, Masutti F et al. Incidence and natural course of fatty liver in the general population: the Dionysos study. Hepatology 2007; 46: 1387-1391
• 15 Powell EE, Jonsson JR, Clouston AD. Dangerous liaisons: the metabolic syndrome and nonalcoholic fatty liver disease. Ann Intern Med 2005; 143: 753-754
• 16 McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 2004; 8: 521-533
• 17 Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006; 43 (02) S99-S112
• 18 Haenle MM, Brockmann SO, Kron M et al. Overweight, physical activity, tobacco and alcohol consumption in a cross-sectional random sample of German adults. BMC Public Health 2006; 6: 233
• 19 Imhof A, Woodward M, Doering A et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille). Eur Heart J 2004; 25: 2092-2100
• 20 WHO Expert Committee on Physical Status: the Use and Interpretation of An-thropometry: report of a WHO expert committee. WHO technical report series Geneva: 1995: 427-437
• 21 Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed) 1986; 292: 13-15
• 22 Joseph AE, Saverymuttu SH, al-Sam S et al. Comparison of liver histology with ultra-sonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43: 26-31
• 23 Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907-1917
• 24 Yu MC, Yuan JM, Govindarajan S et al. Epidemiology of hepatocellular carcinoma. Can J Gastroenterol 2000; 14: 703-709
• 25 El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology 2004; 127 (05) S27-S34
• 26 La Vecchia C, Lucchini F, Franceschi S et al. Trends in mortality from primary liver cancer in Europe. Eur J Cancer 2000; 36: 909-915
• 27 Shibuya K, Yano E. Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972-2001. Int J Epidemiol 2005; 34: 397-402
• 28 Blonski W, Kotlyar DS, Forde KA. Non-viral causes of hepatocellular carcinoma. World J Gastroenterol 2010; 16: 3603-3615
• 29 Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol 2006; 40 (Suppl. 01) S5-S10
• 30 Nationale Verzehrsstudie II. Ergebnisbericht Teil 1. 2008
• 31 Sanyal AJ, Yoon SK, Lencioni R. The etiology of hepatocellular carcinoma and consequences for treatment. Oncologist 2010; 15 (Suppl. 04) 14-22
• 32 Ascha MS, Hanouneh IA, Lopez R et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 2010; 51: 1972-1978
• 33 Ertle J, Dechêne A, Sowa JP et al. Nonalcoholic fatty liver disease progresses to HCC in the absence of apparent cirrhosis. Int J Cancer 2010; 128: 2436-2443
• 34 Rega G, Kaun C, Demyanets S et al. Vascular endothelial growth factor is induced by the inflammatory cytokines interleukin-6 and oncostatin m in human adipose tissue in vitro and in murine adipose tissue in vivo. Arterioscler Thromb Vasc Biol 2007; 27: 1587-1595
• 35 Ikejima K, Takei Y, Honda H et al. Leptin receptor-mediated signaling regulates hepatic fibrogenesis and remodeling of extracellular matrix in the rat. Gastroenterology 2002; 122: 1399-1410
• 36 Saxena NK, Sharma D, Ding X et al. Concomitant activation of the JAK/STAT, PI3K/AKT, and ERK signaling is involved in leptin-mediated promotion of invasion and migration of hepatocellular carcinoma cells. Cancer Res 2007; 67: 2497-2507
• 37 Tokushige K, Hashimoto E, Yatsuji S et al. Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma caused by chronic hepatitis C. J Gastroenterol 2010; 45: 960-967
• 38 Roulot D, Costes JL, Buyck JF et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2011; 60: 977-984
• 39 Ittermann T, Haring R, Wallaschofski H et al. Inverse association between serum free thyroxine levels and hepatic steatosis: results from the Study of Health in Pomerania. Thyroid 2012; 22: 568-574
• 40 Donato F, Tagger A, Gelatti U et al. Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol 2002; 155: 323-331
• 41 Munaka M, Kohshi K, Kawamoto T et al. Genetic polymorphisms of tobacco- and alcohol-related metabolizing enzymes and the risk of hepatocellular carcinoma. J Cancer Res Clin Oncol 2003; 129: 355-360
• 42 Robert Koch-Institut. Zur Situation bei wichtigen Infektionskrankheiten in Deutschland. Virushepatitis B, C, und D im Jahr 2011. Epdemiologisches Bulletin 2012; 38: 371-385
• 43 Montella M, Crispo A, Giudice A. HCC, diet, and metabolic factors. Hepat Mon 2011; 11: 159-162