Nonalcoholic fatty liver disease in Sub-Saharan Africa: A descriptive study of the range of histopathological findings in the South-West zone of Nigeria

Abstract

Abstract Background: Nonalcoholic fatty liver disease (NAFLD) is increasingly becoming a public health problem worldwide. It has been shown that a very strong link exists between NAFLD and the risk of other systemic diseases. Currently, data on the incidence of NAFLD are limited in much of sub-Saharan, whereas hepatitis B virus (HBV) infections are also endemic. Thus, there is an impelling need to assess if NAFLD makes any significant contribution to the severity of HBV-associated chronic liver disease (CLD) in patients who develop NAFLD simultaneously. Aim: This study described the range of histopathological findings in NAFLD and assessed the impact of NAFLD on the severity of HBV-associated chronic hepatitis. Materials and Methods: We retrospectively studied 120 cases of histologically diagnosed NAFLD within a 4-year study period from May 31, 2018 to April 30, 2022. Brunt Scoring System was used to grade and stage NAFLD cases with or without chronic hepatitis B (CHB) infection in each case. Data were analyzed using descriptive and Chi-t tests. Results: The results revealed that the mean age was 45.78 ± 12.29 years with a female predominance. HBV-associated CLD patients with histological diagnosis of NAFLD were present in 55 (45.83%), and NAFLD in patients without CHB was 54.16%. There was a statistically significant association between the older age group with the cohort cases with NAFLD without associated CHB infection (P < 0.001). The grading and fibrosis stage was found not to be related to the age group or gender among any of the cohorts of cases. Conclusion: This study concludes that the histological range primarily includes steatosis with or without lobular and portal inflammation or fibrosis as well as ballooned hepatocytes. There is no statistically significant difference in the grade and stage between NAFLD patients without CHB and HBV-associated CLD patients with histological features of NAFLD. However, the grade tends to be higher in NAFLD patients without CHB, whereas the fibrosis level tends to be higher in cases of HBV-associated CLD patients with histological NAFLD.