Opportunistic Screening for Nonalcoholic Fatty Liver Disease (NAFLD) in Ghana: A Prospective Study

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of cryptogenic cirrhosis and liver transplant in the United States. It is associated with increased length of stay and poor surgical outcomes. NAFLD affects approximately 30% of American adults, and even more Africans. However reported rates of NAFLD in African countries vary widely, where recent studies have shown that up to 50–87% Africans are could be living with NAFLD. The objective of this study was to estimate the prevalence of NAFLD in Ghana and to assess whether NAFLD is associated with increased length of stay and surgical complications.A prospective study on 96 surgical patients aged 18 and older, without a history of alcohol abuse or liver disease, who presented at Eastern Reginal Hospital in Ghana for elective general and gynecological procedures between September and December 2018. A single, expert radiologist screened all patients for NAFLD using an abdominal ultrasound machine. NAFLD was diagnosed in conjunction with the American Association for the study of liver disease guidelines, assessing for increased hepatic echogenicity compared to the spleen and kidneys. Patients were followed up for 30 days and information was collected on length of stay and surgical site occurrences (SSO). Univariate analysis and multivariable logistic regression were performed using SAS 9.4.Of 97 patients, mean age 46 ± 14 years, mean BMI 26.9 ± 7.7, and 40 (42%) Male, the mean length of stay was 2.7 days ± 2.7 days. Eighteen (19%) patients had a length of stay ≥ 5 days and 9 (9%) developed a SSO. Ultrasonography revealed that 54 (56%) of patients had NAFLD, of which 15 (28%) patients had moderate disease (25–50% of liver), and 39 (72%) had mild (5–25%) disease. Diabetes, hypertension, obesity, and BMI were not associated with NAFLD. NAFLD and sex were independent predictors of an increased length of stay ≥ 5 days, where patients with NAFLD were 5x as likely to have an extended length of stay, but not SSO compared to those without NAFLD (OR: 4.8 95% CI 1.1–18.5).Ghana has almost twice the prevalence of NAFLD compared to the United States, suggesting that NAFLD is very common in Africa. It is associated with delayed surgical recovery leading to more than twice the average length of stay.None.