Fatty Liver Among Employees at Banha University
Condition: Fatty Liver Disease; Fatty Infiltration
MeSH terms: Liver Diseases; Fatty Liver
Study type: Observational

Summary: 
      This was cross sectional study at Banha University Hospital among employees. Age of the
      subjects from 20-60 years old both males and females .All investigations done plus abdominal
      ultrasound for grading of fatty liver and dopler for carotid intima media thickness.
    

Detailed description: 
      This cross-sectional study was conducted on employees working for the Benha University
      Hospitals, Qalubeyia Governorate, Egypt. The study population comprised both male and female
      employees (20 to 60 years old) with no history of viral hepatitis(HBV,HCV) and
      autoimmune-liver diseases such as primary sclerosing cholangitis and primary billiary
      cirrhosis . The field work was carried out from September 2018 to March 2019.

      This study was approved by the Research Ethics Committee in Benha Faculty of Medicine. An
      informed consent (in Arabic language) was obtained from all participants. It included all
      details about the study (title, objectives, methods, expected benefits and risks, and
      confidentiality of data).

      Subjects:

      The sample size for the study was calculated according to the following equation 1:

      "Sample size" = (〖Z_(1-∝/2)〗^(2 ) P(1-P))/d^2 Where

      Z 1-α/2 = standard normal deviate; (at 5% type I error (P<0.05) it is 1.96). P=expected
      proportion in population based on previous studies 2. d= absolute error or precision (0.05).
      The total number of the study participants was 165 subjects, who confirm with the inclusion
      criteria and agreed to participate in the study. These were selected by the systematic random
      sampling technique.

      Data collection tools:

      An arranged interview with every study participant was carried out at the Hepatology and
      Gastrointestinal Department of the Benha University Hospital. All the study participants were
      exposed to full history taking and clinical examination. Venous blood samples after fasting
      for 10 hours were collected for complete blood counting, and the assessment of fasting blood
      glucose, fasting insulin, HOMA-IR test by soecific equation , liver functions testing
      (ALT,AST ,GGT &Alk.Phosphatase) . kidney functions testing(Serum Urea & Serum Creatinine )
      and lipid profile include (serum cholesterol, very low density and high density lipoprotein.
      Assessment of Liver Fatty Acid Binding Protein (L-FABP), , was carried out using ELIZA.
      Abdominal Ultrasound for grading of fatty liver from grade 1 to grade 3 according to the
      comparison with echogencity of right kidney and Doppler on external carotid artery were
      performed to measure the the intima media thickness.

      the different study groups were carried out using the Chi-square test (X2) and the Fisher
      Exact test (FET) to compare proportions as appropriate. The Student t-test (t) and the
      Mann-Whitney test (MW) were used to compare two groups of quantitative data regarding
      parametric and non-parametric data, respectively. While the Kruskal Wallis test and One-Way
      Analysis Of Variance (ANOVA; F) were used to compare more than two groups, followed by
      post-hock testing using the Bonferroni method to detect differences in pairs. Spearman
      correlation coefficient (rho) and Pearson correlation coefficient (r) were used to assess the
      correlation between the studies parameters as appropriate. the diagnostic performance of
      L-FAB, HOMA-IR and CIT for NAFLD was examined and the best cut-off and the corresponding
      Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value and Area
      Under the Curve were estimated. Statistical significance was accepted at P value <0.05 (S).

      The statistical analysis was conducted using STATA/SE version 11.2 for Windows (STATA
      corporation, College Station, Texas).

      All the peoples from age 20-60 years old both males and females will be included , apparently
      healthy either obese or not from banha university employees and students.

      They will be evaluated clinically and examined as follow :

        -  Blood pressure , body mass index(BMI)=heigh/weigh2

        -  Invesigations as follow , complete blood count(CBC), fasting blood sugar ,glycosyated
           haemoglobin (HbA1c),Liver function tests including alaninie aminotransferease (ALT)
           ,aspartateaminotransferase(AST),gamma glutamyl transpeptidase (GGT),alkaline phosphatase
           ,serum bilirubin, and serum albumin.

      lipid profile including (cholesterol,triglycerides,HDL,C and LDL).

        -  Serum insulin level for calculating insulin resistance (IR) Homostasis Model Assay for
           Insulin Resistant(HOMA-IR) was assessed using the given mathematical equation; HOMA-IR ¼
           fasting insulin (mU/ml) fasting plasma glucose (mmol/l)/22.5 . A HOMA value of 2.18,
           signifies IR Fatty Acid Binding protein1 (FABP1)

        -  FABP1 was evaluated after the patient fasting 8 hours by the enzyme-linked immunosorbent
           assay (ELISA) according to George Haltern ,et al 2010 and the deviation from the normal
           will be correlated with other investigations and clinical manifestations of the
           subjects.

        -  Abdominal Ultrasound was done for grading of fatty liver , to 3 grades from grade 1 to
           grade3 in comparison to right kidney and diphragm . .

        -  Carotid Intimal Media Thickenss(CIMT) measured for extracranial portion of Carotid artey
           by Colour Dopler by measure while the patiet in recumbancy at45 degree and the probe
           must be in angle less than 90 degree to get the correct results ..
    

Intervention name(s): Abdominal Ultrasound
Intervention type(s): Other
Intervention description(s): patient in supine position and external carotid artery was examined to meausre the intima using US .Machine GE logic FB inear probe10Mhz.and intimal media thickness mean =10mm
Other intervention name(s): External Carotid Intimal thickness by Dopler
Observational model: Case-Crossover
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Both males and females sex aged from 20-60 years old agree was included in the study after
        written consent.
      
Keywords: Insulin resistant (IR)