A Multi-Center Study Exploring the Association of Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease in Cuban Patients
Authors:   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba, MI Castellanos-Fernández , M Stepanova ,   Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA, ME Infante-Velázquez ,   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba, L Henry ,   Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA, E Crespo-Ramírez ,   HospitalGeneral Docente Abel Santamaría Cuadrado, Pinar del Río, Cuba, S del Valle-Díaz ,   HospitalProvincialSaturnino Lora, Santiago de Cuba, Cuba, JD Elias ,   HospitalUniversitario General Calixto García, La Habana, Cuba, L Santaló-Rodríguez ,   HospitalUniversitario General Calixto García, La Habana, Cuba, S Corrales-Alonso ,   HospitalUniversitario Faustino Pérez, Matanzas, Cuba, I Morales-Martínez ,   HospitalOncológico Celestino Hernández Robau, Villa Clara, Cuba, E Cedeño-Ramirez ,   Hospital Clínico Quirúrgico Docente Comandante Manuel Fajardo, La Habana, Cuba, T Pérez-González ,   HospitalGeneral DocenteIvan Portuondo, Artemisa, Cuba, SM González-Suero ,   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba, C Ruenes-Domech ,   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba, EB Suárez ,   Hospital Universitario Manuel Ascunce Domenech, Camagüey, Cuba, A Racila ,   Guy and Betty Beatty Center for the Study of Obesity and Outcomes, Inova Health Systems, Falls Church, VA, USA, ZD Guridi ,   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba, EA Soler ,   Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba
Published: May 2021

Aim: There is a paucity of data on Non-Alcoholic Fatty Liver Disease (NAFLD) and Metabolic Syndrome (MetS) among native Cubans. We aimed to assess the prevalence of MetS in Cubans with NAFLD and the outcomes and predictors for advanced fibrosis. Methods: A multicenter (outpatient clinics of nine hospitals in seven Cuban provinces) cross-sectional study of adults with NAFLD between September 2018 and May 2019. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP: ATPIII) criteria. Advanced fibrosis was defined using AST to Platelet Ratio Index (APRI) ≥1 and Fibrosis-4 score (FIB-4) ≥2.67. Results: 819 patients enrolled, 563 (68.7%) had MetS; mean age 54.9 years, 60.3% female, 65.8% white, 95.1% from urban residency, mean BMI 30.7 kg/m². Fibrosis was present in 114 (13.9%); 94 (82.5%) had APRI ≥1; 77 (67.5%) had FIB-4 ≥ 2.67; 57 (50%) both scores were elevated. MetS group had significantly more fibrosis than no MetS, [17% vs. 7% (p=0.0001)]. Patients with fibrosis were older (57.7 vs. 54.5, P=0.0015), of Mestizos ethnicity (36.8% vs. 16.9%, P<0.0001), and from rural residency (17.5% vs. 2.8%, P<0.0001). MetS was independently associated with fibrosis: Odds Ratio (OR) = 2.05 (95% CI 1.10-3.81) (p=0.024), but, rural residency was the strongest fibrosis predictor [OR: 5.30 (95% CI 2.45-11.47, (P<0.0001)]. Other fibrosis predictors were male gender, sedentary life-style, NAFLD family history, and lower estimated glomerular filtration rate (p<0.05). Risk of fibrosis was not associated with age, ethnicity, or smoking (all p>0.05). Conclusion: Cuban NAFLD patients with MetS have substantial clinical impairment and a higher risk for fibrosis.