The role of aflatoxin B1 in the etiology of liver cirrhosis in Eastern Ethiopia
No Thumbnail Available
Date
2023-10
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa University
Abstract
Background: Liver cirrhosis is deemed to be a major cause of morbidity and
mortality in Eastern Ethiopia; however, few studies have been conducted to
identify its possible etiologies. For instance, in a hospital-based cross-sectional
study, no definite etiologies were found in more than half of liver cirrhosis
patients, suggesting a yet unidentified cause of this disease in this area.
Meanwhile, as indicated in several studies, Eastern Ethiopia is a region with a
diet particularly high in aflatoxin (AFB1). AFB1, a very toxic compound with
sufficient evidence of carcinogenicity in humans, has been implicated as an
emerging cause of liver cirrhosis.
Objective: This study evaluated the role of AFB1 in the etiology of liver
cirrhosis among patients attending Hiwot Fana Comprehensive Specialized
University Hospital (HFCSUH), Eastern Ethiopia, in 2020-2021.
Methods: A consecutive sample of 127 adult patients diagnosed with liver
cirrhosis from internal medicine unit of HFCSUH were enrolled as cases, and
253 adults without any evidence of liver disease were enrolled from the same
unit of the hospital as controls. Demographic, dietary, and lifestyle
characteristics of the participants were collected using a structured
questionnaire. Clinical data were abstracted on standardized reporting forms.
Blood sample were collected and tested for hepatic enzymes, hepatitis C virus
antibody, hepatitis B surface antigen, and AFB1-albumin adduct. Gluthatione S
transferase M1 and T1 (GSTM1 and GSTT1) genes copy number variations
were also determined by TaqManTM Assay. SPSS version 26.0 was used to
compute the statistical analysis.
V | P a g e
Results: The etiology of liver cirrhosis was known in only 23% of patients.
Sorghum consumption as a staple food was significantly associated with liver
cirrhosis of unknown etiology. AFB1-albumin (AF-alb) detection rate was
higher (p<0.05) in cases (75%) than in controls (64%) and with a median
(interquartile range [IQR]) level of 11 pg/mg (5.5-25) and 7.0 pg/mg (4.3-
20.5), respectively (p<0.05). Exposure to high levels of AF-alb (adjusted odds
ratio (AOR) = 2.0; 95% CI: 1.1–3.7) were significantly (p<0.05) associated
with liver cirrhosis. The frequencies of null genotypes for GSTM1 and GSTT1
were 0.39 (95% CI: 0.32, 0.46) and 0.32 (95% CI: 0.26, 0.39), respectively.
The risk of liver cirrhosis was shown to be reduced (p<0.05) in GSTT1 carriers
compared to those with GSTT1 null genotypes (AOR = 0.47; 95% CI: 0.25,
0.86. Furthermore, the risk of liver cirrhosis was significantly lower in those
with one copy of GSTT1 (AOR = 0.48; 95% CI: 0.25, 0.91) and a two or more
combined copy of GSTT1 and GSTM1 genes (AOR = 0.38; 95% CI: 0.16,
0.91).
Conclusions: Sorghum consumption was identified as a potential source of
exposure in the current investigation, which implicated AFB1 exposure as a
possible etiology of hepatic cirrhosis in Eastern Ethiopia with a high
prevalence of cryptogenic cases. GSTT1 and GSTM1 genotypes also played a
role in the risk of liver cirrhosis. To decrease the disease burden in this part of
Ethiopia, plausible aflatoxin control strategies should be implemented.
Description
Keywords
Liver cirrhosis, Aflatoxins, Hepatitis B Virus, glutathione S- transferase, Ethiopia