2004, Number 2
<< Back Next >>
Ann Hepatol 2004; 3 (2)
The Relationship of Overweight and Obesity to High Mortality Rates from Liver Cirrhosis in Mexico
Méndez-Sánchez N, Sánchez-Castillo CP, Villa AR, Madrigal H, Merino B, García E, López P, Pichardo-Ontiveros E, Uribe M
Language: English
References: 27
Page: 66-71
PDF size: 163.59 Kb.
Text Extraction
Background & Aim: Liver cirrhosis continues to be an important cause of death in Mexico. Some data suggest that being overweight is a risk factor for chronic liver disease. The aim of this study was to assess the link between the incidences of being overweight or obese and mortality from liver cirrhosis in Mexico during the period 1990-2001.
Methods: We designed and conducted an ecological study of trends with multiple comparisons of regions of Mexico (North, Central, Mexico City, and South). We built the time trends according to the mortality rates of liver cirrhosis reported by the System of Vital Statistics (Health Ministry) in each state for each year from 1990 to 2001. The information on prevalences of overweight (body mass index (BMI) = 25-29.9) and obesity (BMI • 30) was from two national surveys (1993 and 2000).
Results: The analysis of mortality trends in liver cirrhosis by region showed an increase in the risk of death across time. This risk was considerably higher for the South Region (
β = 1.03,
p ‹0.0001). The mortality rates remained higher than 30 per 100,000 inhabitants. When we selected the three states with the highest mortality rates for each region, the most significant changes in the trends were in the North and South regions (
β = 0.75,
p ‹0.0001 and
β = 1.29,
p ‹0.0001, respectively). In addition, the prevalence of overweight in the four regions increased from 1993 to 2000 (percentage change, 10.2-48.2). Obesity was most prevalent in the North and South regions in 1993.
Conclusion: Our observations support the hypothesis that obesity might play an important role in the risk of developing liver cirrhosis.
REFERENCES
Secretaría de Salud. Mortalidad 1999, México, DF: SSA, 1999.
Méndez-Sánchez N, Aguilar-Ramírez JR, Aguirre J, Bosques-Padilla F Contreras AM, Dehesa M, et al. Etiología de la Cirrosis en México. Rev Gastroenterol Méx 2002;
Kodali VP, Gordon SC, Silverman AL, McCray DG. Cryptogenic liver disease in the United States: further evidence for non-A, non-B, non-C hepatitis. Am J Gastroenterol 1994; 89: 1836-1839.
Saunders JB, Walters JR, Davies AP, Paton A. A twenty year prospective study of cirrhosis. Br Med J 1981; 282: 263-266.
Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990; 11: 74-80.
Bonkovsky H, Jawaid Q, Tortorelli K, LeClair P, Cobb J, Lambrecht R, Banner B. Non-alcoholic steatohepatitis and iron: increased prevalence of mutations of the HFE gene in non-alcoholic steatohepatitis. J Hepatol 1999; 31: 421-429.
Weltman M, Farrell G, Hall P, Ingelman-Sundberg M, Liddle C. Hepatic cytochrome P450 2E1 is increased in patients with nonalcoholic steatohepatitis. Hepatology 1998; 27: 128-133.
Sanchez-Castillo CP, Velazquez-Monroy O, Berber A, Lara-Esqueda A, Tapia-Conyer R, James WP; Encuesta Nacional de Salud (ENSA) 2000 Working Group. Anthropometric cutoff points for predicting chronic diseases in the Mexican National Health Survey 2000. Obes Res 2003; 11: 442-51.
Méndez-Sánchez N, Uribe M. OBESIDAD. Epidemiología, Fisiopatología y Manifestaciones Clínicas. El Manual Moderno, México 2002.
Ludwig J, Viggiano T, McGill D, Ott B. Nonalcoholic steatohepatitis. Mayo clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-438.
Byron D, Minuk G. Clinical hepatology: profile of an urban, hospital-based practice. Hepatology 1996; 24: 813-815.
Nonomura A, Mizukami Y, Unoura M, Kobayashi K, Takeda Y, Takeda R. Clinicopathologic study of alcohol-like liver disease in non-alcoholics; non-alcoholic steatohepatitis and fibrosis. Gastroenterol Jpn 1992; 27: 521-528.
Daniel S, Ben-Menachem T, Vasudevan G, Ma C, Blumenkehl M. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999; 94: 3010-3014.
Wanless I, Lentz J. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990; 12: 1106-1110.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research. Principles and Quantitative Methods. Lifetime Learning Publications. New York, 1982. pp 78-81.
Kleinbaum DG, Kupper LL, Muller KE, Nizam A. Applied Regression Analysis and Other Multivariable Methods. 3rd ed. Duxbury Press. New York, 1998. pp 39-60.
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1999; 282: 1519-1522.
Obesity: preventing and managing the global epidemic. Report of the WHO Consultation on Obesity. Geneva, Switzerland: WHO, 1997.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221-1231.
Angulo P. Treatment of nonalcoholic fatty liver disease. Ann Hepatol 2001; 1: 12-19.
Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC. Excess weight risk factor for alcoholic liver disease. Hepatology 1997; 25: 108-11.
Day CP. Pathogenesis of steatohepatitis. Best Pract Res Clin Gastroenterol 2002; 16: 663-78.
Teish A, Mae Diehl A. Animal models of steatohepatitis. Best Pract Res Clin Gastroenterol 2002; 16: 679-90.
Yang SQ, Lin HZ, Lane MD, Clemens M, Diehl AM. Obesity increases sensitivity to endotoxin liver injury: implications for the pathogenesis of steatohepatitis. Proc Natl Acad Sci USA 1997; 94: 2557-2562.
Chavin KD, Yang S, Lin HZ, Chatham J, Chacko VP, Hoeck JB, Walajtys-Rode E, Rashid A, Chen CH, Huang CC, Wu TC, Lane MD, Diehl AM. Obesity induces expression of uncoupling protein-2 in hepatocytes and promotes liver ATP depletion. J Biol Chem 1999; 274: 5692-5700.
Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, Khalil L, Turpin G, Opolon P, Poynard T. Liver fibrosis in overweight patients. Gastroenterology 2000; 118: 1117-23.
Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30: 1356-62.