The international conference GULF Liver Summit 2013 was held on January 25 – 26, 2013. The problems of diagnosis and treatment of different liver diseases were discussed during the Summit. The special attention was focused on problems of civilization diseases such as obesity, metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus.
The population of Persian GULF countries is known to have own epidemiological features of these diseases related primarily to national traditions and life style.1 Prevalence of obesity among persons living in Persian Gulf area is the sixth-largest in the world.2 According to World Health Organization, approximately 73% of women and 66% of men have increased body weight or obesity.3 In recent years, the problem of obesity in children and adolescents comes to the fore.3 Prevalence of 2 type diabetes mellitus (DM 2) in this area is the second-largest in the world, according to International Diabetes Federation (IDF). In fact, this part of the globe is a “hot point” in terms of DM 2 incidence: 5 out of 10 countries in the region hold leading positions – United Arab Emirates, 20%; Bahrain, 15%; Egypt, 10%; Kuwait, Saudi Arabia. 3
Urbanization phenomenon involving physical activity minimization and fast food rich in saturated and trans fatty acids is closely related to available epidemiological data.6 Besides, a tradition of parallel cousin marriages in some population groups serves a "foundation” for increased incidence of different genetic mutations in population.7
To date, 270 genetic disorders are registered, including blood diseases (thalassemia, sickle-cell anemia etc.), cystic fibrosis, Gilbert disease, Meckel syndrome, multiple metabolic disorders.7 In many investigators’ opinions, the rapid increase in obesity and NAFLD prevalence in this population greatly exceeds the increase in unhealthy food consumption. Therefore, genetic anomalies are of interest. Among them, the most typical for this population single nucleotide polymorphisms related to metabolism processes were determined: brain derived neurotrophic factor (BDNF) ) Val66Met, potentially binding together gene – psychopathology – body weight; polymorphisms of TCF7L2 (Transcription Factor 7-Like 2 (114758349C > T) gene involved in glucose homeostasis; homozygote polymorphisms of hepatic lipase gene (LIPC) C514T lead to highly atherogenic profile and risk of cardiovascular diseases et al. 6,8,9 It is important that disease course peculiarities considering genetic factors prevailing in the region limit the use of genetic screening tool.
However, now we can look at the genetic aspects from the other side. It has become possible to study diet-induced changes in expression of genes coding synthesis of key players of metabolic processes. 6 Effect of nutrition on gene functioning is in focus of nutrigenomics research. Consumption of saturated fats, trans fats (palm oil) leads to posttranslational modifications of protein synthesis and influences intestinal microbiota.10 Therefore, relationship between obesity, NAFLD and intestinal microflora characteristics, as well as treatment and prevention modalities were actively discussed during this Summit.
In this aspect, our colleagues from other countries have got an interesting experience concerning the use of spore form probiotics (Enterogermina, Sanofi Aventis) with high concentration of Bacillus clausii (2 billion), stability to acidic gastric environment and other aggressive effects.11 Efficacy of alternative probiotics forms, in particular having enterosoluble capsule, during antibacterial therapy is known to be doubtful due to bacteriostatic or bactericidal action of the drugs. Meanwhile, probiotics containing bacteria germs are resistant against antibacterial drug effect and, hence, can be used during antibacterial therapy12.
It must be noted that over last years, success was achieved in the treatment and prevention of 2 type diabetes mellitus complications in Persian Gulf countries, which is also promoted by annual international congresses dedicated to these problems. Thus, according to prospective study of 2006 with 409 DM 2 patients enrolled, 46% of patients had never heard about special diet recommendations, 76% of patients knew nothing about difference between high and low glycemic index of products, 50% of patients did not control their BP, lipid profile, body weight (36% of patients with increased body weight and 45% with obesity). 13
Currently, educational programs on the treatment and life style in DM 2 have led to improved understanding of the disease and compliance among the region population.14, 15
Another extremely important challenge is a relationship between cardiovascular diseases and NAFLD. This issue was brought for discussion from the Russian side by Professor O.M. Drapkina, Doctor of medical science. During the report, the evolution of metabolic syndrome understanding, epidemiologic peculiarities of NAFLD in the Russian Federation were demonstrated according to the results of DIREG_L_01903 study.16 The objective of this open-label multicenter prospective observational clinical study conducted in the Russian Federation from March to November 2007 (scientific coordinator was academician V.T. Ivashkin, scientific curator was professor O.M. Drapkina), with 30,000 patients enrolled, was to assess true prevalence of NAFLD among patients applying for ambulatory care. According to the study results, only 1% of patients knew about the diseases due to subclinical course of NAFLD. NAFLD prevalence was 27%. The close relationship between traditional risk factors for cardiovascular diseases and NAFLD was determined. O.M. Drapkina raised questions about importance of NAFLD understanding as a potent risk factor for cardiovascular diseases and need for NAFLD inclusion in metabolic syndrome. The principles of NAFLD therapy were discussed as well. The conference participants have met with interest an experience of Russian doctors in using essential phospholipids for liver disease therapy.
In the future, such representative congresses are necessary for effective exchange of experience in prevention and treatment of non-communicable epidemics and liver diseases, which have swept the entire world.
- Saadi H, Carruthers SG Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates.Diabetes Res Clin Pract. 2007 Dec;78(3):369-77. Epub 2007 May 25.
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- Diabetes in the United Arab Emirates: Crisis or Opportunity? UnitedHealth Group 2010.
- Haleh Ashraf, Epidemiology and risk factors of the cardiometabolic syndrome in the Middle East Expert Review of Cardiovascular Therapy. Mar 2011, Vol. 9, No. 3: 309-320
- IDF Diabetes Atlas Update 2012.
- Akl C. Fahed, Diet, Genetics, and Disease: A Focus on the Middle East and North Africa Region Journal of Nutrition and Metabolism. Jan 2012, Vol. 2012: 1-19
- March of Dimes global report on birth defects
- Al-Gazali L, Ali BR. Mutations of a country: a mutation review of single gene disorders in the United Arab Emirates (UAE). Hum Mutat. 2010 May;31(5):505-20. doi: 10.1002/humu.21232.
- Saadi H Association of TCF7L2 polymorphism with diabetes mellitus, metabolic syndrome, and markers of beta cell function and insulin resistance in a population-based sample of Emirati subjects. Diabetes Res Clin Pract. 2008 Jun;80(3):392-8. doi: 10.1016/j.diabres.2008.01.008. Epub 2008 Feb 20.
- Nicole de Wit Saturated fat stimulates obesity and hepatic steatosis and affects gut microbiota composition by an enhanced overflow of dietary fat to the distal intestine Am J Physiol Gastrointest Liver Physiol 303: G589–G599, 2012.
- Cenci G, Tolerance to challenges miming gastrointestinal transit by spores and vegetative cells of Bacillus clausii. J Appl Microbiol. 2006 Dec;101(6):1208-15.
- Bader J, Albin A, Stahl U. Spore-forming bacteria and their utilisation as probiotics. Benef Microbes. 2012 Mar 1;3(1):67-75. doi: 10.3920/BM2011.0039.
- Al-Kaabi J, Assessment of dietary practice among diabetic patients in the United arab emirates. Rev Diabet Stud. 2008 Summer;5(2):110-5. doi: 10.1900/RDS.2008.5.110. Epub 2008 Aug 10.
- Al-Maskari F, Knowledge, attitude and practices of diabetic patients in the United arab emirates. PLoS One. 2013;8(1):e52857. doi: 10.1371/journal.pone.0052857. Epub 2013 Jan 14.
- Alhyas L, Type 2 diabetes care for patients in a tertiary care setting in UAE: a retrospective cohort study. JRSM Short Rep. 2012 Oct;3(10):67. doi: 10.1258/shorts.2012.012064. Epub 2012 Oct 15.
- 16. Nikitin I.G. Screening program to reveal the prevalence of non-alcoholic fatty liver disease (NAFLD) and to determine risk factors for disease development.
The review was prepared by S.O. Eliashevich