Contribution of Aflatoxin B1 Exposure to Liver Cirrhosis in Eastern Ethiopia: A Case-Control Study

Abstract

Abraham Mekuria,1 Lei Xia,2 Tekabe Abdosh Ahmed,3 Solomon Bishaw,4 Zelalem Teklemariam,5 Teshome Nedi,1 Tefera Abula,1 Ephrem Engidawork,1 Yun Yun Gong2 1Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2School of Food Science and Nutrition, University of Leeds, Leeds, UK; 3Department of Internal Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 4Department of Radiology, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 5School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Ephrem Engidawork; Yun Yun Gong, Email [email protected]; [email protected]: Liver cirrhosis is a global health problem due to a large number of disability-associated life years and mortality. However, evidence is scarce on its causes in Eastern-Ethiopia, a place where there is a high prevalence of liver cirrhosis of unknown etiology. This study attempted to identify the risk factors related to liver cirrhosis in the area.Methods: A case-control study was conducted at a tertiary care hospital from January 2020 to July 2021. Following diagnoses using an ultrasound-based cirrhosis scale, a total of 127 cases were identified and compared with 253 control patients. A structured questionnaire and data abstraction form were used to collect demographic, lifestyle, and clinical information. A blood sample was also taken from each participant for clinical chemistry, hepatitis B virus (HBV), and hepatitis C virus tests as well as for an aflatoxin B1 (AFB1) albumin adduct (AF-alb) assay. Binary logistic regression analysis was used to determine predictors of liver cirrhosis.Results: AF-alb levels were detected in 75% of the cases and 64% of the controls, with a median (IQR) level of 11 pg/mg (5.5– 25) and 7.0 pg/mg (4.3– 20.5), respectively (p< 0.05). Moreover, the number of subjects with high AF-alb levels (≥ 8.6 pg/mg) was greater in cases (45%, p< 0.05)) than controls (28%). Age ≥ 55 years (adjusted odds ratio (AOR)=0.4; 95% CI: 0.2, 0.8), being a farmer (AOR= 3.0; 95% CI: 1.5, 6.0), family history of liver disease (AOR= 2.9; 95% CI: 1.1, 7.9), HBV seropositivity (AOR=4.0; 95% CI: 1.9, 8.8), and exposure to high levels of AF-alb (AOR=2.0; 95% CI: 1.1, 3.7) were significantly associated with liver cirrhosis.Conclusion: This study found a strong link between AFB1 exposure and liver cirrhosis. Mitigation of aflatoxin exposure and a better understanding of additional environmental risk factors like pesticides may be necessary to reduce the disease burden in Ethiopia.Keywords: liver cirrhosis, aflatoxin, hepatitis B virus, Ethiopia

Keywords

• liver cirrhosis
• aflatoxin
• hepatitis b virus
• ethiopia