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Features of fat metabolism in non-alcoholic fatty liver disease in patients with different body weight in the highlands of Kyrgyzstan

https://dx.doi.org/10.51350/zdravkg202293434
Features of fat metabolism in non-alcoholic fatty liver disease in patients with different body weight in the highlands of Kyrgyzstan
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Abstract About the authors References

Abstract

Aim. To study the features of lipid metabolism disorders in non-alcoholic fatty liver disease in patients with different body weights in the conditions of inhabited highlands. Material and methods. The study was carried out within the framework of the project "Etiopathogenetic features and rates of development of non-alcoholic fatty liver disease (NAFLD) in the conditions of Kyrgyzstan" (No. of state registration MHN / TZ-2020-3). An open comparative study of patients with two forms of NAFLD: fatty liver (FL) and non-alcoholic steatohepatitis (NASH) (n=236) living in low mountains (Bishkek, altitude above sea level - 750-800 m, n=111) and inhabited highlands (At-Bashy district , Naryn region, height above sea level - 2046-2300 m, n=125) Kyrgyzstan. The average age of the patients was 55,7±0,95 years. Given that genetic factors may play a role in the development of NAFLD, we analyzed a population represented only by ethnic Kyrgyz. Patients in each group were divided into lean (BMI≤23) and obese (BMI≥23) groups. To determine physical activity, a physical activity questionnaire was used, which was compiled on the basis of the materials of the International Physical Activity Prevalence Study www.ipaq.ki.se. Physical examination included measurement of anthropometric parameters (height, body weight, waist circumference (WC)), calculation of body mass index (BMI), skeletal muscle mass index (SMM), percentage of body fat. According to the grades of the WHO, the degree of obesity was assessed by BMI for Asians. Blood samples were taken for research in the morning on an empty stomach after at least 12 hours of fasting. The following indicators were determined: glucose, lipid spectrum (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), ALT, AST levels. The BARD scale was used as a predictor for assessing the development of liver fibrosis in patients with NAFLD [1]. The scoring system included three variables: BMI, AST / ALT, and the presence of DM 2.The diagnosis of non-alcoholic fatty liver disease was made on the basis of history, laboratory tests, ultrasound examination of the liver, and exclusion of other liver diseases. The results were analyzed using the SPSS 16.0 statistical software package for Windows. A p-value<0.05 was considered statistically significant at the 95% confidence level. Results. It has been established that residents of highlands with NAFLD are represented by lower BMI relative to residents of lowlands. In women, the levels of SMM and the percentage of fat are significantly and statistically significantly correlated (r = - 0.971, p <0.001), while in men these two indicators are not related. Men showed a trend towards higher percentages of fat, regardless of body weight and region of residence. For women, this indicator was within acceptable limits and did not exceed 31%. There was found a statistically significant difference in total cholesterol levels between low and high mountain people in the group of obese patients (p <0.001) suffering from NAFLD. Statistically significant low ALT indices were revealed in the group of obese patients living in mid-mountain conditions. Conclusions. Taken together, our results suggest that chronic high-mountain hypoxia may slow down the course of overweight-induced NAFLD.

About the authors

Токтогулова Нургуль Асылбековна, к.м.н., доцент, зав. кафедрой терапии №1 специальностей «Педиатрия» и «Стоматология» КРСУ им. Б.Н. Ельцина, Бишкек, Бишкек, Кыргызская Республика
Султаналиева Роза Бакаевна, д.м.н., профессор кафедры терапии №1 специальностей «Педиатрия» и «Стоматология» КРСУ им. Б.Н. Ельцина, Бишкек, Кыргызская Республика
Тухватшин Рустам Романович, д.м.н., профессор, зав. кафедрой патологической физиологии КГМА им. И.К. Ахунбаева, Бишкек, Кыргызская Республика

Toktogulova Nurgul Asylbekovna, Ph.D., Associate Professor, Head of Therapy No. 1 department of the specialties "Pediatrics" and "Dentistry" KRSU named after B.N. Yeltsin, Bishkek, Kyrgyz Republic
Sultanalieva Roza Bakaevna, MD, Professor of the Department of Therapy No. 1 of the specialties "Pediatrics" and "Dentistry" KRSU named after B.N. Yeltsin, Bishkek, Kyrgyz Republic
Tukhvatshin Rustam Romanovich, MD, Professor, Head Department of Pathological Physiology, KSMA named after I.K. Akhunbaeva, Bishkek, Kyrgyz Republic

Токтогулова Нургүл Асылбековна, м.и.к., доцент, Б.Н.  Ельцин атындагы КРСУнун «Педиатрия» жана «Стоматология» адистиктеринин No1 терапия кафедрасынын башчысы, Бишкек, Кыргыз Республикасы
Султаналиева Роза Бакаевна, медицина илимдеринин кандидаты, Б.Н. Ельцинатындагы КРСУнун «Педиатрия» жана «Стоматология» адистиктеринин №1 терапия кафедрасынын профессору, Бишкек, Кыргыз Республикасы
Тухватшин Рустам Романович, м.и.д., профессор, И.К. Ахунбаев атындагы КММАнын патологиялык физиология кафедрасынын башчысы, Бишкек, Кыргыз Республикасы

References

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
8. Singh D. K. et al. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis //Digestive diseases and sciences. – 2008. – Т. 53. – №. 7. – С. 1967-1976.
9. Marini M. et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals.– 2008.
10. Consultation W. H. O. E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies //Lancet (London, England). – 2004. – Т. 363. – №. 9403. – С. 157-163.
11. Song K. et al. High-altitude chronic hypoxia ameliorates obesity-induced non-alcoholic fatty liver disease in mice by regulating mitochondrial and AMPK signaling //Life sciences. – 2020. – Т. 252. – С. 117633.
12. Анисонян А. В. и др. Неалкогольная жировая болезнь печени и сахарный диабет 2-го типа: вопросы диагностики фиброза печени //Терапевтический архив. – 2020. – Т. 92. – №. 8. – С. 73-78.
13. Fukuoka Y. et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients //Journal of diabetes investigation. – 2019. – Т. 10. – №. 2. – С. 322-330.

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
8. Singh D. K. et al. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis //Digestive diseases and sciences. – 2008. – Т. 53. – №. 7. – С. 1967-1976.
9. Marini M. et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals.– 2008.
10. Consultation W. H. O. E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies //Lancet (London, England). – 2004. – Т. 363. – №. 9403. – С. 157-163.
11. Song K. et al. High-altitude chronic hypoxia ameliorates obesity-induced non-alcoholic fatty liver disease in mice by regulating mitochondrial and AMPK signaling //Life sciences. – 2020. – Т. 252. – С. 117633.
12. Анисонян А. В. и др. Неалкогольная жировая болезнь печени и сахарный диабет 2-го типа: вопросы диагностики фиброза печени //Терапевтический архив. – 2020. – Т. 92. – №. 8. – С. 73-78.
13. Fukuoka Y. et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients //Journal of diabetes investigation. – 2019. – Т. 10. – №. 2. – С. 322-330.

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
8. Singh D. K. et al. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis //Digestive diseases and sciences. – 2008. – Т. 53. – №. 7. – С. 1967-1976.
9. Marini M. et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals.– 2008.
10. Consultation W. H. O. E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies //Lancet (London, England). – 2004. – Т. 363. – №. 9403. – С. 157-163.
11. Song K. et al. High-altitude chronic hypoxia ameliorates obesity-induced non-alcoholic fatty liver disease in mice by regulating mitochondrial and AMPK signaling //Life sciences. – 2020. – Т. 252. – С. 117633.
12. Анисонян А. В. и др. Неалкогольная жировая болезнь печени и сахарный диабет 2-го типа: вопросы диагностики фиброза печени //Терапевтический архив. – 2020. – Т. 92. – №. 8. – С. 73-78.
13. Fukuoka Y. et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients //Journal of diabetes investigation. – 2019. – Т. 10. – №. 2. – С. 322-330.

Keywords
non-alcoholic fatty liver disease , lean NAFLD , high-altitude , lipid profile
Для цитирования

Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Особенности жирового обмена при неалкогольной жировой болезни печени у больных с различной массой тела в высокогорных условиях Кыргызстана.Здравоохранение Кыргызстана 2022, № 3,с. 34-40. https://dx.doi.org/10.51350/zdravkg202293434
For citation

Toktogulova N.A., Sultanalieva R.B., Tukhvatshin R.R.Features of fat metabolism in non-alcoholic fatty liver disease in
patients with different body weight in the highlands of Kyrgyzstan.Health care of Kyrgyzstan 2022,No.3,pp.34-40.

https://dx.doi.org/10.51350/zdravkg202293434
Цитата үчүн

Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Кыргызстандын саламаттык сактоо 2022, no 3, б. 34-40. https://dx.doi.org/10.51350/zdravkg202293434
Authors Toktogulova N.A., Sultanalieva R.B., Tukhvatshin R.R.
Link doi.org https://dx.doi.org/10.51350/zdravkg202293434
Pages 34-40
Keywords non-alcoholic fatty liver disease, lean NAFLD, high-altitude, lipid profile
Russian
Об авторах

Токтогулова Нургуль Асылбековна, к.м.н., доцент, зав. кафедрой терапии №1 специальностей «Педиатрия» и «Стоматология» КРСУ им. Б.Н. Ельцина, Бишкек, Бишкек, Кыргызская Республика
Султаналиева Роза Бакаевна, д.м.н., профессор кафедры терапии №1 специальностей «Педиатрия» и «Стоматология» КРСУ им. Б.Н. Ельцина, Бишкек, Кыргызская Республика
Тухватшин Рустам Романович, д.м.н., профессор, зав. кафедрой патологической физиологии КГМА им. И.К. Ахунбаева, Бишкек, Кыргызская Республика
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Список литературы

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
8. Singh D. K. et al. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis //Digestive diseases and sciences. – 2008. – Т. 53. – №. 7. – С. 1967-1976.
9. Marini M. et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals.– 2008.
10. Consultation W. H. O. E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies //Lancet (London, England). – 2004. – Т. 363. – №. 9403. – С. 157-163.
11. Song K. et al. High-altitude chronic hypoxia ameliorates obesity-induced non-alcoholic fatty liver disease in mice by regulating mitochondrial and AMPK signaling //Life sciences. – 2020. – Т. 252. – С. 117633.
12. Анисонян А. В. и др. Неалкогольная жировая болезнь печени и сахарный диабет 2-го типа: вопросы диагностики фиброза печени //Терапевтический архив. – 2020. – Т. 92. – №. 8. – С. 73-78.
13. Fukuoka Y. et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients //Journal of diabetes investigation. – 2019. – Т. 10. – №. 2. – С. 322-330.
Для цитирования

Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Особенности жирового обмена при неалкогольной жировой болезни печени у больных с различной массой тела в высокогорных условиях Кыргызстана.Здравоохранение Кыргызстана 2022, № 3,с. 34-40. https://dx.doi.org/10.51350/zdravkg202293434
English
About authors

Toktogulova Nurgul Asylbekovna, Ph.D., Associate Professor, Head of Therapy No. 1 department of the specialties "Pediatrics" and "Dentistry" KRSU named after B.N. Yeltsin, Bishkek, Kyrgyz Republic
Sultanalieva Roza Bakaevna, MD, Professor of the Department of Therapy No. 1 of the specialties "Pediatrics" and "Dentistry" KRSU named after B.N. Yeltsin, Bishkek, Kyrgyz Republic
Tukhvatshin Rustam Romanovich, MD, Professor, Head Department of Pathological Physiology, KSMA named after I.K. Akhunbaeva, Bishkek, Kyrgyz Republic
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References

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
8. Singh D. K. et al. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis //Digestive diseases and sciences. – 2008. – Т. 53. – №. 7. – С. 1967-1976.
9. Marini M. et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals.– 2008.
10. Consultation W. H. O. E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies //Lancet (London, England). – 2004. – Т. 363. – №. 9403. – С. 157-163.
11. Song K. et al. High-altitude chronic hypoxia ameliorates obesity-induced non-alcoholic fatty liver disease in mice by regulating mitochondrial and AMPK signaling //Life sciences. – 2020. – Т. 252. – С. 117633.
12. Анисонян А. В. и др. Неалкогольная жировая болезнь печени и сахарный диабет 2-го типа: вопросы диагностики фиброза печени //Терапевтический архив. – 2020. – Т. 92. – №. 8. – С. 73-78.
13. Fukuoka Y. et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients //Journal of diabetes investigation. – 2019. – Т. 10. – №. 2. – С. 322-330.
For citation

Toktogulova N.A., Sultanalieva R.B., Tukhvatshin R.R.Features of fat metabolism in non-alcoholic fatty liver disease in
patients with different body weight in the highlands of Kyrgyzstan.Health care of Kyrgyzstan 2022,No.3,pp.34-40.

https://dx.doi.org/10.51350/zdravkg202293434
Kyrgyz
Авторлор жөнүндө

Токтогулова Нургүл Асылбековна, м.и.к., доцент, Б.Н.  Ельцин атындагы КРСУнун «Педиатрия» жана «Стоматология» адистиктеринин No1 терапия кафедрасынын башчысы, Бишкек, Кыргыз Республикасы
Султаналиева Роза Бакаевна, медицина илимдеринин кандидаты, Б.Н. Ельцинатындагы КРСУнун «Педиатрия» жана «Стоматология» адистиктеринин №1 терапия кафедрасынын профессору, Бишкек, Кыргыз Республикасы
Тухватшин Рустам Романович, м.и.д., профессор, И.К. Ахунбаев атындагы КММАнын патологиялык физиология кафедрасынын башчысы, Бишкек, Кыргыз Республикасы
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Шилтемелер

1. Fitzpatrick E., Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future//World journal of gastroenterology: WJG. – 2014. – Т. 20. – №. 31. – С. 10851.
2. Younossi Z. M. et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008 //Clinical gastroenterology and hepatology. – 2011. – Т. 9. – №. 6. – С. 524-530. e1.
3. Sattar N., Forrest E., Preiss D. Non-alcoholic fatty liver disease //Bmj. – 2014. – Т. 349.
4. Wei J. L. et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using protonmagnetic resonance spectroscopy //Official journal of the American College of Gastroenterology| ACG. – 2015. – Т. 110. – №.9. – С. 1306-1314.
5. Fan J. G., Kim S. U., Wong V. W. S. New trends on obesity and NAFLD in Asia //Journal of hepatology. – 2017. – Т. 67. – №. 4.– С. 862-873.
6. Nishioji K. et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a non-obese Japanese population, 2011–2012 //Journal of gastroenterology. – 2015. – Т. 50. – №. 1. – С. 95-108.
7. Madan K. et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians //World Journal of Gastroenterology: WJG. – 2006. – Т. 12. – №. 21. – С. 3400.
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Цитата үчүн

Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Токтогулова Н.A., Султаналиева Р.Б., Тухватшин Р.Р. Кыргызстандын саламаттык сактоо 2022, no 3, б. 34-40. https://dx.doi.org/10.51350/zdravkg202293434
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