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      Is Toxoplasma gondii infection correlated with nonalcoholic fatty liver disease?- a population-based study

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          Abstract

          Background

          Previous studies have suggested that Toxoplasma gondii ( T. gondii) infection might be associated with fatty liver disease. However, the relationship between non-alcoholic fatty liver disease (NAFLD) and T. gondii infection has not been investigated in a large population. We aimed to study the relationship between those two diseases using a population-based dataset from the United States.

          Methods

          The data were collected from the third National Health and Nutrition Examination Survey (NHANES III) between 1988 and 1994. Statistical analysis was applied to compare the prevalence of NAFLD in anti- T. gondii antibody-positive participants with antibody-negative ones.

          Results

          A total of 9465 persons with a mean age of 44.33 ± 16.21 years, 46.9% of which were males, were included in the final analysis. Their mean BMI was 27.60 ± 5.96 kg/m 2. A total of 2520 participants (26.62%) were positive for the T. gondii antibody. There was an increasing trend of seroprevalence of T. gondii with age (P for trend < 0.001). The incidence of NAFLD in the seropositive group was higher than that in the seronegative group (27.10% vs 23.40%, p < 0.001). In addition to this, metabolic biomarkers, including serum lipid, fasting blood-glucose, and uric acid were also significantly higher in the seropositive group. However, multivariate analysis revealed that T. gondii infection was not an independent risk factor for NAFLD. Age was independently correlated with both the prevalence of T. gondii and NAFLD.

          Conclusions

          Patients with T. gondii infection may have a higher prevalence of NAFLD. Age may have an effect on the increase of NAFLD in the T. gondii seropositive population.

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          Most cited references18

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          Non-alcoholic fatty liver disease: A sign of systemic disease.

          Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and leading cause of cirrhosis in the United States and developed countries. NAFLD is closely associated with obesity, insulin resistance and metabolic syndrome, significantly contributing to the exacerbation of the latter. Although NAFLD represents the hepatic component of metabolic syndrome, it can also be found in patients prior to their presentation with other manifestations of the syndrome. The pathogenesis of NAFLD is complex and closely intertwined with insulin resistance and obesity. Several mechanisms are undoubtedly involved in its pathogenesis and progression. In this review, we bring together the current understanding of the pathogenesis that makes NAFLD a systemic disease.
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            Toxoplasma gondii seroprevalence in the United States 2009-2010 and comparison with the past two decades.

            Toxoplasma gondii is a ubiquitous parasite that can cause neurologic and ocular disease. We tested sera from 7,072 people ≥ 6 years of age in the 2009-2010 National Health and Nutrition Examination Survey (NHANES) for immunoglobulin G antibodies and compared these results with two previous NHANES studies. The overall T. gondii antibody seroprevalence among persons ≥ 6 years of age in 2009-2010 was 13.2% (95% confidence limit [CL] 11.8%, 14.5%) and age-adjusted seroprevalence was 12.4% (95% CL 11.1%, 13.7%); age-adjusted seroprevalence among women 15-44 years of age was 9.1% (95% CL 7.2%, 11.1%). In U.S. born persons 12-49 years of age, the age-adjusted T. gondii seroprevalence decreased from 14.1% (95% CL 12.7%, 15.5%) in NHANES III (1988-1994) to 9.0% (95% CL 7.6%, 10.5%) in NHANES 1999-2004 to 6.7% (95% CL 5.3%, 8.2%) in NHANES 2009-2010 (P < 0.001 linear trend). Although T. gondii antibody presence is still relatively common, the prevalence in the United States has continued to decline.
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              Sixty Years (1957–2017) of Research on Toxoplasmosis in China—An Overview

              Toxoplasma gondii is a ubiquitous zoonotic pathogen belonging to apicomplexan parasites. Infection in humans and animals may cause abortion and other severe symptoms under certain circumstances, leading to great economical losses and public health problems. T. gondii was first discovered in China in 1955 and the corresponding work was published in 1957. Since then, a lot of work has been done on this parasite and the diseases it causes. This review summarizes the major progress made by Chinese scientists over the last 60 years, and gives our perspectives on what should be done in the near future. A wide variety of diagnostic approaches were designed, including the ones to detect T. gondii specific antibodies in host sera, and T. gondii specific antigens or DNA in tissue and environmental samples. Further work will be needed to translate some of the laboratory assays into reliable products for clinic uses. Epidemiological studies were extensively done in China and the sero-prevalence in humans increased over the years, but is still below the world average, likely due to the unique eating and cooking habits. Infection rates were shown to be fairly high in meat producing animals such as, pigs, sheep, and chickens, as well as in the definitive host cats. Numerous subunit vaccines in the form of recombinant proteins or DNA vaccines were developed, but none of them is satisfactory in the current form. Live attenuated parasites using genetically modified strains may be a better option for vaccine design. The strains isolated from China are dominated by the ToxoDB #9 genotype, but it likely contains multiple subtypes since different ToxoDB #9 strains exhibited phenotypic differences. Further studies are needed to understand the general biology, as well as the unique features of strains prevalent in China.
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                Author and article information

                Contributors
                huangjiaofeng@fjmu.edu.cn
                zhanghaoyang0@hotmail.com
                lesleyliu321@163.com
                wangmingfang@fjmu.edu.cn
                wblu@163.com
                bharat.velani.12@ucl.ac.uk
                zhuyueyong@fjmu.edu.cn
                sumer5129@fjmu.edu.cn
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                6 December 2018
                6 December 2018
                2018
                : 18
                : 629
                Affiliations
                [1 ]ISNI 0000 0004 1758 0400, GRID grid.412683.a, Department of Liver Research Center, , the First Affiliated Hospital of Fujian Medical University, ; Fuzhou, No. 20, Chazhong Road, Taijiang District, Fuzhou, 350001 Fujian China
                [2 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, School of Public Health, , Sun Yat-sen University, ; Guangzhou, 350002 Guangdong China
                [3 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Faculty of Life Sciences and Medicine, , King’s College London, ; London, SE1 1UL UK
                [4 ]ISNI 0000 0004 0374 1509, GRID grid.461344.0, Basildon and Thurrock University Hospitals NHS Foundation Trust, ; Nethermayne, Basildon, Essex SS16 5NL UK
                Author information
                http://orcid.org/0000-0001-7517-9859
                Article
                3547
                10.1186/s12879-018-3547-1
                6282358
                30522446
                06eefa7d-5b03-413a-8fc4-409640703220
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 August 2018
                : 23 November 2018
                Funding
                Funded by: Fujian Provincial Department of Science and Technology (CN)
                Award ID: 2016-CX-33
                Award Recipient :
                Funded by: the Natural Science Foundation of Fujian Province the Pilot of Fujian Science and Technology Project
                Award ID: 2016Y0040
                Award ID: 2017J01187
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Infectious disease & Microbiology
                non-alcoholic fatty liver,toxoplasma gondii,nhanes
                Infectious disease & Microbiology
                non-alcoholic fatty liver, toxoplasma gondii, nhanes

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