The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review (original) (raw)
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Liver International, 2018
The estimated prevalence of non-alcoholic fatty liver disease (NAFLD) worldwide is approximately 25%. However, the real prevalence of NAFLD and the associated disorders is unknown mainly because reliable and applicable diagnostic tests are lacking. This is further complicated by the lack of consensus on the terminology of different How to cite this article: Araújo AR, Rosso N, Bedogni G, et al. Global epidemiology of non-alcoholic fatty liver disease/ non-alcoholic steatohepatitis: What we need in the future. Liver
Hepatology (Baltimore, Md.), 2015
NAFLD is a major cause of liver disease worldwide. We estimated the global prevalence, incidence, progression and outcomes of NAFLD and NASH. Pubmed/MEDLINE were searched from 1989-2015 for terms involving epidemiology and progression of NAFLD. selected groups (only morbidly obese or diabetics or pediatric), no data on alcohol consumption or other liver diseases. Incidence of HCC, cirrhosis, overall mortality and liver-related mortality were determined. NASH required histologic criteria. All studies were reviewed by 3 independent investigators. Analysis was stratified by region, diagnostic technique, biopsy indication and study population. We used random-effects models to provide point estimates (95% CI) of prevalence, incidence, mortality and incidence rate ratios, and meta-regression with sub-group analysis to account for heterogeneity. Out of 729 studies, 86 were included with a sample size of 8,515,431 from 22 countries. Global prevalence of NAFLD is 25.24% (22.10-28.65) with hi...
Journal of Bangladesh College of Physicians and Surgeons, 2015
Fatty liver is a common cause of chronic liver disease in developed as well as developing countries.We have designed this study to estimate the prevalence and predictors for non alcoholic steatohepatitis (NASH) in non alcoholic fatty liver disease (NAFLD). We have included 493 patients with sonographic evidence of fatty change in liver and 177 of them had done liver biopsy for histopathological study. Other causes of liver disease and alcohol consumption were excluded. Metabolic syndrome and biochemical and anthropometric evaluation was done. Females were predominating 250 (57.0 %). Centrally obese 422 (96.2 %) was more than over all obesity330 (75.1%). NASH was absent in 10 (5.6%) cases and diagnostic of NASH was 75
The Lancet Gastroenterology & Hepatology, 2020
Background Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD. Findings We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19•2% (95% CI 15•9-23•0) of people were lean and 40•8% (36•6-45•1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12•1% (95% CI 9•3-15•6) of people had non-obese NAFLD and 5•1% (3•7-7•0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24•6 (95% CI 13•4-39•2) per 1000 person-years. Among people with non-obese or lean NALFD, 39•0% (95% CI 24•1-56•3) had non-alcoholic steatohepatitis, 29•2% (21•9-37•9) had significant fibrosis (stage ≥2), and 3•2% (1•5-5•7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12•1 (95% CI 0•5-38•8) per 1000 person-years, that for liver-related mortality was 4•1 (1•9-7•1) per 1000 person-years, cardiovascular-related mortality was 4•0 (0•1-14•9) per 1000 person-years, newonset diabetes was 12•6 (8•0-18•3) per 1000 person-years, new-onset cardiovascular disease was 18•7 (9•2-31•2) per 1000 person-years, and new-onset hypertension was 56•1 (38•5-77•0) per 1000 person-years. Most analyses were characterised by high heterogeneity. Interpretation Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges.
Epidemiology of Non-Alcoholic Fatty Liver Disease
Digestive Diseases, 2010
general population. The most important risk factors for NAFLD are male gender, age, obesity, insulin resistance and the cardiometabolic alterations that define the metabolic syndrome. The prevalence of NAFLD is 80-90% in obese adults, 30-50% in patients with diabetes and up to 90% in patients with hyperlipidemia. The prevalence of NAFLD among children is 3-10%, rising up to 40-70% among obese children. Moreover, pediatric NAFLD increased from about 3% a decade ago to 5% today, with a male-to-female ratio of 2: 1. The incidence and natural history of NAFLD are still not well defined, but it is recognized that the majority of individuals with NAFLD do not develop NASH. The incidence of NAFLD is probably increasing in Western countries, strictly linked to lifestyle habits.
Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD)
Annals of Hepatology, 2009
The authors summarize and update the most recent knowledge in the field of prevalence, natural history and incidence of Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). These novel diseases, firstly recognized at the beginning of the second millennium, arose suddenly to the attention of the clinicians, because they are the hepatic expression of the "so-called" metabolic syndrome. Due to the epidemic burden of obesity, diabetes, and metabolic diseases, NAFLD and NASH will become soon probably the most common hepatic disease worldwide, and they surely will keep busy our future young hepatologists.
Cureus
In recent times, nonalcoholic fatty liver disease (NAFLD) has been considered one of the major causes of liver disease across the world. NAFLD is defined as the deposition of triglycerides in the liver and is associated with obesity and metabolic syndrome. Hyperinsulinemia, insulin resistance (IR), fatty liver, hepatocyte injury, unbalanced proinflammatory cytokines, mitochondrial dysfunction, oxidative stress, liver inflammation, and fibrosis are the main pathogenesis in NAFLD. Recent studies suggest that the action of intestinal microbiota through chronic inflammation, increased intestinal permeability, and energy uptake plays a vital role in NAFLD. Moreover, polycystic ovarian syndrome also causes NAFLD development through IR. Age, gender, race, ethnicity, sleep, diet, sedentary lifestyle, and genetic and epigenetic pathways are some contributing factors of NAFLD that can exacerbate the risk of liver cirrhosis and hepatocellular carcinoma (HCC) and eventually lead to death. NAFLD has various presentations, including fatigue, unexplained weight loss, bloating, upper abdominal pain, decreased appetite, headache, anxiety, poor sleep, increased thirst, palpitation, and a feeling of warmth. Some studies have shown that NAFLD with severe coronavirus disease 2019 (COVID-19) has poor outcomes. The gold standard for NAFLD diagnosis is liver biopsy. Other diagnostic tools are imaging tests, serum biomarkers, microbiota markers, and tests for extrahepatic complications. There are no specific treatments for NAFLD. Therefore, the main concern for NAFLD is treating the comorbid conditions such as anti-diabetic agents for type 2 diabetes mellitus, statins to reduce HCC progression, antioxidants to prevent hepatocellular damage, and bariatric surgery for patients with a BMI of >40 kg/m 2 and >35 kg/m 2 with comorbidities. Lifestyle and dietary changes are considered preventive strategies against NAFLD advancement. Inadequate treatment of NAFLD further leads to cardiac consequences, sleep apnea, chronic kidney disease, and inflammatory bowel disease. In this systematic review, we have briefly discussed the risk factors, pathogenesis, clinical features, and numerous consequences of NAFLD. We have also reviewed various guidelines for NAFLD diagnosis along with existing therapeutic strategies for the management and prevention of the disease.
Epidemiology of non-alcoholic and alcoholic fatty liver diseases
Translational Gastroenterology and Hepatology
Accumulation of excessive fat in the liver is the common denominator underlying the two most common and emerging causes of chronic liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), that are emerging public health issues globally. The burden of both ALD and NAFLD are increasing worldwide (1,2). ALD occur as a component of a broader perspective of alcohol abuse disorders, is frequently associated with psychiatric comorbidities and is the most frequent cause of morbidity, health care utilization and mortality in alcohol use disorders (3-6). This is in contrast to NAFLD that occurs as an essential component of metabolic disorders that are associated with insulin resistance as the pathophysiological hallmark and is clinically manifest as hepatic, pancreatic, cardiac endothelial cell dysfunction and disease. In NAFLD, death is most commonly due to cardiovascular disease and often nonhepatic cancers apart from liver disease (7,8). The current global march of NAFLD as a public health challenge parallels the global upsurge for food intake, increase in per capita income, sedentary lifestyle, increasing body mass index and finally is an expression of an excess of caloric