Jie Li1, Biyao Zou2, Yee Hui Yeo2, Yuemin Feng3, Xiaoyu Xie3, Dong Hyun Lee4, Hideki Fujii5, Yuankai Wu6, Leslie Y Kam2, Fanpu Ji7, Xiaohe Li8, Nicholas Chien2, Mike Wei2, Eiichi Ogawa9, Changqing Zhao10, Xia Wu11, Christopher D Stave12, Linda Henry2, Scott Barnett2, Hirokazu Takahashi13, Norihiro Furusyo14, Yuichiro Eguchi13, Yao-Chun Hsu15, Teng-Yu Lee16, Wanhua Ren17, Chengyong Qin18, Dae Won Jun19, Hidenori Toyoda20, Vincent Wai-Sun Wong21, Ramsey Cheung22, Qiang Zhu3, Mindie H Nguyen23. 1. Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, China. 2. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA. 3. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, China. 4. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea. 5. Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan; Endowed Department of Liver Cirrhosis Therapeutics, Graduate School of Medicine, Osaka City University, Osaka, Japan. 6. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 7. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an, Xi'an Jiaotong University, Xi'an, China. 8. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Infectious Disease, The Third People's Hospital of Shenzhen, Shenzhen, China. 9. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan. 10. Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China. 11. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 12. Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA. 13. Department of Internal Medicine, Saga Medical School, Saga, Japan. 14. Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan. 15. Department of Medical Research, Fu-Jen Catholic University Hospital, Taipei, Taiwan. 16. Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan. 17. Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 18. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 19. Department of Gastroenterology, Hanyang University, Seoul, South Korea. 20. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 21. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. 22. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. 23. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA. Electronic address: mindiehn@stanford.edu.
Abstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. FINDINGS: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13-31·15). NAFLD prevalence increased significantly over time (25·28% [22·42-28·37] between 1999 and 2005, 28·46% [26·70-30·29] between 2006 and 2011, and 33·90% [31·74-36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8-57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8-3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5-11·4). INTERPRETATION: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men. FUNDING: None.
BACKGROUND:Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. FINDINGS: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13-31·15). NAFLD prevalence increased significantly over time (25·28% [22·42-28·37] between 1999 and 2005, 28·46% [26·70-30·29] between 2006 and 2011, and 33·90% [31·74-36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8-57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8-3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5-11·4). INTERPRETATION: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obesemen. FUNDING: None.
Authors: Shiv K Sarin; Manoj Kumar; Mohammed Eslam; Jacob George; Mamun Al Mahtab; Sheikh M Fazle Akbar; Jidong Jia; Qiuju Tian; Rakesh Aggarwal; David H Muljono; Masao Omata; Yoshihiko Ooka; Kwang-Hyub Han; Hye Won Lee; Wasim Jafri; Amna S Butt; Chern H Chong; Seng G Lim; Raoh-Fang Pwu; Ding-Shinn Chen Journal: Lancet Gastroenterol Hepatol Date: 2019-12-15
Authors: Mohammed Eslam; Shiv K Sarin; Vincent Wai-Sun Wong; Jian-Gao Fan; Takumi Kawaguchi; Sang Hoon Ahn; Ming-Hua Zheng; Gamal Shiha; Yusuf Yilmaz; Rino Gani; Shahinul Alam; Yock Young Dan; Jia-Horng Kao; Saeed Hamid; Ian Homer Cua; Wah-Kheong Chan; Diana Payawal; Soek-Siam Tan; Tawesak Tanwandee; Leon A Adams; Manoj Kumar; Masao Omata; Jacob George Journal: Hepatol Int Date: 2020-10-01 Impact factor: 6.047