The Global NAFLD Epidemic

Overview

Journal Nat Rev Gastroenterol Hepatol

Specialty Gastroenterology

Date 2013 Sep 18

PMID 24042449

Citations 840

Authors

Rohit Loomba

Arun J Sanyal

Affiliations

Soon will be listed here.

Abstract

NAFLD is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. The clinical and histological phenotypes of NAFLD extend from a nonalcoholic fatty liver to NASH. Although the prevalence of NAFLD is increasing globally, and it is set to become the predominant cause of chronic liver disease in many parts of the world, the epidemiology and demographic characteristics of NAFLD vary worldwide. Indeed, the condition is associated with obesity and insulin resistance in most cases in the Western world, but the disease manifests at a lower BMI in Asian countries and many patients do not seem to have insulin resistance as determined using conventional methods. The similarities and differences in the epidemiology of NAFLD in different regions of the world are discussed and the potential role of genetics and insulin resistance in disease progression is also presented.

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References

Anstee Q, Day C . The genetics of NAFLD. Nat Rev Gastroenterol Hepatol. 2013; 10(11):645-55. DOI: 10.1038/nrgastro.2013.182. View

Browning J, Szczepaniak L, Dobbins R, Nuremberg P, Horton J, Cohen J . Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004; 40(6):1387-95. DOI: 10.1002/hep.20466. View

Bechmann L, Gastaldelli A, Vetter D, Patman G, Pascoe L, Hannivoort R . Glucokinase links Krüppel-like factor 6 to the regulation of hepatic insulin sensitivity in nonalcoholic fatty liver disease. Hepatology. 2011; 55(4):1083-93. PMC: 3295906. DOI: 10.1002/hep.24793. View

Singh S, Nayak S, Swain M, Rout N, Mallik R, Agrawal O . Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol. 2004; 25(2):76-9. View

Petersen K, Dufour S, Hariri A, Nelson-Williams C, Foo J, Zhang X . Apolipoprotein C3 gene variants in nonalcoholic fatty liver disease. N Engl J Med. 2010; 362(12):1082-9. PMC: 2976042. DOI: 10.1056/NEJMoa0907295. View

Caballeria L, Pera G, Auladell M, Toran P, Munoz L, Miranda D . Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain. Eur J Gastroenterol Hepatol. 2009; 22(1):24-32. DOI: 10.1097/MEG.0b013e32832fcdf0. View

Ekstedt M, Franzen L, Mathiesen U, Thorelius L, Holmqvist M, Bodemar G . Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006; 44(4):865-73. DOI: 10.1002/hep.21327. View

Sanyal A, Banas C, Sargeant C, Luketic V, Sterling R, Stravitz R . Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006; 43(4):682-9. DOI: 10.1002/hep.21103. View

Noureddin M, Yates K, Vaughn I, Neuschwander-Tetri B, Sanyal A, McCullough A . Clinical and histological determinants of nonalcoholic steatohepatitis and advanced fibrosis in elderly patients. Hepatology. 2013; 58(5):1644-54. PMC: 3760979. DOI: 10.1002/hep.26465. View

10.

Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G . A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010; 53(2):372-84. DOI: 10.1016/j.jhep.2010.04.008. View

11.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

12.

Eguchi Y, Hyogo H, Ono M, Mizuta T, Ono N, Fujimoto K . Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol. 2012; 47(5):586-95. DOI: 10.1007/s00535-012-0533-z. View

13.

Charlton M, Burns J, Pedersen R, Watt K, Heimbach J, Dierkhising R . Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011; 141(4):1249-53. DOI: 10.1053/j.gastro.2011.06.061. View

14.

Chalasani N, Guo X, Loomba R, Goodarzi M, Haritunians T, Kwon S . Genome-wide association study identifies variants associated with histologic features of nonalcoholic Fatty liver disease. Gastroenterology. 2010; 139(5):1567-76, 1576.e1-6. PMC: 2967576. DOI: 10.1053/j.gastro.2010.07.057. View

15.

Welsh J, Karpen S, Vos M . Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. J Pediatr. 2012; 162(3):496-500.e1. PMC: 3649872. DOI: 10.1016/j.jpeds.2012.08.043. View

16.

Fan J, Li F, Cai X, Peng Y, Ao Q, Gao Y . Effects of nonalcoholic fatty liver disease on the development of metabolic disorders. J Gastroenterol Hepatol. 2007; 22(7):1086-91. DOI: 10.1111/j.1440-1746.2006.04781.x. View

17.

Williams C, Stengel J, Asike M, Torres D, Shaw J, Contreras M . Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2010; 140(1):124-31. DOI: 10.1053/j.gastro.2010.09.038. View

18.

Larrain S, Rinella M . A myriad of pathways to NASH. Clin Liver Dis. 2012; 16(3):525-48. DOI: 10.1016/j.cld.2012.05.009. View

19.

Lazo M, Clark J . The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008; 28(4):339-50. DOI: 10.1055/s-0028-1091978. View

20.

Finucane M, Stevens G, Cowan M, Danaei G, Lin J, Paciorek C . National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011; 377(9765):557-67. PMC: 4472365. DOI: 10.1016/S0140-6736(10)62037-5. View