Prevalence Trends in Non-alcoholic Fatty Liver Disease at the Global, Regional and National Levels, 1990-2017: a Population-based Observational Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Aug 5

PMID 32747349

Citations 73

Authors

Xiaojun Ge

Limei Zheng

Mei Wang

Yuxuan Du

Junyao Jiang

Affiliations

Soon will be listed here.

Abstract

Objective: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of end-stage liver diseases worldwide. Understanding NAFLD prevalence and trends over time at the global, regional and national levels is critical to understanding the NAFLD disease burden and creating more tailored prevention strategies.

Design: Population-based observational study.

Setting: The study was global, including 21 regions and 195 countries or territories.

Main Outcomes Measure: The estimated annual percentage change for NAFLD prevalence.

Results: Worldwide, cases of NAFLD have increased from 391.2 million in 1990 to 882.1 million in 2017, with the prevalence rate increasing from 8.2% to 10.9% during the same period. The increasing trends were consistent across sexes. Case numbers were highest in East Asia, followed by South Asia, then North Africa and the Middle East. The highest prevalence of NAFLD was observed in North Africa and the Middle East, while the greatest increase was detected in Western Europe, followed by Tropical Latin America, then high-income North America.

Conclusion: Nearly all countries or territories worldwide have experienced a significant increase in NAFLD prevalence. The greatest increase was observed in Oman. Almost all countries showed a significant increasing trend in NAFLD prevalence over the past three decades. This drastic increase is alarming and suggests that NAFLD has emerged as a new public health concern worldwide. As such, more efficient prevention strategies are urgently needed.

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References

Polyzos S, Kountouras J, Mantzoros C . Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism. 2018; 92:82-97. DOI: 10.1016/j.metabol.2018.11.014. View

Mitchell T, McKinnon E, Ayonrinde O, Adams L, Trinder D, Chua A . Decreased Physical Working Capacity in Adolescents With Nonalcoholic Fatty Liver Disease Associates With Reduced Iron Availability. Clin Gastroenterol Hepatol. 2019; 18(7):1584-1591. DOI: 10.1016/j.cgh.2019.10.017. View

Stefan N, Haring H, Cusi K . Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol. 2018; 7(4):313-324. DOI: 10.1016/S2213-8587(18)30154-2. View

Younossi Z, Tacke F, Arrese M, Sharma B, Mostafa I, Bugianesi E . Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology. 2018; 69(6):2672-2682. DOI: 10.1002/hep.30251. View

Younossi Z, Anstee Q, Marietti M, Hardy T, Henry L, Eslam M . Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2017; 15(1):11-20. DOI: 10.1038/nrgastro.2017.109. View

Younossi Z, Otgonsuren M, Henry L, Venkatesan C, Mishra A, Erario M . Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology. 2015; 62(6):1723-30. DOI: 10.1002/hep.28123. View

Ayonrinde O, Oddy W, Adams L, Mori T, Beilin L, de Klerk N . Infant nutrition and maternal obesity influence the risk of non-alcoholic fatty liver disease in adolescents. J Hepatol. 2017; 67(3):568-576. DOI: 10.1016/j.jhep.2017.03.029. View

Zelber-Sagi S, Ivancovsky-Wajcman D, Fliss Isakov N, Webb M, Orenstein D, Shibolet O . High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance. J Hepatol. 2018; 68(6):1239-1246. DOI: 10.1016/j.jhep.2018.01.015. View

Xanthakos S, Jenkins T, Kleiner D, Boyce T, Mourya R, Karns R . High Prevalence of Nonalcoholic Fatty Liver Disease in Adolescents Undergoing Bariatric Surgery. Gastroenterology. 2015; 149(3):623-34.e8. PMC: 4654456. DOI: 10.1053/j.gastro.2015.05.039. View

10.

. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1789-1858. PMC: 6227754. DOI: 10.1016/S0140-6736(18)32279-7. View

11.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C . Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9945):766-81. PMC: 4624264. DOI: 10.1016/S0140-6736(14)60460-8. View

12.

. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016; 387(10027):1513-1530. PMC: 5081106. DOI: 10.1016/S0140-6736(16)00618-8. View

13.

Anderson E, Howe L, Jones H, Higgins J, Lawlor D, Fraser A . The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10(10):e0140908. PMC: 4626023. DOI: 10.1371/journal.pone.0140908. View

14.

Kim D, Vazquez-Montesino L, Li A, Cholankeril G, Ahmed A . Inadequate Physical Activity and Sedentary Behavior Are Independent Predictors of Nonalcoholic Fatty Liver Disease. Hepatology. 2020; 72(5):1556-1568. DOI: 10.1002/hep.31158. View

15.

Friedman S, Neuschwander-Tetri B, Rinella M, Sanyal A . Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018; 24(7):908-922. PMC: 6553468. DOI: 10.1038/s41591-018-0104-9. View

16.

Stefan N, Kantartzis K, Haring H . Causes and metabolic consequences of Fatty liver. Endocr Rev. 2008; 29(7):939-60. DOI: 10.1210/er.2008-0009. View

17.

Younossi Z, Koenig A, Abdelatif D, Fazel Y, Henry L, Wymer M . Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2015; 64(1):73-84. DOI: 10.1002/hep.28431. View

18.

Cusi K, Sanyal A, Zhang S, Hartman M, Bue-Valleskey J, Hoogwerf B . Non-alcoholic fatty liver disease (NAFLD) prevalence and its metabolic associations in patients with type 1 diabetes and type 2 diabetes. Diabetes Obes Metab. 2017; 19(11):1630-1634. DOI: 10.1111/dom.12973. View

19.

Younossi Z, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y . The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology. 2016; 64(5):1577-1586. DOI: 10.1002/hep.28785. View

20.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal A . Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2017; 67(1):123-133. PMC: 5767767. DOI: 10.1002/hep.29466. View