Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

Key Points

  • As a consequence of the pandemic spread of obesity, NAFLD is one of the most important causes of liver disease worldwide in adults and children, although some patients are lean

  • Global prevalence of NAFLD is estimated at 24%; the highest rates are reported from South America and the Middle East, followed by Asia, the USA and Europe

  • The large volume of patients sets NAFLD apart from other liver disease, meaning the major focus of clinical care is discerning those at highest risk of progressive liver disease

  • Being overweight in childhood and adolescence is associated with increased risk of NAFLD later in life; consequently, the threshold of liver-related morbidity and/or mortality is reached at a younger age

  • Patients with NAFLD have a high risk of liver-related morbidity and mortality along with metabolic comorbidities and might place a growing strain on health-care systems

  • While awaiting effective therapies, NAFLD warrants the attention of primary-care physicians, specialists and health policy makers, starting with prevention of excessive weight gain during childhood

Abstract

NAFLD is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The large number of patients with NAFLD with potential for progressive liver disease creates challenges for screening, as the diagnosis of NASH necessitates invasive liver biopsy. Furthermore, individuals with NAFLD have a high frequency of metabolic comorbidities and could place a growing strain on health-care systems from their need for management. While awaiting the development effective therapies, this disease warrants the attention of primary care physicians, specialists and health policy makers.

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Figure 1: Worldwide estimated prevalence of NAFLD and distribution of PNPLA3 genotypes.
Figure 2: Proportion of individuals with NAFLD stratified by country and obesity status.

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Acknowledgements

Work by the authors of this Review was funded by Horizon 2020 Framework Program of the European Union (under grant agreement number 634413 for the project EPoS to E.B. and Q.M.A.) and by the Robert W. Storr Bequest to the Sydney Medical Foundation, University of Sydney; a National Health and Medical Research Council of Australia (NHMRC) Program Grant (1053206) and Project grants (APP1107178 and APP1108422) to M.E and J.G.). T.H. is the recipient of a Clinical Research Training Fellowship from the Medical Research Council, UK.

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Correspondence to Elisabetta Bugianesi.

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Summary of studies showing the proportion of NAFLD in patients who are lean compared with those who are obese. (PDF 116 kb)

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Summary of studies showing the proportion of NAFLD in patients who are lean. (PDF 113 kb)

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Younossi, Z., Anstee, Q., Marietti, M. et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 15, 11–20 (2018). https://doi.org/10.1038/nrgastro.2017.109

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