Global epidemiology of nonalcoholic fatty liver disease—Meta‐analytic assessment of prevalence, incidence, and outcomes

Hepatology - Tập 64 Số 1 - Trang 73-84 - 2016
Zobair M. Younossi1,2, Aaron B. Koenig1, Dinan Abdelatif1, Yousef Fazel1, Linda Henry3, Mark Wymer1,2
1Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
2Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital,Falls Church,VA
3Center for Outcomes Research in Liver Disease, Washington, DC

Tóm tắt

Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. We estimated the global prevalence, incidence, progression, and outcomes of NAFLD and nonalcoholic steatohepatitis (NASH). PubMed/MEDLINE were searched from 1989 to 2015 for terms involving epidemiology and progression of NAFLD. Exclusions included selected groups (studies that exclusively enrolled morbidly obese or diabetics or pediatric) and no data on alcohol consumption or other liver diseases. Incidence of hepatocellular carcinoma (HCC), cirrhosis, overall mortality, and liver‐related mortality were determined. NASH required histological diagnosis. All studies were reviewed by three independent investigators. Analysis was stratified by region, diagnostic technique, biopsy indication, and study population. We used random‐effects models to provide point estimates (95% confidence interval [CI]) of prevalence, incidence, mortality and incidence rate ratios, and metaregression with subgroup analysis to account for heterogeneity. Of 729 studies, 86 were included with a sample size of 8,515,431 from 22 countries. Global prevalence of NAFLD is 25.24% (95% CI: 22.10‐28.65) with highest prevalence in the Middle East and South America and lowest in Africa. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38‐61.20), type 2 diabetes (22.51%; 95% CI: 17.92‐27.89), hyperlipidemia (69.16%; 95% CI: 49.91‐83.46%), hypertension (39.34%; 95% CI: 33.15‐45.88), and metabolic syndrome (42.54%; 95% CI: 30.06‐56.05). Fibrosis progression proportion, and mean annual rate of progression in NASH were 40.76% (95% CI: 34.69‐47.13) and 0.09 (95% CI: 0.06‐0.12). HCC incidence among NAFLD patients was 0.44 per 1,000 person‐years (range, 0.29‐0.66). Liver‐specific mortality and overall mortality among NAFLD and NASH were 0.77 per 1,000 (range, 0.33‐1.77) and 11.77 per 1,000 person‐years (range, 7.10‐19.53) and 15.44 per 1,000 (range, 11.72‐20.34) and 25.56 per 1,000 person‐years (range, 6.29‐103.80). Incidence risk ratios for liver‐specific and overall mortality for NAFLD were 1.94 (range, 1.28‐2.92) and 1.05 (range, 0.70‐1.56). Conclusions: As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous. (Hepatology 2016;64:73–84)

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Tài liệu tham khảo

2012, The diagnosis and management of non‐alcoholic fatty liverdisease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association, Hepatology, 55, 2005, 10.1002/hep.25762

2011, Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver‐related mortality, Hepatology, 53, 1874, 10.1002/hep.24268

2015, Fibrosis stage is the strongest predictor for disease‐specific mortality in NAFLD after up to 33 years of follow‐up, Hepatology, 61, 1547, 10.1002/hep.27368

2015, Liver fibrosis, but no other histologic features, is ssociated with long‐term outcomes of patients with nonalcoholic fatty liver disease, Gastroenterology, 149, 389, 10.1053/j.gastro.2015.04.043

2005, The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies, J Hepatol, 42, 132, 10.1016/j.jhep.2004.09.012

2004, Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies, Hepatology, 40, 820

2010, Disease progression of non‐alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years, Gut, 59, 969, 10.1136/gut.2009.205088

2011, Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States, Gastroenterology, 141, 1249, 10.1053/j.gastro.2011.06.061

2015, Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States, Gastroenterology, 148, 547, 10.1053/j.gastro.2014.11.039

2011, Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults, Aliment Pharmacol Ther, 34, 274, 10.1111/j.1365-2036.2011.04724.x

2014, Prevalence of nonalcoholic fatty liver disease in mainland of China: a meta‐analysis of published studies, J Gastroenterol Hepatol, 29, 42, 10.1111/jgh.12428

2013, Non‐alcoholic fatty liver disease in diabetics—prevalence and predictive factors in a multiracial hospital clinic population in Malaysia, J Gastroenterol Hepatol, 28, 1375, 10.1111/jgh.12204

2005, Unexplained elevations in alanine aminotransferase in individuals with the metabolic syndrome: results from the Third National Health and Nutrition Survey (NHANES III), Am J Med Sci, 329, 111, 10.1097/00000441-200503000-00001

2014, High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels, J Clin Endocrinol Metab

2013, Influence of non‐alcoholic fatty liver disease on the development of diabetes mellitus, J Gastroenterol Hepatol., 28, 142, 10.1111/j.1440-1746.2012.07264.x

2015, Independent association between improvement of nonalcoholic fatty liver disease and reduced incidence of type 2 diabetes mellitus, Diabetes Care, 38, 1673, 10.2337/dc15-0140

2009, Long‐term follow‐up of patients with nonalcoholic fatty liver, Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc, 7, 234

2013, Predictors of all‐cause mortality and liver‐related mortality in patients with non‐alcoholic fatty liver disease (NAFLD), Dig Dis Sci, 58, 3017, 10.1007/s10620-013-2743-5

2013, NAFLD in Asia—as common and important as in the West, Nat Rev Gastroenterol Hepatol, 10, 307, 10.1038/nrgastro.2013.34

2010, Non‐alcoholic and alcoholic fatty liver disease—two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN‐D2D survey, BMC Public Health, 10, 237, 10.1186/1471-2458-10-237

2015, Prevalence and determinants of fatty liver in normal‐weight and overweight young adults. The Cardiovascular Risk in Young Finns Study, Ann Med, 47, 40, 10.3109/07853890.2014.966752

2014, Non alcoholic fatty liver disease (NAFLD) in a Sudanese population: what is the prevalence and risk factors?, Arab J Gastroenterol Off Publ Pan‐Arab Assoc Gastroenterol, 15, 12

2011, Non‐alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community, Ann Hepatol, 10, 119, 10.1016/S1665-2681(19)31559-5

2013, Serum uric acid levels and non‐alcoholic fatty liver disease in Uyghur and Han ethnic groups in northwestern China, Arq Bras Endocrinol Metabol, 57, 617, 10.1590/S0004-27302013000800006

2014, The prevalence of nonalcoholic fatty liver disease and relationship with serum uric acid level in Uyghur population, ScientificWorldJournal, 2014, 393628

2013, Cohort study of non‐alcoholic fatty liver disease, NAFLD fibrosis score, and the risk of incident diabetes in a Korean population, Am J Gastroenterol, 108, 1861, 10.1038/ajg.2013.349

2006, Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults, J Clin Gastroenterol, 40, 745, 10.1097/00004836-200609000-00016

2006, Interaction of obesity, metabolic syndrome and Framingham risk on steatohepatitis among healthy Taiwanese: population‐based nested case‐control study, Cardiovasc Diabetol, 5, 12, 10.1186/1475-2840-5-12

2009, Prevalence and risk factors for non‐alcoholic fatty liver disease among adults in an urban Sri Lankan population, J Gastroenterol Hepatol, 24, 1284, 10.1111/j.1440-1746.2009.05831.x

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Hepatology

Tập 64 Số 1

73-84

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