2021 TDDW
Symposium (IV) NASH SYMPOSIUM
UPDATED PREVALENCE OF NAFLD AND NASH IN ASIA Jian-Gao Fan Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the world, and affects around 25% of adult population. From 2012 to 2017, the global liver-related deaths have increased 11.4% according to the Global Burden of Disease study. The Asia–Pacifc region with over 50% of the world’s population and accounted for 54% of cirrhosis-related deaths and 73% of hepatocellular carcinoma (HCC)-related deaths, respectively. NAFLD is the most rapidly growing contributor to liver mortality and morbidity both in the Western countries and the Eastern countries. The exponential growing burden of NAFLD parallels the increasing prevalence of obesity and type 2 diabetes mellitus in the Asia region. A recent systematic review and meta-analysis of the prevalence, incidence, and outcomes of NAFLD in the Asian population comprising 237 studies (13 044 518 individuals) suggested that the overall prevalence of NAFLD was 29·62% (exceeded that in the West), and up to 25% of NAFLD have developed to nonalcoholic steatohepatitis (NASH). NAFLD prevalence increased significantly over time from 25·28% between 1999 and 2005, through 28·46% between 2006 and 2011, to 33·90% between 2012 and 2017. The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years. The annual incidence of HCC in NAFLD patients was 1·8 cases per 1000 person-years and overall mortality rate was 5·3 deaths per 1000 person-years. Within the Asia–Pacifc region, NAFLD prevalence varies widely as would be predicted
34
from tremendous variations in genetic background, urbanisation, overnutrition, reduced physical activity, and a sedentary lifestyle. However, there is a common trend to increasing prevalence of obesity and NAFLD with time in the entire AsiaPacific region. Asia is a populous region with a quick spread of the childhood obesity epidemic as well. Recently, we did a systematic review with metaanalyses to provide the prevalence of and risk factors for pediatric NAFLD in Asia. Of 33 included Asian populations, 9 studies comprising 20595 children reported a pooled NAFLD prevalence of 5.53% (95% CI 3.46%-8.72%), which increased about 1.6-fold from 2004-2010 to the last decade. The pooled prevalence of NAFLD was ranked in increasing order for normal-weight (1.49%; 95% CI 0.88%-2.51%; 2610 participants), overweight (16.72%, n=1265), and obese (50.13%, n=6434) among Asia children. After full covariate adjustment, the multivariate meta-regression showed that boy percentage and body mass index were positively correlated with NAFLD. In this regard, pooled analysis showed that after age 10 years, boys were more prone to have NAFLD than girls. Furthermore, cardio-metabolic risk factors such as waist circumference, systolic and diastolic blood pressure, serum triglycerides, and insulin resistance were significantly associated with NAFLD. In addition, chronic hepatitis B (CHB) and NAFLD are increasingly observed together in Asian populations, and development of NASH represents
