Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019

a systematic review and meta-analysis

Jie Li, Biyao Zou, Yee Hui Yeo, Yuemin Feng, Xiaoyu Xie, Dong Hyun Lee, Hideki Fujii, Yuankai Wu, Leslie Y. Kam, Fanpu Ji, Xiaohe Li, Nicholas Chien, Mike Wei, Eiichi Ogawa, Changqing Zhao, Xia Wu, Christopher D. Stave, Linda Henry, Scott Barnett, Hirokazu Takahashi & 12 others Norihiro Furusyo, Yuichiro Eguchi, Yao Chun Hsu, Teng Yu Lee, Wanhua Ren, Chengyong Qin, Dae Won Jun, Hidenori Toyoda, Vincent Wai Sun Wong, Ramsey Cheung, Qiang Zhu, Mindie H. Nguyen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. Methods: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. Findings: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13–31·15). NAFLD prevalence increased significantly over time (25·28% [22·42–28·37] between 1999 and 2005, 28·46% [26·70–30·29] between 2006 and 2011, and 33·90% [31·74–36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8–57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8–3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5–11·4). Interpretation: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men. Funding: None.

Original languageEnglish
Pages (from-to)389-398
Number of pages10
JournalThe Lancet Gastroenterology and Hepatology
Volume4
Issue number5
DOIs
Publication statusPublished - May 1 2019

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Meta-Analysis
Incidence
Hepatocellular Carcinoma
Non-alcoholic Fatty Liver Disease
Liver Diseases
Mortality
PubMed
Social Class
Alcohol Drinking
Libraries
Observational Studies
Longitudinal Studies
Chronic Disease
Public Health
Obesity
Research Personnel
Databases
Biopsy
Liver

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019 : a systematic review and meta-analysis. / Li, Jie; Zou, Biyao; Yeo, Yee Hui; Feng, Yuemin; Xie, Xiaoyu; Lee, Dong Hyun; Fujii, Hideki; Wu, Yuankai; Kam, Leslie Y.; Ji, Fanpu; Li, Xiaohe; Chien, Nicholas; Wei, Mike; Ogawa, Eiichi; Zhao, Changqing; Wu, Xia; Stave, Christopher D.; Henry, Linda; Barnett, Scott; Takahashi, Hirokazu; Furusyo, Norihiro; Eguchi, Yuichiro; Hsu, Yao Chun; Lee, Teng Yu; Ren, Wanhua; Qin, Chengyong; Jun, Dae Won; Toyoda, Hidenori; Wong, Vincent Wai Sun; Cheung, Ramsey; Zhu, Qiang; Nguyen, Mindie H.

In: The Lancet Gastroenterology and Hepatology, Vol. 4, No. 5, 01.05.2019, p. 389-398.

Research output: Contribution to journalArticle

Li, J, Zou, B, Yeo, YH, Feng, Y, Xie, X, Lee, DH, Fujii, H, Wu, Y, Kam, LY, Ji, F, Li, X, Chien, N, Wei, M, Ogawa, E, Zhao, C, Wu, X, Stave, CD, Henry, L, Barnett, S, Takahashi, H, Furusyo, N, Eguchi, Y, Hsu, YC, Lee, TY, Ren, W, Qin, C, Jun, DW, Toyoda, H, Wong, VWS, Cheung, R, Zhu, Q & Nguyen, MH 2019, 'Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis', The Lancet Gastroenterology and Hepatology, vol. 4, no. 5, pp. 389-398. https://doi.org/10.1016/S2468-1253(19)30039-1
Li, Jie ; Zou, Biyao ; Yeo, Yee Hui ; Feng, Yuemin ; Xie, Xiaoyu ; Lee, Dong Hyun ; Fujii, Hideki ; Wu, Yuankai ; Kam, Leslie Y. ; Ji, Fanpu ; Li, Xiaohe ; Chien, Nicholas ; Wei, Mike ; Ogawa, Eiichi ; Zhao, Changqing ; Wu, Xia ; Stave, Christopher D. ; Henry, Linda ; Barnett, Scott ; Takahashi, Hirokazu ; Furusyo, Norihiro ; Eguchi, Yuichiro ; Hsu, Yao Chun ; Lee, Teng Yu ; Ren, Wanhua ; Qin, Chengyong ; Jun, Dae Won ; Toyoda, Hidenori ; Wong, Vincent Wai Sun ; Cheung, Ramsey ; Zhu, Qiang ; Nguyen, Mindie H. / Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019 : a systematic review and meta-analysis. In: The Lancet Gastroenterology and Hepatology. 2019 ; Vol. 4, No. 5. pp. 389-398.
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abstract = "Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. Methods: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. Findings: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62{\%} (95{\%} CI 28·13–31·15). NAFLD prevalence increased significantly over time (25·28{\%} [22·42–28·37] between 1999 and 2005, 28·46{\%} [26·70–30·29] between 2006 and 2011, and 33·90{\%} [31·74–36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95{\%} CI 44·8–57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8–3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5–11·4). Interpretation: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men. Funding: None.",
author = "Jie Li and Biyao Zou and Yeo, {Yee Hui} and Yuemin Feng and Xiaoyu Xie and Lee, {Dong Hyun} and Hideki Fujii and Yuankai Wu and Kam, {Leslie Y.} and Fanpu Ji and Xiaohe Li and Nicholas Chien and Mike Wei and Eiichi Ogawa and Changqing Zhao and Xia Wu and Stave, {Christopher D.} and Linda Henry and Scott Barnett and Hirokazu Takahashi and Norihiro Furusyo and Yuichiro Eguchi and Hsu, {Yao Chun} and Lee, {Teng Yu} and Wanhua Ren and Chengyong Qin and Jun, {Dae Won} and Hidenori Toyoda and Wong, {Vincent Wai Sun} and Ramsey Cheung and Qiang Zhu and Nguyen, {Mindie H.}",
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TY - JOUR

T1 - Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019

T2 - a systematic review and meta-analysis

AU - Li, Jie

AU - Zou, Biyao

AU - Yeo, Yee Hui

AU - Feng, Yuemin

AU - Xie, Xiaoyu

AU - Lee, Dong Hyun

AU - Fujii, Hideki

AU - Wu, Yuankai

AU - Kam, Leslie Y.

AU - Ji, Fanpu

AU - Li, Xiaohe

AU - Chien, Nicholas

AU - Wei, Mike

AU - Ogawa, Eiichi

AU - Zhao, Changqing

AU - Wu, Xia

AU - Stave, Christopher D.

AU - Henry, Linda

AU - Barnett, Scott

AU - Takahashi, Hirokazu

AU - Furusyo, Norihiro

AU - Eguchi, Yuichiro

AU - Hsu, Yao Chun

AU - Lee, Teng Yu

AU - Ren, Wanhua

AU - Qin, Chengyong

AU - Jun, Dae Won

AU - Toyoda, Hidenori

AU - Wong, Vincent Wai Sun

AU - Cheung, Ramsey

AU - Zhu, Qiang

AU - Nguyen, Mindie H.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. Methods: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. Findings: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13–31·15). NAFLD prevalence increased significantly over time (25·28% [22·42–28·37] between 1999 and 2005, 28·46% [26·70–30·29] between 2006 and 2011, and 33·90% [31·74–36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8–57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8–3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5–11·4). Interpretation: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men. Funding: None.

AB - Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden. Methods: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468. Findings: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13–31·15). NAFLD prevalence increased significantly over time (25·28% [22·42–28·37] between 1999 and 2005, 28·46% [26·70–30·29] between 2006 and 2011, and 33·90% [31·74–36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8–57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8–3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5–11·4). Interpretation: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men. Funding: None.

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