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; 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

doi:10.1016/S2468-1253(19)30039-1

Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis

Lancet Gastroenterol Hepatol. 2019 May;4(5):389-398. doi: 10.1016/S2468-1253(19)30039-1. Epub 2019 Mar 20.

Authors

Jie Li¹, Biyao Zou², Yee Hui Yeo², Yuemin Feng³, Xiaoyu Xie³, Dong Hyun Lee⁴, Hideki Fujii⁵, Yuankai Wu⁶, Leslie Y Kam², Fanpu Ji⁷, Xiaohe Li⁸, Nicholas Chien², Mike Wei², Eiichi Ogawa⁹, Changqing Zhao¹⁰, Xia Wu¹¹, Christopher D Stave¹², Linda Henry², Scott Barnett², Hirokazu Takahashi¹³, Norihiro Furusyo¹⁴, Yuichiro Eguchi¹³, Yao-Chun Hsu¹⁵, Teng-Yu Lee¹⁶, Wanhua Ren¹⁷, Chengyong Qin¹⁸, Dae Won Jun¹⁹, Hidenori Toyoda²⁰, Vincent Wai-Sun Wong²¹, Ramsey Cheung²², Qiang Zhu³, Mindie H Nguyen²³

Affiliations

¹ Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, China.
² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
³ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, China.
⁴ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea.
⁵ Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan; Endowed Department of Liver Cirrhosis Therapeutics, Graduate School of Medicine, Osaka City University, Osaka, Japan.
⁶ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an, Xi'an Jiaotong University, Xi'an, China.
⁸ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Infectious Disease, The Third People's Hospital of Shenzhen, Shenzhen, China.
⁹ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
¹⁰ Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
¹¹ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
¹² Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA.
¹³ Department of Internal Medicine, Saga Medical School, Saga, Japan.
¹⁴ Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
¹⁵ Department of Medical Research, Fu-Jen Catholic University Hospital, Taipei, Taiwan.
¹⁶ Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁷ Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
¹⁸ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
¹⁹ Department of Gastroenterology, Hanyang University, Seoul, South Korea.
²⁰ Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
²¹ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
²² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
²³ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA. Electronic address: mindiehn@stanford.edu.

PMID: 30902670
DOI: 10.1016/S2468-1253(19)30039-1

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.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Asia / epidemiology
Carcinoma, Hepatocellular / epidemiology*
Humans
Incidence
Liver Neoplasms / epidemiology*
Mortality*
Non-alcoholic Fatty Liver Disease / epidemiology*
Outcome Assessment, Health Care
Prevalence