Increasing prevalence OF NAFLD/NASH
THE RISING CLINICAL AND ECONOMIC BURDEN
In 2021, it is estimated that 25% of the global adult population is potentially affected by non-alcoholic fatty liver disease (NAFLD), with the highest prevalence in the Middle East (31,8%) and South America (30,5%) and the lowest in Africa (13,5%). A recent study by Harrison et al. used a combination of state-of-the-art liver imaging methods and liver biopsy to prospectively determine the prevalence of NAFLD and NASH in asymptomatic middle-aged Americans. In this study, the prevalence of NAFLD was 38% (95% CI 34-41%) and the prevalence of NASH was 14% (95% CI 12-17%).
Geographic variation in the daily energy availability per capita and the prevalence of NAFLD
Adapted from : Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-8
There is a significant racial disparity in the prevalence of NAFLD in the United States. A systematic review and meta-analysis by Rich et al. in 2018, showed significant racial disparities in NAFLD prevalence and severity in the United States, with NAFLD prevalence being highest in Hispanics, intermediate in Whites, and lowest in Blacks. Among patients with NAFLD, risk for progression to NASH was higher in Hispanics and lower in Blacks than in Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial groups. A study of etiology-based and ethnicity-based annual mortality rates of cirrhosis and hepatocellular carcinoma (HCC) in the United State by Kim et al. showed that the mortality rates for NAFLD-cirrhosis and HCC have increased in non-Hispanic whites followed by Hispanics and non-Hispanic blacks.
Furthermore, the prevalence of NAFLD among children and adolescents is increasing, affecting approximately 3% to 10% of all children and over one-third of obese children in developed countries. The increasing prevalence of NAFLD is linked to a rise in other non-communicable diseases such as type-2 diabetes mellitus (T2DM), obesity and cardiovascular disease (CVD), which are primarily related to unhealthy lifestyles and diet. However, ageing and genetics might also play an important role, particularly in Native American and Hispanic populations.
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