Materiały źródłowe

• #1 Global burden of liver disease: 2023 update – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36990226/

  Liver disease accounts for two million deaths annually and is responsible for 4% of all deaths (1 out of every 25 deaths worldwide); approximately two-thirds of all liver-related deaths occur in men. […] The most common causes of cirrhosis worldwide are related to viral hepatitis, alcohol, and non-alcoholic fatty liver disease. […] Hepatotropic viruses are the aetiological factor in most cases of acute hepatitis, but drug-induced liver injury increasingly accounts for a significant proportion of cases. […] This iteration of the global burden of liver disease is an update of the 2019 version and focuses mainly on areas where significant new information is available like alcohol-associated liver disease, non-alcoholic fatty liver disease, viral hepatitis, and hepatocellular carcinoma. […] We also devote a separate section to the burden of liver disease in Africa, an area of the world typically neglected in such documents.

• #1 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver diseases represent a wide array of disorders characterized by hepatocyte injury, inflammatory cell infiltration, and HSC activation, which cumulatively impair liver function and disrupt its architecture. Annually, liver diseases are linked to approximately 2 million deaths and account for 4% of global mortality. Acute liver diseases often result from hepatotropic virus infections, though drug-induced liver injury (DILI) is also becoming increasingly prevalent worldwide. Chronic liver conditions, on the other hand, typically arise from factors like alcohol consumption, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections, along with a rising incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) globally. Progression from such chronic conditions to end-stage liver diseases, including cirrhosis and liver cancer, contributes significantly to morbidity and mortality.

• #1 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease stands as a leading cause of global mortality. The Global Burden of Disease 2019 study reported that 1.26 million individuals succumbed to cirrhosis and other chronic liver diseases in 2019, marking a 13% increase since 1990. Liver cancer, a terminal outcome of liver disease, accounted for approximately 830,000 deaths in 2020, representing 8.3% of global cancer-related deaths. Viral hepatitis, especially HBV and HCV, annually leads to around 1.3 million deaths. Moreover, approximately 3.3 million people are diagnosed with alcohol-associated liver disease (ALD) annually, accounting for 5.9% of global deaths. The rising fatalities from MASLD are also noteworthy, with an estimated 280,000 deaths in 2019. Notably, liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.).

• #1 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease incidence is on the rise worldwide, posing an increasing risk of morbidity. Despite intensified global public health interventions, liver diseases continue to represent a significant portion of the global disease burden, underscoring the complexity and multidimensionality of liver disease epidemiology. The shift towards lifestyle-associated liver diseases, such as MASLD and ALD, is particularly alarming. This trend is closely linked to changes in global dietary habits, sedentary behavior, and rising obesity rates. Recent meta-analyses have identified MASLD as the most common chronic liver disease, affecting 38.0% of the global adult population between 2016-2019. Additionally, the incidence of ALD is climbing, paralleling increases in global alcohol consumption. […] While new infections of HBV and HCV are declining in many regions due to effective public health interventions, chronic infections continue to pose a global challenge. The reduction in new infections can be attributed primarily to several key health measures beyond vaccination. Enhanced screening protocols for blood and organ donors have significantly reduced the risk of transfusion-associated hepatitis. Furthermore, harm reduction programs targeting high-risk populations, such as needle and syringe exchange programs, have been instrumental in preventing transmission among intravenous drug users.

• #1 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  The global incidence of cirrhosis, the end-stage of various chronic liver conditions, increased from 20.7 per 100,000 people in 2000 to 23.4 per 100,000 in 2015. Moreover, the incidence of liver cancer continues to escalate, with around 20 million new cases reported globally in 2022. Although improved diagnostics have enhanced early detection, they may also contribute to apparent increases in incidence. Emerging risk factors, such as environmental pollution and hepatotoxic drug use, further complicate efforts to reduce the global burden of liver diseases. […] Liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.). This stark contrast arises primarily from the higher prevalence of HBV and HCV, limited healthcare resources, and elevated levels of alcohol consumption in Mongolia. Conversely, the U.S. benefits from effective hepatitis vaccination programs, comprehensive screening, and advanced treatment options, resulting in significantly lower mortality rates.

• #1 Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9669831/

  Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

• #1 Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9669831/

  The most recent data available on the global prevalence of cirrhosis are from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The GBD 2017 reported the burden of cirrhosis based on pooled epidemiological data from 195 countries and territories stratified by cause, age, and sex from 1990 to 2017. The results for prevalence are presented as numbers and age-standardized or age-specific rates per 100000 populations with 95% uncertainty intervals (UIs). In 2017, there were an estimated 112 (107-119) million cases of compensated cirrhosis and 10.6 (10.3-10.9) million cases of decompensated cirrhosis prevalent worldwide. This represented a huge increase compared to the prevalence figures for 1990, when 65.9 (63.4-68.7) million cases of compensated cirrhosis and 5.20 (5.08-5.32) million cases of decompensated cirrhosis were observed. The age-standardized prevalence of compensated cirrhosis increased from 1354.5 (1300.6-1411.7) per 100000 in 1990 to 1395.0 (1323.5-1470.5) in 2017, while decompensated cirrhosis increased from 110.6 (108.0-113.0) per 100000 in 1990 to 132.5 (128.6-136.2) in 2017. In 2017, 58.8% of compensated cirrhosis cases and 60.3% of decompensated cirrhosis cases were observed in males, suggesting that men suffer from cirrhosis at higher rates. In males, the age-standardized prevalence of compensated cirrhosis increased by 2.9% from 1990 to 2017; the prevalence of decompensated cirrhosis increased by 21.1%. In females, these figures were 3.5% and 18.1%, respectively. Overall, the prevalence of liver cirrhosis increased by 74.53% from 1990 to 2017.

• #1 Clinical epidemiology and disease burden of nonalcoholic fatty liver disease

  https://www.wjgnet.com/1007-9327/full/v23/i47/8263.htm

  Nonalcoholic fatty liver disease (NAFLD) has become a common cause of chronic liver disease in the world since its first description in 1980 as the unnamed disease. It has been studied in-depth subsequently with continuous myriad of further investigations being carried into this soon to be common indication for liver transplantation (LT). NAFLD has diverse manifestations described in all ethnicities all over the world and present in both sexes. The variable presentations probably contribute to the underreported new and existing cases of NAFLD as well as the limited studies undertaken to elucidate the exact incidence and prevalence of NAFLD. It is currently estimated that the global prevalence of NAFLD is as high as one billion. In the United States, NAFLD is estimated to be the most common cause of chronic liver disease, affecting between 80 and 100 million individuals, among whom nearly 25% progress to NASH. A study from Japan which followed 3147 patients over 414 d found a 10% annual incidence rate. Another Japanese study evaluated elevated aminotransferase levels, weight gain and insulin resistance development over 5 years to classify patients with NAFLD and their incidence was reported as 31 per 1000 person-years. A retrospective study done in England later demonstrated a much lower incidence of 29 per 100000 person-years. A recent extensive meta-analysis described a pooled regional incidence of NAFLD in Asia and Israel to be 52 per 1000 person-years and 28 per 1000 person-years, respectively. Current data on incidence for NAFLD are limited in some regions of the world due to the limited number of studies. Further studies seem warranted to determine the true incidence in general population. In general, the prevalence of NAFLD has increased over the last 20 years. In addition to the gold standard diagnostic test of liver biopsy, there are some noninvasive modalities available to diagnose NAFLD. Hepatic ultrasonography, computed tomography (CT), and MRI are accepted modalities for detecting hepatic fatty infiltration. The difference in sensitivity of diagnostic modalities may account for the discrepancy in prevalence data for NAFLD. Using aminotransferase levels as a screening laboratory test for liver disease, prevalence of elevated aminotransferases was 7.9% in the United States general population (1988-1992) with unexplained liver disease in 69% of these subjects. In a recent meta-analysis, hepatic ultrasonography allowed for the reliable and accurate detection of moderate-to-severe fatty liver and is now considered the screening modality of choice. Prevalence of ultrasonographic diagnosis of NAFLD ranged between 17% in India to 46% in the United States. The Middle East and South America have the highest NAFLD prevalence at 31% and 32% respectively with the lowest prevalence in Africa at 13.5%. Recently, Asia has been facing the highest obesity epidemic and thus not surprisingly has been experiencing a rapid rate of increase in the prevalence of NAFLD. Chinese adolescents on a westernized diet have a greater than 25% prevalence of NAFLD. Studies from Korea, China, Japan and Taiwan have all reported a prevalence ranging from 11%-45%. Along with the global drift, United States has not been immune to the uptrend in NAFLD. A recent United States-based study using the National Health and Nutrition Examination Surveys (NHANES) conducted between 1988 and 2008 found that the prevalence of NAFLD using elevated alanine aminotransferese (ALT) doubled in the United States during this time period (5.5% to 11.0%). Based on the NHANES-III data collected between 1988 and 1994, the prevalence of ultrasonography-diagnosed NAFLD was 34%. Meta-regression of studies done globally also displayed an increased prevalence of NAFLD from 15% in 2005 to 25% in 2010. The discrepancy in the prevalence of NAFLD among studies is most likely due to differences in sample selection, diagnostic modalities, dietary and lifestyle habits. The current annual medical and societal costs of NAFLD are estimated at $292 billion in the United States. The projected cost of caring for patients is expected to increase by 18% from 2000 to 2035 and health-related quality of life of NAFLD patients is described as declining. NAFLD is a term for a host of histological findings stemming from hepatic steatosis and remains the most common liver disease globally with increasing prevalence. The vast variation in disease presentation complicates diagnosis, leading to an underestimate of actual disease occurrence. NAFLD is associated with many metabolic comorbidities, including obesity, type II diabetes, dyslipidemia, and metabolic syndrome. Its potential to develop into more severe liver conditions, such as nonalcoholic steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma, can lead to a state in which liver transplantation is the only treatment option available. The population at risk of developing progressive liver disease creates a challenge to the healthcare system in terms of screening for this evolving epidemic of liver disease. Further research must be conducted to understand NAFLD pathophysiology and its treatment, as well as, define accurate incidence, current disease burden, and socioeconomic effects of this disease.

• #1

  https://journals.lww.com/hep/fulltext/2016/07000/global_epidemiology_of_nonalcoholic_fatty_liver.14.aspx

  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). […] 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. […] HCC incidence among NAFLD patients was 0.44 per 1,000 person-years (range, 0.29-0.66). Liverspecific 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). […] As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #1 Epidemiology of chronic liver diseases in the USA in the past three decades | Gut

  https://gut.bmj.com/content/69/3/564

  Objective Given significant advances in treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of liver diseases in the USA may be changing. Our aim was to assess the shift in the prevalence of different liver disease aetiologies in the USA over the past three decades. […] Results A total of 58731 adults from NHANES (19882016) were included. Over the study period, the prevalence of chronic hepatitis B and alcoholic liver disease remained stable: 0.3%0.4% and 0.8%1.0%, respectively (p0.05). The prevalence of chronic hepatitis C decreased nearly twofold: 1.6% in 19881994 to 0.9% in 20132016 (p=0.03). In contrast, the prevalence of non-alcoholic fatty liver disease (NAFLD; by US-Fatty Liver Index) increased from 20.0% (19881994) to 28.3% (19992004) to 33.2% (20092012) and 31.9% (20132016) (p0.0001). […] Conclusions Over the past 30 years in the USA, NAFLD is the only liver disease with growing prevalence, synchronous with the increasing rates of obesity and T2DM.

• #1

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  Alcohol-associated liver disease (ALD), as highlighted in this narrative review, is a major public health concern, increasingly impacting global disease burden and premature mortality. In 2019, ALD accounted for the loss of 11 million life-years worldwide. The rising number of deaths and disability-adjusted life-years attributed to ALD, particularly pronounced in the United States, are alarming. Projections suggest that the economic impact of ALD, as seen in the United States, could potentially double by 2040. ALD is increasingly prevalent among younger adults (20-45 y) and has become the leading cause of liver transplantation in both United States and Europe. […] The prevalence of ALD is estimated at 3.5% in the general population, 26.0% among hazardous drinkers, and 55.1% among those with alcohol use disorders. Alarmingly, 5-year mortality rates for patients with ALD exceed 50%, with even higher rates in more advanced disease stages.

• #1

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  Addressing the growing ALD concern requires robust public health initiatives, heightened awareness, refined diagnostic techniques, and comprehensive epidemiological studies. These measures are vital to tackle the increasing prevalence of ALD and mitigate its extensive impact on individuals and health care systems. […] The accurate estimation of the impact of ALD is complicated by factors such as underreporting, diagnostic difficulties, inconsistent data quality across health registries, and interactions of alcohol with other risk factors for liver disease. […] The COVID-19 pandemic exacerbated the trend of increasing ALD incidence, as high-risk drinking patterns coincided with more hospital admissions for alcohol-associated hepatitis and a rise in ALD-related mortality. […] A robust response to ALD requires public health initiatives, better diagnostic techniques, and comprehensive studies to understand and mitigate its rising impact.

• #1

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  The GBD studies offer the most comprehensive global data on the burden of ALD, encompassing cirrhosis and other chronic liver diseases due to alcohol use. […] Globally, both the absolute number of deaths and DALYs due to ALD are increasing, driven in part by population growth and aging. […] The rising burden of ALD in the United States, especially among young adults (2534 y), has recently been confirmed in several studies. […] Projections based on GBD data suggest that without new interventions, the number of deaths and DALYs from liver cirrhosis and liver cancer attributable to alcohol will continue to rise over the next 25 years, particularly among men. […] The growing burden of ALD is particularly notable among younger adults. […] Since the onset of the COVID-19 pandemic, ALD has emerged as the leading indication for liver transplant listing, with this trend being especially pronounced among young adults. […] In 2019, ALD was responsible for the loss of ~11 million life-years globally, with an upward trend observed in various regions. This significant impact is being amplified by the obesity epidemic, with obesity-alcohol interactions playing a crucial role in liver disease outcomes.

• #1

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

  Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. […] WHO estimates that 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year. […] In 2022, hepatitis B resulted in an estimated 1.1 million deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). […] Hepatitis B can cause a chronic infection and puts people at high risk of death from cirrhosis and liver cancer. […] Hepatitis B is a major global health problem. The burden of infection is highest in the WHO Western Pacific Region and the WHO African Region, where 97 million and 65 million people, respectively, are chronically infected. […] Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases.

• #1

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

  As of 2022, 13% of all people estimated to be living with hepatitis B were aware of their infection, while 3% (7 million) of the people living with chronic hepatitis B were on treatment. […] According to latest WHO estimates, the proportion of children under five years of age chronically infected with HBV dropped to just under 1% in 2019 down from around 5% in the pre-vaccine era ranging from the 1980s to the early 2000s. […] With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria. […] In low-income settings, most people with liver cancer present late in the course of the disease and die within months of diagnosis. […] Hepatitis B can be passed from mother to child. This can be prevented by taking antiviral medicines to prevent transmission, in addition to the vaccine. […] WHO organizes annual World Hepatitis Day campaigns to increase awareness and understanding of viral hepatitis.

• #1 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  Liver cancer surveillance is recommended for all patients with Child-Turcotte-Pugh (CTP) Class A and B cirrhosis and patients with CTP Class C cirrhosis listed for liver transplantation who are eligible for curative or palliative (surgical, locoregional, or systemic) therapies for hepatocellular carcinoma (HCC). […] HCC occurs most often (80% of the time) in patients with advanced fibrosis/cirrhosis. […] Screening (or more accurately, surveillance for this at-risk population) will result in earlier stage at diagnosis and greater chance of cure. […] Most guidelines call for ultrasound every 6 months with or without alpha-fetoprotein (AFP) screening in all patients with cirrhosis. […] There is significant variability in practice with respect to awareness of surveillance guidelines, surveillance rates, and imaging modalities; this field is likely to evolve significantly in the future.

• #1 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  The HCC guidelines published by the American Society for the Study of Liver Disease (AASLD) in 2018 recommend: Surveillance of adults with cirrhosis because it improves overall survival. […] Surveillance using ultrasound, with or without AFP screening, every 6 months. […] No surveillance of patients with cirrhosis with CTP Class C unless they are on the transplant waiting list, given low anticipated survival for patients with this degree of hepatic dysfunction. […] The U.S. Preventive Services Task Force has not issued guidance on surveillance for HCC, and primary care providers may not be aware of specialty guidelines. […] Ultrasound is cost-effective as a surveillance modality; however, it is operator-dependent and results are often affected by body habitus. […] Patients with chronic hepatitis B are at risk of liver cancer even in the absence of cirrhosis.

• #1 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  Ultrasound surveillance is advised every 6 months in the following populations (regardless of stage of fibrosis): Patients with cirrhosis, African decent over 20 years of age, ALL males over 40 years of age, Asian females over 50 years of age. […] HCC is increasingly being reported in patients with nonalcoholic steatohepatitis (NASH) without cirrhosis; the pathogenesis of HCC in this population may be different than in the population with viral hepatitis; there are currently no recommendations for surveillance in this population. […] Several studies have reported that patients with cirrhosis who have achieved sustained viralogic response (SVR) after direct-acting antiviral (DAA) therapy for hepatitis C may experience decreased risk of HCC and/or regression of fibrosis; the natural history of cancer risk and regression of fibrosis in this population is still being studied; therefore, patients with stage 3 or 4 fibrosis at the time of initiation of DAA therapy should continue HCC surveillance until more data are available.

• #1 Liver Cirrhosis: Classification, Surveillance — EACS Guidelines

  https://eacs.sanfordguide.com/eacs-part2/hepatic-complications/liver-cirrhosis-classification-surveillance

  Child-Pugh classification of the severity of cirrhosis […] Based on Baveno VII consensus (EASL); only applicable to patients with Child-Pugh A cirrhosis. Patients with Child-Pugh B and C cirrhosis should undergo yearly gastroscopy independently of Baveno VII criteria. […] Persons with compensated cirrhosis without varices on screening endoscopy should have endoscopy repeated every 2 years with ongoing liver injury, overweight or alcohol use or every 3 years if liver injury is quiescent, e.g., after viral clearance, alcohol abstinence. […] Hepatic Venous Pressure Gradient (HVPG) when available, is the gold standard and allows a direct measure of portal hypertension and prognostic stratification of persons with compensated cirrhosis. […] In primary and secondary prophylaxis for variceal bleeding HVPG measurement allows to monitor efficacy of beta-blockers LSM by TE 15 kPa plus platelet count 150×109/L rules out clinically significant portal hypertension (sensitivity and negative predictive value 90%) in patients with compensated liver cirrhosis. […] The Baveno VII consensus (EASL) mentions the term compensated advanced chronic liver disease (cACLD), which encompasses both advanced liver fibrosis and cirrhosis. […] Surveillance and management for hepatocellular carcinoma should be conducted according to the EASL guidelines.

• #1 Regular checks for liver cancer (surveillance) – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/diagnosis-and-care/regular-checks-for-liver-cancer/

  Liver cancer is more common in people who have serious liver damage, but finding it early means it can often be cured. Doctors use regular checks called surveillance to help find cancer early. […] Most people with cirrhosis or long-term hepatitis B infection will be offered a clinical check-up every 6 months. These check-ups help your clinical team look after your liver health as well as giving any treatment you need such as anti-viral therapy for hepatitis B. And they normally include surveillance checks that look for signs of liver cancer. […] Because these checks aim to find liver cancer as soon as possible, its important to take part every time. Even if you feel okay. […] You will be invited for regular liver cancer checks if you have been diagnosed with cirrhosis. […] In some places in England there is an NHS pilot programme offering liver health checks to look for signs of liver disease in people who are at higher risk. People who have signs they could have serious liver damage may be referred for regular liver cancer checks.

• #1 Quality statement 4: Surveillance for hepatocellular carcinoma | Liver disease | Quality standards | NICE

  https://www.nice.org.uk/guidance/qs152/chapter/quality-statement-4-surveillance-for-hepatocellular-carcinoma

  Adults with cirrhosis are offered 6-monthly surveillance for hepatocellular carcinoma. […] Cirrhosis is a substantial risk factor for hepatocellular carcinoma. Hepatocellular carcinoma develops quickly and may be asymptomatic until it is advanced. Regular surveillance of adults with cirrhosis at 6-month intervals helps to ensure that it is detected early. Treatment can then begin promptly, which can improve the person’s chances of survival. […] Evidence of local arrangements to ensure that adults with cirrhosis are offered 6-monthly surveillance for hepatocellular carcinoma. […] Proportion of adults with cirrhosis who received ultrasound surveillance for hepatocellular carcinoma within the past 6 months. […] a) Proportion of adults with cirrhosis who are diagnosed with hepatocellular carcinoma at an early stage.

• #1 Global epidemiology of cirrhosis — aetiology, trends and predictions | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-023-00759-2

  Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. […] the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. […] The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care. […] The global burden of cirrhosis associated with non-alcoholic fatty liver disease (NAFLD) has increased substantially in the past decade. […] The focus of care should be shifted upstream towards primary prevention and early detection of liver disease to reduce the global burden of cirrhosis.

• #1 Surveillance for liver cancer in primary care: A systematic review of the evidence

  https://www1.racgp.org.au/ajgp/2023/november/surveillance-for-liver-cancer-in-primary-care

  Many studies have evaluated the effectiveness of HCC surveillance in the primary care setting. Several of these have attributed underutilisation of surveillance to both patient (eg poor adherence, cost) and PCP (lack of awareness of surveillance guidelines) factors. […] This is the first systematic review of the evidence for HCC surveillance in primary care settings. We found that irrespective of HCC risk factors, surveillance rates were consistently lower for patients managed by PCPs compared with gastroenterologists or hepatologists. When additional support was provided to PCPs to address a range of barriers, surveillance rates increased substantially. […] HCC surveillance is of critical importance in reducing morbidity and mortality for high-risk populations. […] Barriers to HCC surveillance included lack of knowledge and awareness of HCC and associated risk factors. A key barrier identified was PCP lack of awareness of surveillance recommendations.

• #2

  https://liverlearning.aasld.org/AssetListing/The-Liver-Meeting-2019-5616/Global-Epidemiology-of-Liver-Disease-32606

  Global Epidemiology of Liver Disease […] So cirrhosis is the 11th leading cause of global mortality, accounting for 1.2 million deaths in 2016. […] Over time, the total number of annual deaths from cirrhosis have, in fact, increased. […] In addition, the percent of total deaths attributed to cirrhosis have also increased over time. […] Cirrhosis is also a leading cause of morbidity globally. […] So in 2016, cirrhosis was the number 15 leading cause of morbidity worldwide, accounting for 45 million DALYs globally. […] In summary, cirrhosis does have significant public health implications. It’s the 11th leading cause of global mortality, the 15th leading cause of global morbidity, and it’s associated with very high economic cost. […] It’s been estimated that the absolute number of chronic liver disease cases in 2017 was a whopping 1.5 billion, meaning 1.5 billion people across the world affected with any stage of chronic liver disease.

• #2 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver diseases represent a wide array of disorders characterized by hepatocyte injury, inflammatory cell infiltration, and HSC activation, which cumulatively impair liver function and disrupt its architecture. Annually, liver diseases are linked to approximately 2 million deaths and account for 4% of global mortality. Acute liver diseases often result from hepatotropic virus infections, though drug-induced liver injury (DILI) is also becoming increasingly prevalent worldwide. Chronic liver conditions, on the other hand, typically arise from factors like alcohol consumption, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections, along with a rising incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) globally. Progression from such chronic conditions to end-stage liver diseases, including cirrhosis and liver cancer, contributes significantly to morbidity and mortality.

• #2 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease stands as a leading cause of global mortality. The Global Burden of Disease 2019 study reported that 1.26 million individuals succumbed to cirrhosis and other chronic liver diseases in 2019, marking a 13% increase since 1990. Liver cancer, a terminal outcome of liver disease, accounted for approximately 830,000 deaths in 2020, representing 8.3% of global cancer-related deaths. Viral hepatitis, especially HBV and HCV, annually leads to around 1.3 million deaths. Moreover, approximately 3.3 million people are diagnosed with alcohol-associated liver disease (ALD) annually, accounting for 5.9% of global deaths. The rising fatalities from MASLD are also noteworthy, with an estimated 280,000 deaths in 2019. Notably, liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.).

• #2 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease incidence is on the rise worldwide, posing an increasing risk of morbidity. Despite intensified global public health interventions, liver diseases continue to represent a significant portion of the global disease burden, underscoring the complexity and multidimensionality of liver disease epidemiology. The shift towards lifestyle-associated liver diseases, such as MASLD and ALD, is particularly alarming. This trend is closely linked to changes in global dietary habits, sedentary behavior, and rising obesity rates. Recent meta-analyses have identified MASLD as the most common chronic liver disease, affecting 38.0% of the global adult population between 2016-2019. Additionally, the incidence of ALD is climbing, paralleling increases in global alcohol consumption. […] While new infections of HBV and HCV are declining in many regions due to effective public health interventions, chronic infections continue to pose a global challenge. The reduction in new infections can be attributed primarily to several key health measures beyond vaccination. Enhanced screening protocols for blood and organ donors have significantly reduced the risk of transfusion-associated hepatitis. Furthermore, harm reduction programs targeting high-risk populations, such as needle and syringe exchange programs, have been instrumental in preventing transmission among intravenous drug users.

• #2 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  The global incidence of cirrhosis, the end-stage of various chronic liver conditions, increased from 20.7 per 100,000 people in 2000 to 23.4 per 100,000 in 2015. Moreover, the incidence of liver cancer continues to escalate, with around 20 million new cases reported globally in 2022. Although improved diagnostics have enhanced early detection, they may also contribute to apparent increases in incidence. Emerging risk factors, such as environmental pollution and hepatotoxic drug use, further complicate efforts to reduce the global burden of liver diseases. […] Liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.). This stark contrast arises primarily from the higher prevalence of HBV and HCV, limited healthcare resources, and elevated levels of alcohol consumption in Mongolia. Conversely, the U.S. benefits from effective hepatitis vaccination programs, comprehensive screening, and advanced treatment options, resulting in significantly lower mortality rates.

• #2 Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9669831/

  Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

• #2 Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9669831/

  The most recent data available on the global prevalence of cirrhosis are from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The GBD 2017 reported the burden of cirrhosis based on pooled epidemiological data from 195 countries and territories stratified by cause, age, and sex from 1990 to 2017. The results for prevalence are presented as numbers and age-standardized or age-specific rates per 100000 populations with 95% uncertainty intervals (UIs). In 2017, there were an estimated 112 (107-119) million cases of compensated cirrhosis and 10.6 (10.3-10.9) million cases of decompensated cirrhosis prevalent worldwide. This represented a huge increase compared to the prevalence figures for 1990, when 65.9 (63.4-68.7) million cases of compensated cirrhosis and 5.20 (5.08-5.32) million cases of decompensated cirrhosis were observed. The age-standardized prevalence of compensated cirrhosis increased from 1354.5 (1300.6-1411.7) per 100000 in 1990 to 1395.0 (1323.5-1470.5) in 2017, while decompensated cirrhosis increased from 110.6 (108.0-113.0) per 100000 in 1990 to 132.5 (128.6-136.2) in 2017. In 2017, 58.8% of compensated cirrhosis cases and 60.3% of decompensated cirrhosis cases were observed in males, suggesting that men suffer from cirrhosis at higher rates. In males, the age-standardized prevalence of compensated cirrhosis increased by 2.9% from 1990 to 2017; the prevalence of decompensated cirrhosis increased by 21.1%. In females, these figures were 3.5% and 18.1%, respectively. Overall, the prevalence of liver cirrhosis increased by 74.53% from 1990 to 2017.

• #2

  https://journals.lww.com/hep/fulltext/2016/07000/global_epidemiology_of_nonalcoholic_fatty_liver.14.aspx

  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). […] 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. […] HCC incidence among NAFLD patients was 0.44 per 1,000 person-years (range, 0.29-0.66). Liverspecific 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). […] As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #2

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  Alcohol-associated liver disease (ALD), as highlighted in this narrative review, is a major public health concern, increasingly impacting global disease burden and premature mortality. In 2019, ALD accounted for the loss of 11 million life-years worldwide. The rising number of deaths and disability-adjusted life-years attributed to ALD, particularly pronounced in the United States, are alarming. Projections suggest that the economic impact of ALD, as seen in the United States, could potentially double by 2040. ALD is increasingly prevalent among younger adults (20-45 y) and has become the leading cause of liver transplantation in both United States and Europe. […] The prevalence of ALD is estimated at 3.5% in the general population, 26.0% among hazardous drinkers, and 55.1% among those with alcohol use disorders. Alarmingly, 5-year mortality rates for patients with ALD exceed 50%, with even higher rates in more advanced disease stages.

• #2

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

  Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. […] WHO estimates that 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year. […] In 2022, hepatitis B resulted in an estimated 1.1 million deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). […] Hepatitis B can cause a chronic infection and puts people at high risk of death from cirrhosis and liver cancer. […] Hepatitis B is a major global health problem. The burden of infection is highest in the WHO Western Pacific Region and the WHO African Region, where 97 million and 65 million people, respectively, are chronically infected. […] Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases.

• #2

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

  As of 2022, 13% of all people estimated to be living with hepatitis B were aware of their infection, while 3% (7 million) of the people living with chronic hepatitis B were on treatment. […] According to latest WHO estimates, the proportion of children under five years of age chronically infected with HBV dropped to just under 1% in 2019 down from around 5% in the pre-vaccine era ranging from the 1980s to the early 2000s. […] With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria. […] In low-income settings, most people with liver cancer present late in the course of the disease and die within months of diagnosis. […] Hepatitis B can be passed from mother to child. This can be prevented by taking antiviral medicines to prevent transmission, in addition to the vaccine. […] WHO organizes annual World Hepatitis Day campaigns to increase awareness and understanding of viral hepatitis.

• #2 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  Liver cancer surveillance is recommended for all patients with Child-Turcotte-Pugh (CTP) Class A and B cirrhosis and patients with CTP Class C cirrhosis listed for liver transplantation who are eligible for curative or palliative (surgical, locoregional, or systemic) therapies for hepatocellular carcinoma (HCC). […] HCC occurs most often (80% of the time) in patients with advanced fibrosis/cirrhosis. […] Screening (or more accurately, surveillance for this at-risk population) will result in earlier stage at diagnosis and greater chance of cure. […] Most guidelines call for ultrasound every 6 months with or without alpha-fetoprotein (AFP) screening in all patients with cirrhosis. […] There is significant variability in practice with respect to awareness of surveillance guidelines, surveillance rates, and imaging modalities; this field is likely to evolve significantly in the future.

• #2 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  The HCC guidelines published by the American Society for the Study of Liver Disease (AASLD) in 2018 recommend: Surveillance of adults with cirrhosis because it improves overall survival. […] Surveillance using ultrasound, with or without AFP screening, every 6 months. […] No surveillance of patients with cirrhosis with CTP Class C unless they are on the transplant waiting list, given low anticipated survival for patients with this degree of hepatic dysfunction. […] The U.S. Preventive Services Task Force has not issued guidance on surveillance for HCC, and primary care providers may not be aware of specialty guidelines. […] Ultrasound is cost-effective as a surveillance modality; however, it is operator-dependent and results are often affected by body habitus. […] Patients with chronic hepatitis B are at risk of liver cancer even in the absence of cirrhosis.

• #2 Hepatocellular Carcinoma Surveillance – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/complications/hcc-surveillance.asp

  Ultrasound surveillance is advised every 6 months in the following populations (regardless of stage of fibrosis): Patients with cirrhosis, African decent over 20 years of age, ALL males over 40 years of age, Asian females over 50 years of age. […] HCC is increasingly being reported in patients with nonalcoholic steatohepatitis (NASH) without cirrhosis; the pathogenesis of HCC in this population may be different than in the population with viral hepatitis; there are currently no recommendations for surveillance in this population. […] Several studies have reported that patients with cirrhosis who have achieved sustained viralogic response (SVR) after direct-acting antiviral (DAA) therapy for hepatitis C may experience decreased risk of HCC and/or regression of fibrosis; the natural history of cancer risk and regression of fibrosis in this population is still being studied; therefore, patients with stage 3 or 4 fibrosis at the time of initiation of DAA therapy should continue HCC surveillance until more data are available.

• #2 Liver Cirrhosis: Classification, Surveillance — EACS Guidelines

  https://eacs.sanfordguide.com/eacs-part2/hepatic-complications/liver-cirrhosis-classification-surveillance

  Child-Pugh classification of the severity of cirrhosis […] Based on Baveno VII consensus (EASL); only applicable to patients with Child-Pugh A cirrhosis. Patients with Child-Pugh B and C cirrhosis should undergo yearly gastroscopy independently of Baveno VII criteria. […] Persons with compensated cirrhosis without varices on screening endoscopy should have endoscopy repeated every 2 years with ongoing liver injury, overweight or alcohol use or every 3 years if liver injury is quiescent, e.g., after viral clearance, alcohol abstinence. […] Hepatic Venous Pressure Gradient (HVPG) when available, is the gold standard and allows a direct measure of portal hypertension and prognostic stratification of persons with compensated cirrhosis. […] In primary and secondary prophylaxis for variceal bleeding HVPG measurement allows to monitor efficacy of beta-blockers LSM by TE 15 kPa plus platelet count 150×109/L rules out clinically significant portal hypertension (sensitivity and negative predictive value 90%) in patients with compensated liver cirrhosis. […] The Baveno VII consensus (EASL) mentions the term compensated advanced chronic liver disease (cACLD), which encompasses both advanced liver fibrosis and cirrhosis. […] Surveillance and management for hepatocellular carcinoma should be conducted according to the EASL guidelines.

• #2

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  Addressing the growing ALD concern requires robust public health initiatives, heightened awareness, refined diagnostic techniques, and comprehensive epidemiological studies. These measures are vital to tackle the increasing prevalence of ALD and mitigate its extensive impact on individuals and health care systems. […] The accurate estimation of the impact of ALD is complicated by factors such as underreporting, diagnostic difficulties, inconsistent data quality across health registries, and interactions of alcohol with other risk factors for liver disease. […] The COVID-19 pandemic exacerbated the trend of increasing ALD incidence, as high-risk drinking patterns coincided with more hospital admissions for alcohol-associated hepatitis and a rise in ALD-related mortality. […] A robust response to ALD requires public health initiatives, better diagnostic techniques, and comprehensive studies to understand and mitigate its rising impact.

• #2 Global epidemiology of cirrhosis — aetiology, trends and predictions | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-023-00759-2

  Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. […] the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. […] The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care. […] The global burden of cirrhosis associated with non-alcoholic fatty liver disease (NAFLD) has increased substantially in the past decade. […] The focus of care should be shifted upstream towards primary prevention and early detection of liver disease to reduce the global burden of cirrhosis.

• #3 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  The global incidence of cirrhosis, the end-stage of various chronic liver conditions, increased from 20.7 per 100,000 people in 2000 to 23.4 per 100,000 in 2015. Moreover, the incidence of liver cancer continues to escalate, with around 20 million new cases reported globally in 2022. Although improved diagnostics have enhanced early detection, they may also contribute to apparent increases in incidence. Emerging risk factors, such as environmental pollution and hepatotoxic drug use, further complicate efforts to reduce the global burden of liver diseases. […] Liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.). This stark contrast arises primarily from the higher prevalence of HBV and HCV, limited healthcare resources, and elevated levels of alcohol consumption in Mongolia. Conversely, the U.S. benefits from effective hepatitis vaccination programs, comprehensive screening, and advanced treatment options, resulting in significantly lower mortality rates.

• #3 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease incidence is on the rise worldwide, posing an increasing risk of morbidity. Despite intensified global public health interventions, liver diseases continue to represent a significant portion of the global disease burden, underscoring the complexity and multidimensionality of liver disease epidemiology. The shift towards lifestyle-associated liver diseases, such as MASLD and ALD, is particularly alarming. This trend is closely linked to changes in global dietary habits, sedentary behavior, and rising obesity rates. Recent meta-analyses have identified MASLD as the most common chronic liver disease, affecting 38.0% of the global adult population between 2016-2019. Additionally, the incidence of ALD is climbing, paralleling increases in global alcohol consumption. […] While new infections of HBV and HCV are declining in many regions due to effective public health interventions, chronic infections continue to pose a global challenge. The reduction in new infections can be attributed primarily to several key health measures beyond vaccination. Enhanced screening protocols for blood and organ donors have significantly reduced the risk of transfusion-associated hepatitis. Furthermore, harm reduction programs targeting high-risk populations, such as needle and syringe exchange programs, have been instrumental in preventing transmission among intravenous drug users.

• #3 Clinical epidemiology and disease burden of nonalcoholic fatty liver disease

  https://www.wjgnet.com/1007-9327/full/v23/i47/8263.htm

  Nonalcoholic fatty liver disease (NAFLD) has become a common cause of chronic liver disease in the world since its first description in 1980 as the unnamed disease. It has been studied in-depth subsequently with continuous myriad of further investigations being carried into this soon to be common indication for liver transplantation (LT). NAFLD has diverse manifestations described in all ethnicities all over the world and present in both sexes. The variable presentations probably contribute to the underreported new and existing cases of NAFLD as well as the limited studies undertaken to elucidate the exact incidence and prevalence of NAFLD. It is currently estimated that the global prevalence of NAFLD is as high as one billion. In the United States, NAFLD is estimated to be the most common cause of chronic liver disease, affecting between 80 and 100 million individuals, among whom nearly 25% progress to NASH. A study from Japan which followed 3147 patients over 414 d found a 10% annual incidence rate. Another Japanese study evaluated elevated aminotransferase levels, weight gain and insulin resistance development over 5 years to classify patients with NAFLD and their incidence was reported as 31 per 1000 person-years. A retrospective study done in England later demonstrated a much lower incidence of 29 per 100000 person-years. A recent extensive meta-analysis described a pooled regional incidence of NAFLD in Asia and Israel to be 52 per 1000 person-years and 28 per 1000 person-years, respectively. Current data on incidence for NAFLD are limited in some regions of the world due to the limited number of studies. Further studies seem warranted to determine the true incidence in general population. In general, the prevalence of NAFLD has increased over the last 20 years. In addition to the gold standard diagnostic test of liver biopsy, there are some noninvasive modalities available to diagnose NAFLD. Hepatic ultrasonography, computed tomography (CT), and MRI are accepted modalities for detecting hepatic fatty infiltration. The difference in sensitivity of diagnostic modalities may account for the discrepancy in prevalence data for NAFLD. Using aminotransferase levels as a screening laboratory test for liver disease, prevalence of elevated aminotransferases was 7.9% in the United States general population (1988-1992) with unexplained liver disease in 69% of these subjects. In a recent meta-analysis, hepatic ultrasonography allowed for the reliable and accurate detection of moderate-to-severe fatty liver and is now considered the screening modality of choice. Prevalence of ultrasonographic diagnosis of NAFLD ranged between 17% in India to 46% in the United States. The Middle East and South America have the highest NAFLD prevalence at 31% and 32% respectively with the lowest prevalence in Africa at 13.5%. Recently, Asia has been facing the highest obesity epidemic and thus not surprisingly has been experiencing a rapid rate of increase in the prevalence of NAFLD. Chinese adolescents on a westernized diet have a greater than 25% prevalence of NAFLD. Studies from Korea, China, Japan and Taiwan have all reported a prevalence ranging from 11%-45%. Along with the global drift, United States has not been immune to the uptrend in NAFLD. A recent United States-based study using the National Health and Nutrition Examination Surveys (NHANES) conducted between 1988 and 2008 found that the prevalence of NAFLD using elevated alanine aminotransferese (ALT) doubled in the United States during this time period (5.5% to 11.0%). Based on the NHANES-III data collected between 1988 and 1994, the prevalence of ultrasonography-diagnosed NAFLD was 34%. Meta-regression of studies done globally also displayed an increased prevalence of NAFLD from 15% in 2005 to 25% in 2010. The discrepancy in the prevalence of NAFLD among studies is most likely due to differences in sample selection, diagnostic modalities, dietary and lifestyle habits. The current annual medical and societal costs of NAFLD are estimated at $292 billion in the United States. The projected cost of caring for patients is expected to increase by 18% from 2000 to 2035 and health-related quality of life of NAFLD patients is described as declining. NAFLD is a term for a host of histological findings stemming from hepatic steatosis and remains the most common liver disease globally with increasing prevalence. The vast variation in disease presentation complicates diagnosis, leading to an underestimate of actual disease occurrence. NAFLD is associated with many metabolic comorbidities, including obesity, type II diabetes, dyslipidemia, and metabolic syndrome. Its potential to develop into more severe liver conditions, such as nonalcoholic steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma, can lead to a state in which liver transplantation is the only treatment option available. The population at risk of developing progressive liver disease creates a challenge to the healthcare system in terms of screening for this evolving epidemic of liver disease. Further research must be conducted to understand NAFLD pathophysiology and its treatment, as well as, define accurate incidence, current disease burden, and socioeconomic effects of this disease.

• #3

  https://journals.lww.com/hep/fulltext/2024/12000/alcohol_associated_liver_disease_global.4.aspx

  Alcohol-associated liver disease (ALD), as highlighted in this narrative review, is a major public health concern, increasingly impacting global disease burden and premature mortality. In 2019, ALD accounted for the loss of 11 million life-years worldwide. The rising number of deaths and disability-adjusted life-years attributed to ALD, particularly pronounced in the United States, are alarming. Projections suggest that the economic impact of ALD, as seen in the United States, could potentially double by 2040. ALD is increasingly prevalent among younger adults (20-45 y) and has become the leading cause of liver transplantation in both United States and Europe. […] The prevalence of ALD is estimated at 3.5% in the general population, 26.0% among hazardous drinkers, and 55.1% among those with alcohol use disorders. Alarmingly, 5-year mortality rates for patients with ALD exceed 50%, with even higher rates in more advanced disease stages.

• #4 Clinical epidemiology and disease burden of nonalcoholic fatty liver disease

  https://www.wjgnet.com/1007-9327/full/v23/i47/8263.htm

  Nonalcoholic fatty liver disease (NAFLD) has become a common cause of chronic liver disease in the world since its first description in 1980 as the unnamed disease. It has been studied in-depth subsequently with continuous myriad of further investigations being carried into this soon to be common indication for liver transplantation (LT). NAFLD has diverse manifestations described in all ethnicities all over the world and present in both sexes. The variable presentations probably contribute to the underreported new and existing cases of NAFLD as well as the limited studies undertaken to elucidate the exact incidence and prevalence of NAFLD. It is currently estimated that the global prevalence of NAFLD is as high as one billion. In the United States, NAFLD is estimated to be the most common cause of chronic liver disease, affecting between 80 and 100 million individuals, among whom nearly 25% progress to NASH. A study from Japan which followed 3147 patients over 414 d found a 10% annual incidence rate. Another Japanese study evaluated elevated aminotransferase levels, weight gain and insulin resistance development over 5 years to classify patients with NAFLD and their incidence was reported as 31 per 1000 person-years. A retrospective study done in England later demonstrated a much lower incidence of 29 per 100000 person-years. A recent extensive meta-analysis described a pooled regional incidence of NAFLD in Asia and Israel to be 52 per 1000 person-years and 28 per 1000 person-years, respectively. Current data on incidence for NAFLD are limited in some regions of the world due to the limited number of studies. Further studies seem warranted to determine the true incidence in general population. In general, the prevalence of NAFLD has increased over the last 20 years. In addition to the gold standard diagnostic test of liver biopsy, there are some noninvasive modalities available to diagnose NAFLD. Hepatic ultrasonography, computed tomography (CT), and MRI are accepted modalities for detecting hepatic fatty infiltration. The difference in sensitivity of diagnostic modalities may account for the discrepancy in prevalence data for NAFLD. Using aminotransferase levels as a screening laboratory test for liver disease, prevalence of elevated aminotransferases was 7.9% in the United States general population (1988-1992) with unexplained liver disease in 69% of these subjects. In a recent meta-analysis, hepatic ultrasonography allowed for the reliable and accurate detection of moderate-to-severe fatty liver and is now considered the screening modality of choice. Prevalence of ultrasonographic diagnosis of NAFLD ranged between 17% in India to 46% in the United States. The Middle East and South America have the highest NAFLD prevalence at 31% and 32% respectively with the lowest prevalence in Africa at 13.5%. Recently, Asia has been facing the highest obesity epidemic and thus not surprisingly has been experiencing a rapid rate of increase in the prevalence of NAFLD. Chinese adolescents on a westernized diet have a greater than 25% prevalence of NAFLD. Studies from Korea, China, Japan and Taiwan have all reported a prevalence ranging from 11%-45%. Along with the global drift, United States has not been immune to the uptrend in NAFLD. A recent United States-based study using the National Health and Nutrition Examination Surveys (NHANES) conducted between 1988 and 2008 found that the prevalence of NAFLD using elevated alanine aminotransferese (ALT) doubled in the United States during this time period (5.5% to 11.0%). Based on the NHANES-III data collected between 1988 and 1994, the prevalence of ultrasonography-diagnosed NAFLD was 34%. Meta-regression of studies done globally also displayed an increased prevalence of NAFLD from 15% in 2005 to 25% in 2010. The discrepancy in the prevalence of NAFLD among studies is most likely due to differences in sample selection, diagnostic modalities, dietary and lifestyle habits. The current annual medical and societal costs of NAFLD are estimated at $292 billion in the United States. The projected cost of caring for patients is expected to increase by 18% from 2000 to 2035 and health-related quality of life of NAFLD patients is described as declining. NAFLD is a term for a host of histological findings stemming from hepatic steatosis and remains the most common liver disease globally with increasing prevalence. The vast variation in disease presentation complicates diagnosis, leading to an underestimate of actual disease occurrence. NAFLD is associated with many metabolic comorbidities, including obesity, type II diabetes, dyslipidemia, and metabolic syndrome. Its potential to develop into more severe liver conditions, such as nonalcoholic steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma, can lead to a state in which liver transplantation is the only treatment option available. The population at risk of developing progressive liver disease creates a challenge to the healthcare system in terms of screening for this evolving epidemic of liver disease. Further research must be conducted to understand NAFLD pathophysiology and its treatment, as well as, define accurate incidence, current disease burden, and socioeconomic effects of this disease.

Zobacz więcej