Materiały źródłowe

• #1 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?pn=mostcited&uid=1764&vmd=Full

  The ongoing obesity epidemic and the increasing recognition of metabolic syndrome have contributed to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common form of liver disease worldwide. […] It is imperative to understand the incidence and prevalence of NAFLD as it is associated with a profound economic burden of hospitalizations, including the shifting trends in liver transplantation. […] The long-term cumulative healthcare cost of NAFLD patients has been shown to be 80% higher than that of non-NAFLD patients. […] A major limitation in understanding the epidemiology of NAFLD has been the lack of a distinct classification of the disease. […] A systemic review and meta-analysis on the global epidemiology of NAFLD estimated prevalence of NAFLD by imaging to be 25.2% (95% CI, 22.1 to 28.7) with an estimated prevalence of NASH to be lower ranging from 3 to 5%.

• #2 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) […] The authors summarize and update the most recent knowledge in the field of prevalence, natural history and incidence of Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). […] NAFLD is now the most common liver disease in the United States and possibly worldwide. Furthermore, the number of affected patients is growing rapidly, and the disease has reached epidemic proportions. […] NAFLD has also reached epidemic proportions among populations typically considered at low risk for this liver condition, with a prevalence in China and Japan of 15 and 14%, respectively, among adults. […] The prevalence of NAFLD among children is unknown, but some data indicate that 2.6-9.6% of children have NAFLD, increasing up to 38-53% among obese children.

• #3 The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36626630/

  NAFLD is a leading cause of liver-related morbidity and mortality. […] We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.4-33.09), respectively. […] Global NAFLD prevalence increased by +50.4% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019 ( p 0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46-31.87) in 1990-2006 to 34.59% (29.05-40.57) ( p =0.029). […] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). […] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #4

  https://journals.lww.com/hep/fulltext/2023/04000/the_global_epidemiology_of_nonalcoholic_fatty.27.aspx

  NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.43%-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59%-29.33) in 1990-2006 to 38.00% (33.71%-42.49) in 2016-2019 (p<0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46%-31.87) in 1990-2006 to 34.59% (29.05%-40.57) (p=0.029). [...] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). [...] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #5 The global epidemiology of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic… : Falk Foundation

  https://falkfoundation.org/en/fgr/detail/the-global-epidemiology-of-non-alcoholic-fatty-liver-disease-nafld-and-non-alcoholic-steatohepatitis-nash-a-systematic-review/

  Non-alcoholic fatty liver disease (NAFLD) is a leading cause of liver-related morbidity and mortality. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% confidence interval [CI]: 27.88-32.32%) and 30.69% (28.43-33.09%), respectively. […] Global NAFLD prevalence increased by +50.4% from 25.26% (21.59-29.33%) in 1990-2006 to 38.00% (33.71-42.49%) in 2016-2019 (p). […] Non-alcoholic fatty liver disease (NAFLD) global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #6

  https://journals.lww.com/hep/fulltext/2023/04000/the_global_epidemiology_of_nonalcoholic_fatty.27.aspx

  NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.43%-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59%-29.33) in 1990-2006 to 38.00% (33.71%-42.49) in 2016-2019 (p<0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46%-31.87) in 1990-2006 to 34.59% (29.05%-40.57) (p=0.029). [...] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). [...] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #7 Up-to-date global epidemiology of nonalcoholic fatty liver disease – Manikat – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/118927/html

  Nonalcoholic fatty liver disease (NAFLD) is known as the most prevalent cause of chronic liver disease globally, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), which can lead to advanced fibrosis and cirrhosis. The burden of NAFLD is projected to increase over the next decade because of the lack of effective approved medications and continued increases in obesity and diabetes. […] The recent article published by Younossi et al. (1) sheds light on the contemporary health burden of NAFLD. This meta-analysis assessed 92 studies, including over 9 million individuals all over the globe, and reported that NAFLD has a global prevalence of 30.1% [95% confidence interval (CI): 27.932.3%], with a prevalence rising over the three decades [19902019]. Global prevalence of NAFLD increased by 50.4% from 25.3% (95% CI: 21.629.3%) in 19902006 to 38.2% (95% CI: 33.742.9%) in 20162019.

• #8

  https://journals.lww.com/hep/fulltext/2023/04000/the_global_epidemiology_of_nonalcoholic_fatty.27.aspx

  NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.43%-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59%-29.33) in 1990-2006 to 38.00% (33.71%-42.49) in 2016-2019 (p<0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46%-31.87) in 1990-2006 to 34.59% (29.05%-40.57) (p=0.029). [...] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). [...] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #9 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #10

  https://journals.lww.com/hep/fulltext/2023/04000/the_global_epidemiology_of_nonalcoholic_fatty.27.aspx

  NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.43%-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59%-29.33) in 1990-2006 to 38.00% (33.71%-42.49) in 2016-2019 (p<0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46%-31.87) in 1990-2006 to 34.59% (29.05%-40.57) (p=0.029). [...] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). [...] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #11 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #12 Global incidence and prevalence of nonalcoholic fatty liver disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10029957/

  Nonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. The estimated global incidence of NAFLD is 47 cases per 1,000 population and is higher among males than females. The estimated global prevalence of NAFLD among adults is 32% and is higher among males (40%) compared to females (26%). The global prevalence of NAFLD has increased over time, from 26% in studies from 2005 or earlier to 38% in studies from 2016 or beyond. The prevalence of NAFLD varies substantially by world region, contributed by differing rates of obesity, and genetic and socioeconomic factors. The prevalence of NAFLD exceeds 40% in the Americas and South-East Asia. The prevalence of NAFLD is projected to increase significantly in multiple world regions by 2030 if current trends are left unchecked.

• #13 NAFLD incidence is increasing | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-023-00787-y

  A systematic review and meta-analysis of cohort studies from Mainland China, Hong Kong, South Korea, Japan, Sri Lanka and Israel of adults at risk without nonalcoholic fatty liver disease (NAFLD) at baseline (n=1,201,807) evaluated the incidence of ultrasound-diagnosed NAFLD. The incidence rate was estimated at 46.13 (95% CI 3,931.55,294.2) per 1,000 person years and is increasing (median study year 20002016). Individuals with overweight or obesity and smokers had increased incidence rates compared with people with normal weight and nonsmokers (P0.0001 and P=0.046, respectively).

• #14

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #15

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #16 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  NAFLD is more frequent among obese subjects (75%) compared to controls (16%), and among patients with type 2 diabetes (34-74%), whereas it is an almost universal finding in obese patients with type 2 diabetes. […] Recent data indicate a doubling of the prevalence in children: from 2.6% a decade ago to 5% today in normal-weight, and 38% or 48% in obese and diabetic children respectively. […] Overall, a diagnosis of NAFLD is associated with a shorter survival than expected for the general population of the same age and gender, and the higher mortality is mainly due to cardiovascular disease (CVD). […] The incidence of NAFLD remains unknown because no prospective studies have been conducted. […] NAFLD has become a common diagnosis in clinical practice of several medical specialties, and its prevalence in the general population is increasing together with obesity, type 2 diabetes and the metabolic syndrome.

• #17 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #18 Metabolic dysfunction–associated steatotic liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease

  For severely obese individuals, the prevalence of MASLD rises over 90%, and for those with diabetes, over 60%, and up to 20% for normal-weight people. […] MASLD is present in 65% to 90% of people who had bariatric surgery, and up to 75% of them have MASH. […] Ultrasonography and proton NMR spectroscopy studies suggest about 25% of the population seems to be affected by MASLD or MASH. […] Although the disease is commonly associated with obesity, a significant proportion of those affected are normal weight or lean. […] Lean MASLD affects between 10 and 20% of Americans and Europeans, and approximately 25% of Asians, although some countries have a higher incidence (e.g., India has a very high proportion of lean MASLD and almost no obese MASLD). […] NAFLD prevalence is expected to increase steadily, from 25% in 2018 to a projected 33.5% of people with MASLD globally in 2030, and from 20% to a projected 27% of those with MASLD will progress to MASH.

• #19 Metabolic dysfunction–associated steatotic liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease

  For severely obese individuals, the prevalence of MASLD rises over 90%, and for those with diabetes, over 60%, and up to 20% for normal-weight people. […] MASLD is present in 65% to 90% of people who had bariatric surgery, and up to 75% of them have MASH. […] Ultrasonography and proton NMR spectroscopy studies suggest about 25% of the population seems to be affected by MASLD or MASH. […] Although the disease is commonly associated with obesity, a significant proportion of those affected are normal weight or lean. […] Lean MASLD affects between 10 and 20% of Americans and Europeans, and approximately 25% of Asians, although some countries have a higher incidence (e.g., India has a very high proportion of lean MASLD and almost no obese MASLD). […] NAFLD prevalence is expected to increase steadily, from 25% in 2018 to a projected 33.5% of people with MASLD globally in 2030, and from 20% to a projected 27% of those with MASLD will progress to MASH.

• #20 Fatty Liver: Overview, Etiology, Epidemiology

  https://emedicine.medscape.com/article/175472-overview

  NAFLD was the most common etiology of chronic liver disease and of cirrhosis among all the groups; however, the most common causes of cirrhosis by ethnicity were NAFLD in Japanese Americans, Native Hawaiians, and Latinos; ALD in white persons; and hepatitis C in black persons. […] Fatty liver has been found across all races, but NAFLD is most common in white persons, and it is in this population that most of the research has been done. […] NAFLD can be prevented in most patients by taking the following measures: Eating appropriate portions, Eating healthy choices, Exercising regularly.

• #21 Metabolic dysfunction–associated steatotic liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease

  MASLD incidence is rapidly rising, along with obesity and diabetes, and has become the most common cause of liver disease in developed countries, for adults, teenagers, and children. […] The percentage of people with MASLD ranges from 9 to 36.9% in different parts of the world. […] Approximately 20% of the United States and 25% of the Asia-Pacific populations have non-alcoholic fatty liver. […] MASLD is the most common in the Middle East (32%) and South America (30%), while Africa has the lowest rates (13%). […] Compared to the 2000s, NAFL and NASH respectively increased 2-fold and 2.5-fold in the 2010s in the USA. […] MASLD and NASH are more prevalent in Hispanics – which can be attributed to high rates of obesity and type 2 diabetes in Hispanic populations, intermediate in Whites, and lowest in Blacks.

• #22 Marshall Digital Scholar

  https://mds.marshall.edu/int_med/63/

  Background: Non-alcoholic fatty liver disease (NAFLD) is a clinical syndrome predicted to be the next global epidemic affecting millions of people worldwide. The natural course of this disease including its subtype, non-alcoholic steatohepatitis (NASH), is not clearly defined especially in the African-American segment of the US population. […] Aims: To conduct a review of the global epidemiology of NAFLD with emphasis on US minority populations. […] Results: NAFLD and its subtype NASH are becoming the principal cause of chronic liver disease across the world. In the US, Hispanics are the most disproportionately affected ethnic group with hepatic steatosis, and elevated aminotransferase levels, whereas African-Americans are the least affected. Genetic disparities involved in lipid metabolism seem to be the leading explanation for the lowest incidence and prevalence of both NAFLD and NASH in African-Americans.

• #23 Epidemiology of Alcoholic Liver Disease and Non-Alcoholic Fatty Liver Disease. How to Differentiate Between Them and Their Implications for Cardiovascular Risk – European Medical Journal

  https://www.emjreviews.com/gastroenterology/abstract/epidemiology-of-alcoholic-liver-disease-and-non-alcoholic-fatty-liver-disease-how-to-differentiate-between-them-and-their-implications-for-cardiovascular-risk/

  Fatty liver disease encompasses a spectrum of diseases, including alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), one type of which is non-alcoholic steatohepatitis (NASH). […] The prevalence of NAFLD worldwide is estimated to be 25.2%, the highest being in the Middle East and the lowest being in Africa, which could be related to the nutritional and physical activity status in these areas. […] NAFLD incidence is more frequent in males, increases with age, and increases in the presence of a metabolic syndrome, such as hypertension, obesity, or dyslipidemia. […] Recently, two variants of the genes PNPLA3 and TM6SF2 were found to have a strong effect on the risk and severity of NAFLD and ALD. […] NAFLD is linked to an increased risk of cardiovascular disease; several studies have demonstrated that the major cause of death in patients with NAFLD is cardiovascular related, including a recent meta-analysis of 8 studies, as well as a 26-year long-term study that reported 43% of deaths of NAFLD patients was due to cardiovascular disease.

• #24 Genetic and metabolic aspects of non-alcoholic fatty liver disease (NAFLD) pathogenicity | Egyptian Journal of Medical Human Genetics | Full Text

  https://jmhg.springeropen.com/articles/10.1186/s43042-023-00433-x

  Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease showing a rising prevalence globally. […] Recent evidences suggest that there is a strong genetic contribution toward susceptibility to NAFLD and its severity. […] As reported in many studies, the PNPLA3rs738409 variant seems to be significantly associated with NAFLD susceptibility. […] Other gene variants like TM6SF2rs58542926, MBOAT7rs641738 and GCKR variants also appear to be more prevalent among NAFLD patients. […] The genetic background of NAFLD is being widely investigated to identify pathogenic gene variants that may predispose to such conditions. […] Various studies were designed addressing candidate genes which may have some role in NAFLD pathogenicity. […] Studies revealing gene variants associated with NAFLD are important in developing noninvasive biomarkers for disease prediction, detection and monitoring prognosis.

• #25 Metabolic dysfunction–associated steatotic liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease

  For severely obese individuals, the prevalence of MASLD rises over 90%, and for those with diabetes, over 60%, and up to 20% for normal-weight people. […] MASLD is present in 65% to 90% of people who had bariatric surgery, and up to 75% of them have MASH. […] Ultrasonography and proton NMR spectroscopy studies suggest about 25% of the population seems to be affected by MASLD or MASH. […] Although the disease is commonly associated with obesity, a significant proportion of those affected are normal weight or lean. […] Lean MASLD affects between 10 and 20% of Americans and Europeans, and approximately 25% of Asians, although some countries have a higher incidence (e.g., India has a very high proportion of lean MASLD and almost no obese MASLD). […] NAFLD prevalence is expected to increase steadily, from 25% in 2018 to a projected 33.5% of people with MASLD globally in 2030, and from 20% to a projected 27% of those with MASLD will progress to MASH.

• #26 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5499/html_2

  NAFLD prevalence is showing a fairly steady upslope in most of the populations over time in the last two decades. […] NAFLD subjects are almost always obese and obese people have increased prevalence of NAFLD, underscoring the tight pathogenic connection between them. […] Insulin resistance of varying degree is considered to be the critical cellular abnormality that underlie both NAFLD and type 2 diabetes. […] NAFLD and aging are strongly correlated and increasing age is one of the most robust epidemiological factors for NAFLD, NASH and fibrosis. […] Racial differences in prevalence of NAFLD have been most evident in the studies from USA that involved multiethnic populations. […] It is now largely considered that the prevalence of obesity and NAFLD in children as well as adolescents is increasing fast, not only in the western population but also in Asia.

• #27 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

  Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals […] Experts provide 15 best practices for the diagnosis and treatment of lean individuals with NAFLD. […] 1. Lean NAFLD should be diagnosed in individuals with NAFLD and body mass index <25 kg/m2 (non-Asian race) or body mass index <23 kg/m2 (Asian race). [...] 2. Lean individuals with NAFLD should be evaluated routinely for comorbid conditions, such as type 2 diabetes mellitus, dyslipidemia and hypertension. [...] 3. Lean individuals with NAFLD should be risk stratified for hepatic fibrosis to identify those with advanced fibrosis or cirrhosis. [...] 4. Lean individuals in the general population should not undergo routine screening for NAFLD; however, screening should be considered for individuals older than 40 years with type 2 diabetes mellitus.

• #28 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

  Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals […] Experts provide 15 best practices for the diagnosis and treatment of lean individuals with NAFLD. […] 1. Lean NAFLD should be diagnosed in individuals with NAFLD and body mass index <25 kg/m2 (non-Asian race) or body mass index <23 kg/m2 (Asian race). [...] 2. Lean individuals with NAFLD should be evaluated routinely for comorbid conditions, such as type 2 diabetes mellitus, dyslipidemia and hypertension. [...] 3. Lean individuals with NAFLD should be risk stratified for hepatic fibrosis to identify those with advanced fibrosis or cirrhosis. [...] 4. Lean individuals in the general population should not undergo routine screening for NAFLD; however, screening should be considered for individuals older than 40 years with type 2 diabetes mellitus.

• #29 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

  5. NAFLD should be considered in lean individuals with metabolic diseases (such as type 2 diabetes mellitus, dyslipidemia and hypertension), elevated liver biochemical tests or incidentally noted hepatic steatosis. […] 6. Clinicians should query patients routinely regarding alcohol consumption patterns in all patients with lean NAFLD. […] 7. In patients with lean NAFLD, other causes of liver disease should be ruled out, including other causes of fatty liver, such as HIV, lipodystrophy, lysosomal acid lipase deficiency, familial hypobetalipoproteinemia and medication-induced hepatic steatosis (methotrexate, amiodarone, tamoxifen and steroids). […] 8. Current evidence is inadequate to support routine testing for genetic variants in patients with lean NAFLD. […] 9. Liver biopsy, as the reference standard, should be considered if there is uncertainty regarding contributing causes of liver injury and/or the stage of liver fibrosis.

• #30 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) […] The authors summarize and update the most recent knowledge in the field of prevalence, natural history and incidence of Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). […] NAFLD is now the most common liver disease in the United States and possibly worldwide. Furthermore, the number of affected patients is growing rapidly, and the disease has reached epidemic proportions. […] NAFLD has also reached epidemic proportions among populations typically considered at low risk for this liver condition, with a prevalence in China and Japan of 15 and 14%, respectively, among adults. […] The prevalence of NAFLD among children is unknown, but some data indicate that 2.6-9.6% of children have NAFLD, increasing up to 38-53% among obese children.

• #31 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #32 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  NAFLD is more frequent among obese subjects (75%) compared to controls (16%), and among patients with type 2 diabetes (34-74%), whereas it is an almost universal finding in obese patients with type 2 diabetes. […] Recent data indicate a doubling of the prevalence in children: from 2.6% a decade ago to 5% today in normal-weight, and 38% or 48% in obese and diabetic children respectively. […] Overall, a diagnosis of NAFLD is associated with a shorter survival than expected for the general population of the same age and gender, and the higher mortality is mainly due to cardiovascular disease (CVD). […] The incidence of NAFLD remains unknown because no prospective studies have been conducted. […] NAFLD has become a common diagnosis in clinical practice of several medical specialties, and its prevalence in the general population is increasing together with obesity, type 2 diabetes and the metabolic syndrome.

• #33 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #34 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  NAFLD is more frequent among obese subjects (75%) compared to controls (16%), and among patients with type 2 diabetes (34-74%), whereas it is an almost universal finding in obese patients with type 2 diabetes. […] Recent data indicate a doubling of the prevalence in children: from 2.6% a decade ago to 5% today in normal-weight, and 38% or 48% in obese and diabetic children respectively. […] Overall, a diagnosis of NAFLD is associated with a shorter survival than expected for the general population of the same age and gender, and the higher mortality is mainly due to cardiovascular disease (CVD). […] The incidence of NAFLD remains unknown because no prospective studies have been conducted. […] NAFLD has become a common diagnosis in clinical practice of several medical specialties, and its prevalence in the general population is increasing together with obesity, type 2 diabetes and the metabolic syndrome.

• #35 Epidemiology and lifestyle survey of non-alcoholic fatty liver disease in school-age children and adolescents in Shenyang, Liaoning | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03351-w

  Non-alcoholic fatty liver disease (NAFLD) is diagnosed increasingly in children and adolescents. We aimed to investigate the prevalence and related influencing factors of NAFLD in school-aged children and adolescents in Shenyang, Liaoning Province. Furthermore, we analyzed the relationship between lifestyle and fatty liver. […] NAFLD was present in 23.83% of subjects. The prevalence of children and adolescents was 22.73% and 24.43%, respectively. Fatty liver prevalence differs significantly by gender and learning stages. The highest rate of fatty liver was seen in obese children (71.68%). Moreover, exercise, diet, and parental factors can affect children with fatty liver. […] NAFLD is very prevalent in children and adolescents in Shenyang city. Due to the close relationship between NAFLD and obesity, lifestyle plays a major role in the occurrence of NAFLD.

• #36 Epidemiology and lifestyle survey of non-alcoholic fatty liver disease in school-age children and adolescents in Shenyang, Liaoning | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03351-w

  We found that boys showed a higher prevalence of NAFLD than girls did, and this conclusion is the same as that of most studies. The prevalence of severe fatty liver increased significantly as the rise of the learning stage. This result indicates that senior high school students have a higher risk of severe fatty liver. […] Through questionnaires, our study confirmed that NAFLD was closely related to lifestyle habits and parental factors. A larger amount of data are needed to more thoroughly explore the prevalence of NAFLD and lifestyle in children and adolescents in Shenyang.

• #37 The Epidemiology, Risk Profiling and Diagnostic Challenges of Nonalcoholic Fatty Liver Disease

  https://www.mdpi.com/2305-6320/6/1/41

  Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver damage from the more prevalent (75%–80%) and nonprogressive nonalcoholic fatty liver (NAFL) category to its less common and more ominous subset, nonalcoholic steatohepatitis (NASH). NAFLD is now the most common cause of chronic liver disease in the developed world and is a leading indication for liver transplantation in United States (US). The global prevalence of NAFLD is estimated to be 25%, with the lowest prevalence in Africa (13.5%) and highest in the Middle East (31.8%) and South America (30.4%). The increasing incidence of NAFLD has been associated with the global obesity epidemic and manifestation of metabolic complications, including hypertension, diabetes, and dyslipidemia. […] The US population has seen a similar trend with the National Health and Nutrition Examination Survey (NHANES), demonstrating a doubling in the prevalence of NAFLD in the US from 5.5% (1988–1994) to 11% (2005–2008). In a study using the fatty liver index to diagnose NAFLD, the prevalence of NAFLD increased from 18% in 1988–1991 to 31% in 2011–2012.

• #38 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) is defined as the presence of hepatic fat accumulation after the exclusion of other causes of hepatic steatosis, including other causes of liver disease, excessive alcohol consumption, and other conditions that may lead to hepatic steatosis. NAFLD encompasses a broad clinical spectrum ranging from nonalcoholic fatty liver to nonalcoholic steatohepatitis (NASH), advanced fibrosis, cirrhosis, and finally hepatocellular carcinoma (HCC). NAFLD is the most common liver disease in the world and NASH may soon become the most common indication for liver transplantation. Ongoing persistence of obesity with increasing rate of diabetes will increase the prevalence of NAFLD, and as this population ages, many will develop cirrhosis and end-stage liver disease. […] There has been a general increase in the prevalence of NAFLD, with Asia leading the rise, yet the United States is following closely behind with a rising prevalence from 15% in 2005 to 25% within 5 years. NAFLD is commonly associated with metabolic comorbidities, including obesity, type II diabetes, dyslipidemia, and metabolic syndrome. Our understanding of the pathophysiology of NAFLD is constantly evolving. Based on NAFLD subtypes, it has the potential to progress into advanced fibrosis, end-stage liver disease and HCC. The increasing prevalence of NAFLD with advanced fibrosis, is concerning because patients appear to experience higher liver-related and non-liver-related mortality than the general population. The increased morbidity and mortality, healthcare costs and declining health related quality of life associated with NAFLD makes it a formidable disease, and one that requires more in-depth analysis.

• #39 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  Over the past two decades, one of the key issues has been the variations in the reported prevalence of NAFLD, with differences arising out of geography, ethnicity, type of population studied, reporting, selection bias, and lack of uniformity in definitions. Albeit, the exponential evolution is reflected in the temporal change in NAFLD prevalence, which has increased by more than 50% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019. The prevalence varies geographically, with the highest pooled prevalence being in Latin America (44.3%), followed by the Middle East and North Africa (MENA) (36.5%), South Asia (33.8%), Southeast Asia (33.1%), North America (31.2%,), East Asia (29.71%), Asia Pacific (28.0%), Western Europe (25.1%). In sync with the prevalence of NAFLD, the global prevalence of non-alcoholic steatohepatitis (NASH) is estimated to be 5.27%, with the highest prevalence being in Latin America (7.1%), followed by MENA (5.8%), South Asia (5.4%), Southeast Asia (5.3%), North America (5.0%), East Asia (4.7%) Asia Pacific (4.5%) and Western Europe (4.02%). When we look at subgroups, the prevalence of NAFLD goes up to 40%-60% in overweight and obese subjects and around 10% in lean subjects, with lean NAFLD being higher in Asians. NAFLD in people with diabetes appears to be most worrisome, with an overall global prevalence of 55.5% (95% CI 47.3-63.7) 37.3%, and 17% prevalence of NASH and advanced fibrosis, respectively. Lastly, beyond the adult population, NAFLD has also emerged as a growing problem associated with the pediatric population, with an overall pooled prevalence of 7.6%, which alarmingly increases to 34% in subjects with pediatric obesity.

• #40 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Approximately 10-30% have the potentially progressive form of NAFLD, non-alcoholic steatohepatitis (NASH), which is associated with hepatocellular injury and inflammation. […] The development of cirrhosis due to NASH is associated with a poor long-term prognosis. […] In addition, subjects with NASH cirrhosis are at significant risk of developing hepatocellular carcinoma (2.6% per year). […] All NAFLD patients should be advised to lose weight (by diet and exercise) and modify their metabolic risk factors. […] NAFLD is very common and the majority of patients have mild disease, but patients with advanced NASH need to be identified to offer treatment and surveillance for liver-related complications. […] Accurate diagnosis and staging is important in determining the appropriate long-term management for patients with NAFLD.

• #41 The epidemiology of non-alcoholic steatohepatitis (NASH) in the United States between 2010-2020: a population-based study | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-the-epidemiology-non-alcoholic-steatohepatitis-nash–S1665268122000692

  The annual prevalence rate has significantly increased from 1.51% in 2010 to 2.79% in 2020. […] Caucasian were found to have higher odds of having NASH in comparison with non-Caucasian. […] NASH is strongly associated with DM and Obesity. […] The prevalence of NASH in diabetes mellitus is 22%. […] In conclusion, in the past decade, the prevalence of NASH has increased by almost 100%. NASH disproportionately affects Caucasians, males, people aged 50-70, and individuals with diabetes, obesity, dyslipidemia, and hypertension. The rising prevalence of metabolic syndrome in the United States is expected to further contribute to the burden of liver disease, notably NASH and its complications such as cirrhosis, hepatocellular carcinoma, and the need for a liver transplant.

• #42 Nonalcoholic Fatty Liver Disease | Cleveland Clinic

  https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/nonalcoholic-fatty-liver-disease

  While the majority of patients with NAFLD have simple steatosis, 4% develop NASH over at least 10 years. An average of 3% – 6% of patients with NAFLD have NASH, and 22% of patients with NASH progress to cirrhosis over at least a 10-year period. It is also reported that up to 5% of patients with NASH may spontaneously regress over time. In patients with T2D, 37% have NASH and 17% – have advanced fibrosis on liver biopsy. In patients with incidentally discovered steatosis, 11% might be at high risk for advanced hepatic fibrosis. […] The estimated annual incidence of HCC in NASH cirrhosis ranges between 0.5% – 2.6%, and between 0.1 – 1.3 per 1000 person-year in non-cirrhotic individuals. Although these numbers may appear small, the absolute numbers are important considering the prevalence of the disease.

• #43 Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1115/p603.html

  A liver biopsy should be offered to patients with NAFLD who are at increased risk of nonalcoholic steatohepatitis or advanced fibrosis based on noninvasive testing or if noninvasive testing cannot rule out other possible causes of chronic liver disease. […] Weight loss through diet and exercise is the primary treatment for NAFLD. […] There is insufficient evidence to support bariatric surgery, vitamin supplements, thiazolidinediones (pioglitazone [Actos]), and glucagon-like peptide-1 analogues (liraglutide [Victoza]) as first-line/primary treatments for NAFLD. […] Most patients with NAFL will have a benign, nonprogressive disease course. Only 20% develop NASH, and 20% of those with NASH develop cirrhosis. […] Patients with a higher degree of fibrosis have a higher risk of death, mainly from cardiovascular disease, cancer, and end-stage liver disease. […] Referral to gastroenterology should be considered in patients who have a high likelihood of NASH fibrosis because of the presence of metabolic syndrome or type 2 diabetes.

• #44 Nonalcoholic fatty liver disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567

  Nonalcoholic fatty liver disease, often called NAFLD, is a liver problem that affects people who drink little to no alcohol. In NAFLD, too much fat builds up in the liver. It is seen most often in people who are overweight or obese. […] NAFLD is becoming more common, especially in Middle Eastern and Western nations as the number of people with obesity rises. It is the most common form of liver disease in the world. NAFLD ranges in severity from hepatic steatosis, called fatty liver, to a more severe form of disease called nonalcoholic steatohepatitis (NASH). […] Experts guess that about 24% of adults in the U.S. have NAFLD, and about 1.5% to 6.5% have NASH. […] It is hard to tell apart NAFLD from NASH without a clinical evaluation and testing. […] Many diseases and health problems can increase your risk of NAFLD, including family history of fatty liver disease or obesity, growth hormone deficiency, high cholesterol, high levels of triglycerides in the blood, insulin resistance, metabolic syndrome, obesity, especially when fat is centered in the waist, polycystic ovary syndrome, obstructive sleep apnea, type 2 diabetes, underactive thyroid, and underactive pituitary gland. […] NASH is more likely in these groups: people older than 50, people with certain genetic risk factors, people with obesity, people with diabetes or high blood sugar, and people with symptoms of metabolic syndrome, such as high blood pressure, high triglycerides, and a large waist size.

• #45 Non-alcoholic fatty liver disease-related hepatocellular carcinoma

  https://www.e-jlc.org/journal/view.php?number=514

  Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). […] NAFLD currently accounts for approximately 20% of HCC, although this is anticipated to increase in most countries over the next decade. […] The prevalence of NAFLD is highest in North America and Europe, with nearly one-third of people having NAFLD, including 64 million people in the United States. […] Patients with NASH cirrhosis have an annual HCC incidence of 1-2%, although more than one-fourth of NASH-related HCC occur without underlying cirrhosis. […] The incidence of HCC in NAFLD patients without cirrhosis is approximately 23-46 per 100,000 patient-years. […] Although cirrhosis is the strongest risk factor for HCC in those with NAFLD, there is a wide variation in HCC risk between patients.

• #46

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #47 Recent Epidemiology and Risk Factors of Nonalcoholic Fatty Liver Disease

  https://www.jomes.org/journal/view.html?doi=10.7570/jomes22021

  The annual incidence of HCC in NAFLD patients was 0.44 per 1,000 person-years. The incidence of HCC due to NAFLD is also on the rise. […] According to a meta-analysis of cohort studies on NAFLD, pooled liver-specific and overall mortality rates were 0.77 per 1,000 person-years and 15.44 per 1,000 person-years, respectively. […] The prevalence of NAFLD was 4-fold higher in individuals with metabolic syndrome than those without it, and the presence of multiple traits of metabolic syndrome was associated with a higher likelihood of more severe liver disease. […] NAFLD is the most common chronic liver disease with an increasing prevalence globally. Various risk factors such as genetic predisposition and health-related behaviors are associated with the incidence and progression of NAFLD.

• #48 Non-alcoholic fatty liver disease-related hepatocellular carcinoma

  https://www.e-jlc.org/journal/view.php?number=514

  Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). […] NAFLD currently accounts for approximately 20% of HCC, although this is anticipated to increase in most countries over the next decade. […] The prevalence of NAFLD is highest in North America and Europe, with nearly one-third of people having NAFLD, including 64 million people in the United States. […] Patients with NASH cirrhosis have an annual HCC incidence of 1-2%, although more than one-fourth of NASH-related HCC occur without underlying cirrhosis. […] The incidence of HCC in NAFLD patients without cirrhosis is approximately 23-46 per 100,000 patient-years. […] Although cirrhosis is the strongest risk factor for HCC in those with NAFLD, there is a wide variation in HCC risk between patients.

• #49 Non-alcoholic fatty liver disease-related hepatocellular carcinoma

  https://www.e-jlc.org/journal/view.php?number=514

  HCC risk factors among those with NAFLD include older age, male sex, Hispanic ethnicity, and metabolic syndrome features like diabetes, obesity, and dyslipidemia. […] Data from European and USA real-world studies with 18 million patients identified diabetes as the strongest independent metabolic risk factor for HCC. […] Clinical risk calculators have been proposed to help stratify NAFLD patients into high- and low-risk groups. […] Most risk calculators have been evaluated among patients with NAFLD cirrhosis and similar work is needed to identify high-risk patients with non-cirrhotic NAFLD who may benefit from surveillance. […] The NAFLD patient population presents unique challenges for HCC surveillance and necessitates novel potential solutions. […] Although patients with NASH-related cirrhosis have a lower annual HCC incidence than those with viral-related cirrhosis, their risk exceeds 1% per year and HCC surveillance remains cost-effective.

• #50 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?pn=mostcited&uid=1764&vmd=Full

  The ongoing obesity epidemic and the increasing recognition of metabolic syndrome have contributed to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common form of liver disease worldwide. […] It is imperative to understand the incidence and prevalence of NAFLD as it is associated with a profound economic burden of hospitalizations, including the shifting trends in liver transplantation. […] The long-term cumulative healthcare cost of NAFLD patients has been shown to be 80% higher than that of non-NAFLD patients. […] A major limitation in understanding the epidemiology of NAFLD has been the lack of a distinct classification of the disease. […] A systemic review and meta-analysis on the global epidemiology of NAFLD estimated prevalence of NAFLD by imaging to be 25.2% (95% CI, 22.1 to 28.7) with an estimated prevalence of NASH to be lower ranging from 3 to 5%.

• #51

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #52

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

• #53 Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173499

  In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 19881994. […] Our goal was to determine the NAFLD prevalence in the recent 19992012 NHANES, risk factors for advanced fibrosis (stage 34) and mortality. […] In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. […] Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). […] NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.935.08, p0.001).

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

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

  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. […] In general, the prevalence of NAFLD has increased over the last 20 years. […] 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%. […] 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%). […] Meta-regression of studies done globally also displayed an increased prevalence of NAFLD from 15% in 2005 to 25% in 2010. […] 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.

• #55 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?pn=mostcited&uid=1764&vmd=Full

  The ongoing obesity epidemic and the increasing recognition of metabolic syndrome have contributed to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common form of liver disease worldwide. […] It is imperative to understand the incidence and prevalence of NAFLD as it is associated with a profound economic burden of hospitalizations, including the shifting trends in liver transplantation. […] The long-term cumulative healthcare cost of NAFLD patients has been shown to be 80% higher than that of non-NAFLD patients. […] A major limitation in understanding the epidemiology of NAFLD has been the lack of a distinct classification of the disease. […] A systemic review and meta-analysis on the global epidemiology of NAFLD estimated prevalence of NAFLD by imaging to be 25.2% (95% CI, 22.1 to 28.7) with an estimated prevalence of NASH to be lower ranging from 3 to 5%.

• #56 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl20127

  Based on the United States (US) Third National Health and Nutrition Examination Survey (NHANES III), an extensive representative survey of the US civilian population, the prevalence of NAFLD by ultrasonography is estimated to be 34.0% in the US. […] The burden of NAFLD on healthcare costs and resource utilization remains significant nowadays. […] A study based on real-world data from a US medical claims determined that the long-term cumulative healthcare cost of NAFLD is 80% higher than that of a non-NAFLD of similar age and metabolic comorbidities. […] Even though the prevalence of NAFLD is already 30% and projected to increase substantially, there is no clear consensus currently on the most cost-effective to identify the approximately 100 million NAFLD patients in the US general population that will progress to the 1.5% who experience fibrosis and cirrhosis. […] This review summarizes the worldwide incidence and prevalence of NAFLD, discusses diagnostic nuances in determining subjects with NAFLD who progress to cirrhosis, and quantifies downstream impacts on the healthcare economy in the context of all-cause and cause-specific mortality.

• #57 Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1115/p603.html

  Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States, affecting up to 30% of adults. […] Individuals with obesity are at highest risk of NAFLD. Other established risk factors include metabolic syndrome and type 2 diabetes mellitus. […] Although NAFLD is common and typically asymptomatic, screening is not currently recommended, even in high-risk patients. […] It is projected that 100 million people in the United States will have nonalcoholic fatty liver disease by 2030, with direct medical costs of about $103 billion annually. […] By 2030, nonalcoholic steatohepatitis is predicted to become the leading indication for liver transplantation in U.S. adults, surpassing hepatitis C. […] NAFLD is the most common form of liver disease in the United States and other developed countries, with rates in the adult population estimated to be between 10% and 30%.

• #58 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  More specifically, HCC incidence in NAFLD was 0.03 and 3.78 per 100 person-years, respectively, for those without and with cirrhosis, according to a meta-analysis that included 470,404 patients from 18 studies. […] According to the United Network for Organ Sharing registry, NAFLD is the most rapidly growing etiology of HCC-related liver transplant, and the number of NAFLD patients undergoing liver transplantation for HCC nearly quadrupled from 2002 to 2012 based on a study of 61,868 liver transplant patients, including 10,061 patients with HCC, in the United States. […] The incidence of HCC in NAFLD patients with cirrhosis is ~1 per 100 person-years. […] Although HCC incidence in NAFLD cirrhosis is lower or comparable compared to that of hepatitis C virus (HCV) or alcoholic cirrhosis, respectively, NAFLD and its high prevalence contribute to a greater global burden of HCC compared to other chronic liver disease etiologies.

• #59 Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

  https://www.mdpi.com/2075-4418/10/8/579

  Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of hepatocellular carcinoma (HCC), liver-related mortality, and liver transplantation. There is sufficient epidemiological cohort data to recommend the surveillance of patients with NAFLD based upon the incidence of HCC. The American Gastroenterology Association (AGA) expert review published in 2020 recommends that NAFLD patients with cirrhosis or advanced fibrosis estimated by non-invasive tests (NITs) consider HCC surveillance. […] NAFLD affects about 25% of adults, but about 25% (6.7%–59%) transition to NASH, 25% of whom develop cirrhosis. […] Although it is clear that NAFLD portends a lower risk for HCC than HBV or HCV, the high prevalence of NAFLD in the population underlies the importance of NAFLD in the development of HCC.

• #60 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Furthermore, NAFLD has been shown to develop in approximately 10%-20% of non-obese [body mass index (BMI) 30 kg/m2] or lean (BMI 25 kg/m2) Americans, for whom clinical suspicion for and timely diagnosis of HCC may remain low. […] However, prevalence rates of HCC in lean NAFLD have yet to be investigated. […] Surveillance for HCC remains suboptimal in NAFLD, as 51.5% of NASH cirrhotic fail to undergo any screening before the diagnosis of HCC, compared with 25.9% of HCV cirrhotics. […] This may be due in part to the fact that NAFLD and HCC can often be clinically silent, especially in the early stages, and patients may therefore never consult the doctor. […] Currently, the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) recommend surveillance for HCC for NAFLD patients with cirrhosis regardless of compensation or decompensation, which is cost-effective given that the predicted HCC incidence remains 1.5% annually.

• #61 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Recommendations for HCC surveillance in those without cirrhosis remain controversial. […] Both EASL guidelines and the American Gastroenterological Association (AGA) Clinical Practice Update recommend surveilling for HCC in those with advanced fibrosis, defined as fibrosis stage 3 or higher (F 3). […] Additionally, AASLD guidance advises against screening for HCC in those with advanced fibrosis, considering the need for additional cost-effectiveness studies. […] In the absence of advanced fibrosis, AASLD and AGA clinical practice guidance recommend against routine HCC screening, whereas EASL states that this remains unclear given the known possibility of HCC occurrence in NAFLD patients without advanced fibrosis. […] Factors such as genetics may play a role in the pathophysiology of HCC in NAFLD without advanced fibrosis or cirrhosis.

• #62 MASLD, NAFLD and fatty liver disease – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/masld-nafld-and-fatty-liver-disease/

  Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated to affect up to 1 in 5 people in the UK. Rates are increasing with rising levels of obesity. […] MASLD, also known as NAFLD, is estimated to affect up to 1 in 5 people in the UK. Rates are increasing with rising levels of obesity. […] The amount of scarring (fibrosis) in your liver is the main sign of how advanced your MASLD is. […] It is very important that the amount of scarring in your liver is tested as part of your MASLD or NAFLD diagnosis. This is the main sign of how advanced your liver disease is. […] People with cirrhosis should be offered scans to check for liver cancer every 6 months. This is called surveillance.

• #63 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

  13. Administration of vitamin E may be considered in lean persons with biopsy-confirmed nonalcoholic steatohepatitis, but without type 2 diabetes mellitus or cirrhosis. Oral pioglitazone 30 mg daily may be considered in lean persons with biopsy-confirmed nonalcoholic steatohepatitis without cirrhosis. […] 14. The therapeutic role of glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors in the management of lean NAFLD is not fully defined and requires further investigation. […] 15. Hepatocellular carcinoma surveillance with abdominal ultrasound with or without serum α-fetoprotein twice per year is suggested in patients with lean NAFLD and clinical markers compatible with liver cirrhosis.

• #64 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Given the drawbacks of percutaneous liver biopsy and the vast array of available non-invasive testing, advanced fibrosis for which HCC surveillance can be considered in NAFLD may be determined via concordance from 2 non-invasive tests (1 serum-based, 1 imaging-based), based on the AGA Clinical Practice Update. […] However, this guidance is limited in that these NAFLD patients with advanced fibrosis may have a HCC risk that is less than the proposed 1.5% deemed optimal for cost-effectiveness. […] As such, utilizing higher thresholds with 90% specificity for HCC surveillance is recommended by the AGA. […] Both EASL and AASLD recommend biannual ultrasonography (US) with or without serum -fetoprotein (AFP) levels for NAFLD patients meeting the aforementioned recommended eligibility criteria for HCC screening.

• #65 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide and is an umbrella term for liver disease encompassing non-alcoholic steatohepatitis (NASH), advanced fibrosis, cirrhosis, and/or hepatocellular carcinoma (HCC). […] The burden of NAFLD is rapidly mounting alongside rising rates of metabolic syndrome and obesity, and NAFLD is projected to become the leading cause of HCC in the United States. […] Among the NAFLDs global burden, HCC surveillance in patients with NAFLD is challenging given the drawbacks of specific screening modalities and the well-recognized potential for HCC development in those without cirrhosis and even in those with lean NAFLD. […] Using the National Veterans Affairs system, a retrospective cohort study of 296,707 NAFLD patients found that the overall mean risk of HCC in NAFLD was 1.06% annually in the United States.

• #66 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Up to 40% of HCC cases can develop in NAFLD patients without cirrhosis, and NAFLD represents the most common cause of HCC in those without cirrhosis, accounting for 26.3% of 605 HCC cases without cirrhosis compared to 13.4% of 4539 of HCC cases with cirrhosis. […] In the NAFLD spectrum, HCC incidence in patients with uncomplicated steatosis is estimated to be approximately 0.8-6.2 per 100 person-years, but is poorly reported in NASH due to its invasive histological nature. […] However, it is reasonable to approximate the incidence of HCC in NASH to the median prevalence of simple steatosis and cirrhosis. […] The pathophysiology of NAFLD may therefore independently contribute to the development of HCC regardless of fibrosis stage and brings up key challenges regarding screening for HCC.

• #67 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Up to 40% of HCC cases can develop in NAFLD patients without cirrhosis, and NAFLD represents the most common cause of HCC in those without cirrhosis, accounting for 26.3% of 605 HCC cases without cirrhosis compared to 13.4% of 4539 of HCC cases with cirrhosis. […] In the NAFLD spectrum, HCC incidence in patients with uncomplicated steatosis is estimated to be approximately 0.8-6.2 per 100 person-years, but is poorly reported in NASH due to its invasive histological nature. […] However, it is reasonable to approximate the incidence of HCC in NASH to the median prevalence of simple steatosis and cirrhosis. […] The pathophysiology of NAFLD may therefore independently contribute to the development of HCC regardless of fibrosis stage and brings up key challenges regarding screening for HCC.

• #68 Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

  https://www.oaepublish.com/articles/2394-5079.2022.63

  Other biomarkers have been investigated for HCC surveillance. […] In light of these findings, biomarker-based algorithms such as the GALAD score have been developed to predict the development of HCC. […] US for HCC screening has previously been shown to be inadequate. […] According to a retrospective cohort study of 941 patients, 20% and over 33% of USs, respectively, are insufficient for excluding HCC in cirrhotic patients overall and with BMI 35 kg/m2. […] According to the AGA, the quality of US in detecting mass lesions in the liver parenchyma should be documented in order to identify those with suboptimal US screening who should instead undergo computed tomography (CT) or magnetic resonance imaging (MRI) in the future. […] As NAFLD remains the most rapidly growing cause of HCC in the United States, HCC surveillance in NAFLD is essential but plagued by questions surrounding the identification of those without advanced fibrosis or cirrhosis who may warrant HCC screening and the best screening modalities that balance cost-effectiveness and comprehensiveness in detecting HCC lesions.

• #69 Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

  https://www.mdpi.com/2075-4418/10/8/579

  According to cohort studies from Italy and the United States, many patients with NAFLD-related HCC are not diagnosed through regular surveillance (compared to patients with HCV-related HCC), resulting in a more advanced HCC burden at diagnosis. […] The best available evidence suggests that NAFLD-related cirrhosis is a risk factor for HCC, albeit at a lower rate compared to HCV-related cirrhosis. However, the annual incidence rate of NASH-cirrhosis remains higher than 1%. […] An important issue is how to determine high-risk cases from a large number of NAFLD patients for early diagnosis and treatment of HCC. […] In 2020, eight recommendations (best practices) were published by the American Gastroenterology Association (AGA) for HCC surveillance in NAFLD patients. […] The AGA expert review recommends to consistently record the adequacy of the liver via US, including parenchyma heterogeneity, visualization of the entire liver, and beam attenuation because abdominal US results are often difficult to visualize in many cases of severe obesity.

• #70 Global epidemiology of non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis: What we need in the future – PHC

  http://www.aphc.info/phc-paris-hepatology-conference-2018-materials/global-epidemiology-non%E2%80%90alcoholic-fatty-liver-diseasenon%E2%80%90alcoholic-steatohepatitis-need-future/

  The estimated prevalence of nonalcoholic fatty liver disease (NAFLD) worldwide is approximately 25%. […] However, the real prevalence of NAFLD and the associated disorders is unknown mainly because reliable and applicable diagnostic tests are lacking. […] Although assessing fatty infiltration in the liver is simple by ultrasound, the gold standard for the assessment of fibrosis, the only marker of progression towards more severe liver disease is still liver biopsy. […] Because NAFL/NAFLD/NASH and related metabolic diseases represent an economic burden, finding an inexpensive method to diagnose and stage fatty liver is a priority.

• #71 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?pn=mostcited&uid=1764&vmd=Full

  The ongoing obesity epidemic and the increasing recognition of metabolic syndrome have contributed to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common form of liver disease worldwide. […] It is imperative to understand the incidence and prevalence of NAFLD as it is associated with a profound economic burden of hospitalizations, including the shifting trends in liver transplantation. […] The long-term cumulative healthcare cost of NAFLD patients has been shown to be 80% higher than that of non-NAFLD patients. […] A major limitation in understanding the epidemiology of NAFLD has been the lack of a distinct classification of the disease. […] A systemic review and meta-analysis on the global epidemiology of NAFLD estimated prevalence of NAFLD by imaging to be 25.2% (95% CI, 22.1 to 28.7) with an estimated prevalence of NASH to be lower ranging from 3 to 5%.

• #72 Global epidemiology of non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis: What we need in the future – PHC

  http://www.aphc.info/phc-paris-hepatology-conference-2018-materials/global-epidemiology-non%E2%80%90alcoholic-fatty-liver-diseasenon%E2%80%90alcoholic-steatohepatitis-need-future/

  The estimated prevalence of nonalcoholic fatty liver disease (NAFLD) worldwide is approximately 25%. […] However, the real prevalence of NAFLD and the associated disorders is unknown mainly because reliable and applicable diagnostic tests are lacking. […] Although assessing fatty infiltration in the liver is simple by ultrasound, the gold standard for the assessment of fibrosis, the only marker of progression towards more severe liver disease is still liver biopsy. […] Because NAFL/NAFLD/NASH and related metabolic diseases represent an economic burden, finding an inexpensive method to diagnose and stage fatty liver is a priority.

• #73 Non-alcoholic fatty liver disease in Africa: a hidden danger | Global Health, Epidemiology and Genomics | Cambridge Core

  https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/nonalcoholic-fatty-liver-disease-in-africa-a-hidden-danger/F545E87E177B63464CC003F181E41C8D

  There is a dearth of data on the burden and spectrum of non-alcoholic fatty liver disease (NAFLD) in African populations. […] The limited available information suggests that the prevalence of NAFLD in the general population is lowest for the Africa region. […] However, this is likely to be an underestimate and also does not take into consideration the long-term impact of rising rates of obesity, type-2 diabetes mellitus (T2DM) and high human immunodeficiency virus infection burden in Africa. […] There is an absence of data from population-based studies in Africa and this highlights the need for such studies, to reliably define the health service needs for this region. […] What is required as a priority from Africa, are well-designed epidemiologic studies that screen for NAFLD in the general population as well as high-risk groups such as patients with T2DM or obesity.

• #74 Non-alcoholic fatty liver disease in Africa: a hidden danger | Global Health, Epidemiology and Genomics | Cambridge Core

  https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/nonalcoholic-fatty-liver-disease-in-africa-a-hidden-danger/F545E87E177B63464CC003F181E41C8D

  The actual prevalence of NAFLD may vary depending on the sensitivity of the detection method used. […] The reported prevalence of NAFLD from population-based studies in high-income countries (HIC) such as the United States, is 8.1% based on elevated transaminase levels, 18.8% using ultrasound (USS) for diagnosis and 31% with magnetic resonance (MR) spectroscopy. […] It is interesting to note that the region with the lowest reported prevalence was Africa (13.48%). […] However, the meta-analysis only included two studies from Africa with a small sample size. […] The limited data suggest the prevalence of NAFLD in the general population is comparatively lower in Africa, but the prevalence in subjects with T2DM is similar to those reported globally. […] The healthcare agenda in sub-Saharan Africa has been dominated by poverty, undernutrition and communicable diseases with less attention paid to non-communicable diseases.

• #75 Non-alcoholic fatty liver disease in Africa: a hidden danger | Global Health, Epidemiology and Genomics | Cambridge Core

  https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/nonalcoholic-fatty-liver-disease-in-africa-a-hidden-danger/F545E87E177B63464CC003F181E41C8D

  The actual prevalence of NAFLD may vary depending on the sensitivity of the detection method used. […] The reported prevalence of NAFLD from population-based studies in high-income countries (HIC) such as the United States, is 8.1% based on elevated transaminase levels, 18.8% using ultrasound (USS) for diagnosis and 31% with magnetic resonance (MR) spectroscopy. […] It is interesting to note that the region with the lowest reported prevalence was Africa (13.48%). […] However, the meta-analysis only included two studies from Africa with a small sample size. […] The limited data suggest the prevalence of NAFLD in the general population is comparatively lower in Africa, but the prevalence in subjects with T2DM is similar to those reported globally. […] The healthcare agenda in sub-Saharan Africa has been dominated by poverty, undernutrition and communicable diseases with less attention paid to non-communicable diseases.

• #76 NASH Definition & Progression

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence/

  NAFLD is the most common chronic liver condition in the United States. Its estimated that about 25 percent of adults in the U.S. have NAFLD. Of those with NAFLD, about 20 percent have NASH (5% of adults in the U.S.). Most people with NAFLD have simply fatty liver. […] The reason some people with NAFLD have simple fatty liver and others get NASH isnt known, although research suggests that certain genes may play a role. […] NAFLD is newly renamed metabolic dysfunction-associated steatotic liver disease or MASLD. […] NASH has been newly renamed metabolic dysfunction associated steatohepatitis or MASH. […] Fatty liver disease is newly renamed steatotic liver disease.

• #77 Updates in fatty liver disease: Pathophysiology, diagnosis and management

  https://www1.racgp.org.au/ajgp/2021/october/updates-in-fatty-liver-disease

  What was previously termed non-alcoholic fatty liver disease (NAFLD) is now referred to as metabolic (dysfunction) associated fatty liver disease (MAFLD). […] Importantly, MAFLD allows a patient to have dual (or more) aetiologies for their liver disease (eg alcohol and MAFLD, or hepatitis C and MAFLD), something that by definition is not possible with the old NAFLD term. […] Previous definitions of NAFLD in international guidelines required the presence of steatosis in 5% of hepatocytes in the absence of significant ongoing or recent alcohol consumption and other known causes of liver disease. […] If not adequately treated, approximately one in 510 people will develop liver fibrosis over time, which can progress to cirrhosis, liver failure or liver cancer. […] Importantly, as a result of the link with metabolic dysregulation, people with fatty liver are at an increased risk of extrahepatic complications including cardiovascular disease, type 2 diabetes and cancers.

• #78 Updates in fatty liver disease: Pathophysiology, diagnosis and management

  https://www1.racgp.org.au/ajgp/2021/october/updates-in-fatty-liver-disease

  What was previously termed non-alcoholic fatty liver disease (NAFLD) is now referred to as metabolic (dysfunction) associated fatty liver disease (MAFLD). […] Importantly, MAFLD allows a patient to have dual (or more) aetiologies for their liver disease (eg alcohol and MAFLD, or hepatitis C and MAFLD), something that by definition is not possible with the old NAFLD term. […] Previous definitions of NAFLD in international guidelines required the presence of steatosis in 5% of hepatocytes in the absence of significant ongoing or recent alcohol consumption and other known causes of liver disease. […] If not adequately treated, approximately one in 510 people will develop liver fibrosis over time, which can progress to cirrhosis, liver failure or liver cancer. […] Importantly, as a result of the link with metabolic dysregulation, people with fatty liver are at an increased risk of extrahepatic complications including cardiovascular disease, type 2 diabetes and cancers.

• #79 Fatty liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Fatty_liver_disease

  NAFLD affects about 30% of people in Western countries and 10% of people in Asia. […] In the United States, rates are around 35% with about 7% having the severe form NASH. […] NAFLD affects about 10% of children in the United States. […] Recently the term Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace NAFLD. […] Using this more inclusive definition, the global prevalence of MAFLD is an astonishingly high 50.7%. […] Indeed, also using the old NAFLD definition, the disease is observed in up to 80% of obese people, 35% of whom progress to NASH, and in up to 20% of normal weight people, despite no evidence of excessive alcohol consumption. […] FLD is the most common cause of abnormal liver function tests in the United States. […] Fatty liver is more prevalent in Hispanic people than white, with black people having the lowest prevalence. […] After the lockdown of the COVID-19 pandemic, a study demonstrated that 48% of patients with liver steatosis gained weight, while 16% had a worsened steatosis grade.

• #80 Global incidence and prevalence of nonalcoholic fatty liver disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10029957/

  The overall prevalence of NAFLD in Asia is approximately 30%. A meta-analysis by Le et al. conducted a literature search in 2019 (182 studies with 2,385,999 individuals) and estimated NAFLD prevalence in Asia at 30.5%. A recent meta-analysis by Riazi et al. which included 63 studies (1,000,681 individuals) found that NAFLD prevalence in Asia was 31.6%. […] A meta-analysis comprising 19 studies (5,626 individuals) by Rojas et al. estimated the prevalence of NAFLD in South America at up to 59%. Le et al. pooled data from 3 studies (5,716 individuals) and determined that South America had the greatest estimated NAFLD prevalence among the continents at 35.7%. […] There is a paucity of data from Africa on the epidemiology of NAFLD. A meta-analysis estimated the prevalence of NAFLD in Africa at 13.5%, ranging from 9% in Nigeria to 20% in Sudan. More recently, NAFLD prevalence was reported at 28.2% in the meta-analysis by Le, and 56.8% in the meta-analysis by Riazi. […] Based on mathematical modeling studies, the burden of NAFLD and NASH will continue to increase over the next 10 years worldwide. The global prevalence of NAFLD is forecasted to reach 55.4% by 2040.

• #81 Global incidence and prevalence of nonalcoholic fatty liver disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10029957/

  The overall prevalence of NAFLD in Asia is approximately 30%. A meta-analysis by Le et al. conducted a literature search in 2019 (182 studies with 2,385,999 individuals) and estimated NAFLD prevalence in Asia at 30.5%. A recent meta-analysis by Riazi et al. which included 63 studies (1,000,681 individuals) found that NAFLD prevalence in Asia was 31.6%. […] A meta-analysis comprising 19 studies (5,626 individuals) by Rojas et al. estimated the prevalence of NAFLD in South America at up to 59%. Le et al. pooled data from 3 studies (5,716 individuals) and determined that South America had the greatest estimated NAFLD prevalence among the continents at 35.7%. […] There is a paucity of data from Africa on the epidemiology of NAFLD. A meta-analysis estimated the prevalence of NAFLD in Africa at 13.5%, ranging from 9% in Nigeria to 20% in Sudan. More recently, NAFLD prevalence was reported at 28.2% in the meta-analysis by Le, and 56.8% in the meta-analysis by Riazi. […] Based on mathematical modeling studies, the burden of NAFLD and NASH will continue to increase over the next 10 years worldwide. The global prevalence of NAFLD is forecasted to reach 55.4% by 2040.

• #82 Recent Epidemiology of Nonalcoholic Fatty Liver Disease

  https://www.gutnliver.org/journal/view.html?pn=mostcited&uid=1764&vmd=Full

  Based on the United States (US) Third National Health and Nutrition Examination Survey (NHANES III), an extensive representative survey of the US civilian population, the prevalence of NAFLD by ultrasonography is estimated to be 34.0% in the US. […] The burden of NAFLD on healthcare costs and resource utilization remains significant nowadays. […] The prevalence of NAFLD using noninvasive panels by US Fatty Liver Index increased from 20.0% (1988-1994) to 28.3% (1999-2004) to 33.2% (2009-2012) and 31.9% (2013-2016) over 30 years. […] A recent study using the Markov prediction model reported that NAFLD is projected to increase by 21% from 83 million in 2015 to 101 million in 2030. […] This review summarizes the worldwide incidence and prevalence of NAFLD, discusses diagnostic nuances in determining subjects with NAFLD who progress to cirrhosis, and quantifies downstream impacts on the healthcare economy in the context of all-cause and cause-specific mortality.

• #83 Metabolic dysfunction–associated steatotic liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease

  For severely obese individuals, the prevalence of MASLD rises over 90%, and for those with diabetes, over 60%, and up to 20% for normal-weight people. […] MASLD is present in 65% to 90% of people who had bariatric surgery, and up to 75% of them have MASH. […] Ultrasonography and proton NMR spectroscopy studies suggest about 25% of the population seems to be affected by MASLD or MASH. […] Although the disease is commonly associated with obesity, a significant proportion of those affected are normal weight or lean. […] Lean MASLD affects between 10 and 20% of Americans and Europeans, and approximately 25% of Asians, although some countries have a higher incidence (e.g., India has a very high proportion of lean MASLD and almost no obese MASLD). […] NAFLD prevalence is expected to increase steadily, from 25% in 2018 to a projected 33.5% of people with MASLD globally in 2030, and from 20% to a projected 27% of those with MASLD will progress to MASH.

• #84 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  NAFLD is a major global public health challenge. Although several strides have been made in the understanding and management of the disease, its translation into acceptance as a public health challenge has several areas of deficiency. Globally countries lack appropriate preparatory strategies to combat the evolving epidemic of NAFLD. Holistic approaches involving increased awareness, infrastructure development, interdisciplinary collaboration and strategic action plans at national levels are urgently required for comprehensive care.

• #85 Up-to-date global epidemiology of nonalcoholic fatty liver disease – Manikat – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/118927/html

  Current evidence suggests heterogeneous and various prevalence of NAFLD across the region, race/ethnicity, and obesity status. Therefore, researchers should consider body mass index or waist circumferences, geographical location, and race/ethnicity for epidemiologic research of NAFLD. […] Given the rising prevalence of NAFLD, the risk factors of NAFLD and its causes of mortality should be understood. […] Awareness of the prevalence of NAFLD is essential, but timely action is required. […] The need to curb the NAFLD epidemic is pressing, not only due to the breadth of the disease but also to protect these at-risk populations. […] Future research will need to address the global trends in the incidence and prevalence of advanced fibrosis.

• #86 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  NAFLD is a major global public health challenge. Although several strides have been made in the understanding and management of the disease, its translation into acceptance as a public health challenge has several areas of deficiency. Globally countries lack appropriate preparatory strategies to combat the evolving epidemic of NAFLD. Holistic approaches involving increased awareness, infrastructure development, interdisciplinary collaboration and strategic action plans at national levels are urgently required for comprehensive care.

• #87

  https://journals.lww.com/hep/fulltext/2023/04000/the_global_epidemiology_of_nonalcoholic_fatty.27.aspx

  NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.43%-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59%-29.33) in 1990-2006 to 38.00% (33.71%-42.49) in 2016-2019 (p<0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46%-31.87) in 1990-2006 to 34.59% (29.05%-40.57) (p=0.029). [...] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). [...] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #88 The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36626630/

  NAFLD is a leading cause of liver-related morbidity and mortality. […] We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. […] Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.4-33.09), respectively. […] Global NAFLD prevalence increased by +50.4% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019 ( p 0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46-31.87) in 1990-2006 to 34.59% (29.05-40.57) ( p =0.029). […] The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). […] NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

• #89 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) […] The authors summarize and update the most recent knowledge in the field of prevalence, natural history and incidence of Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). […] NAFLD is now the most common liver disease in the United States and possibly worldwide. Furthermore, the number of affected patients is growing rapidly, and the disease has reached epidemic proportions. […] NAFLD has also reached epidemic proportions among populations typically considered at low risk for this liver condition, with a prevalence in China and Japan of 15 and 14%, respectively, among adults. […] The prevalence of NAFLD among children is unknown, but some data indicate that 2.6-9.6% of children have NAFLD, increasing up to 38-53% among obese children.

• #90 Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD) | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-epidemiology-natural-history-non-alcoholic-fatty-S1665268119318204

  NAFLD is more frequent among obese subjects (75%) compared to controls (16%), and among patients with type 2 diabetes (34-74%), whereas it is an almost universal finding in obese patients with type 2 diabetes. […] Recent data indicate a doubling of the prevalence in children: from 2.6% a decade ago to 5% today in normal-weight, and 38% or 48% in obese and diabetic children respectively. […] Overall, a diagnosis of NAFLD is associated with a shorter survival than expected for the general population of the same age and gender, and the higher mortality is mainly due to cardiovascular disease (CVD). […] The incidence of NAFLD remains unknown because no prospective studies have been conducted. […] NAFLD has become a common diagnosis in clinical practice of several medical specialties, and its prevalence in the general population is increasing together with obesity, type 2 diabetes and the metabolic syndrome.

• #91

  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. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). 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). Incidence risk ratios for liverspecific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.

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

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

  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. […] In general, the prevalence of NAFLD has increased over the last 20 years. […] 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%. […] 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%). […] Meta-regression of studies done globally also displayed an increased prevalence of NAFLD from 15% in 2005 to 25% in 2010. […] 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.

• #93 Non-Alcoholic Fatty Liver Disease: Global Scenario, Challenges, and Preparedness | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/non-alcoholic-fatty-liver-disease-global-scenario-challenges-and-preparedness

  NAFLD is a major global public health challenge. Although several strides have been made in the understanding and management of the disease, its translation into acceptance as a public health challenge has several areas of deficiency. Globally countries lack appropriate preparatory strategies to combat the evolving epidemic of NAFLD. Holistic approaches involving increased awareness, infrastructure development, interdisciplinary collaboration and strategic action plans at national levels are urgently required for comprehensive care.

• #94 Up-to-date global epidemiology of nonalcoholic fatty liver disease – Manikat – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/118927/html

  Current evidence suggests heterogeneous and various prevalence of NAFLD across the region, race/ethnicity, and obesity status. Therefore, researchers should consider body mass index or waist circumferences, geographical location, and race/ethnicity for epidemiologic research of NAFLD. […] Given the rising prevalence of NAFLD, the risk factors of NAFLD and its causes of mortality should be understood. […] Awareness of the prevalence of NAFLD is essential, but timely action is required. […] The need to curb the NAFLD epidemic is pressing, not only due to the breadth of the disease but also to protect these at-risk populations. […] Future research will need to address the global trends in the incidence and prevalence of advanced fibrosis.

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