Niealkoholowa stłuszczeniowa choroba wątroby – Rokowania, prognozy i postęp choroby

Niealkoholowa stłuszczeniowa choroba wątroby
Rokowania, prognozy i postęp choroby

Niealkoholowa stłuszczeniowa choroba wątroby (NAFLD) dotyka 25-30% populacji i stanowi najczęstszą przyczynę przewlekłej choroby wątroby. Kluczowe jest rozróżnienie NAFL (proste stłuszczenie) od NASH (niealkoholowe stłuszczeniowe zapalenie wątroby), gdyż NASH wiąże się z gorszym rokowaniem, progresją do zwłóknienia, marskości i raka wątrobowokomórkowego (HCC). Tempo progresji włóknienia wynosi około 1 stopień na 7 lat w NASH i 1 stopień na 14 lat w NAFLD. Stopień włóknienia jest najważniejszym czynnikiem prognostycznym, a zaawansowane włóknienie koreluje ze zwiększoną śmiertelnością wątrobową i ogólną. U pacjentów z marskością NASH 10-letnia śmiertelność wynosi 20% (klasa A Child-Pugh), a ryzyko rozwoju HCC to około 2,6% rocznie. Dekompensacja wątroby pojawia się u 5% pacjentów po 5 latach i 10% po 10 latach od diagnozy NAFLD, a ryzyko powikłań jest wyższe przy elastografii wątroby (LSM) ≥13 kPa. NAFLD zwiększa ryzyko zgonu o 34% (SMR=1,34; 95% CI 1,003-1,76), głównie z powodu chorób sercowo-naczyniowych, nowotworów i choroby wątroby.

Niealkoholowa stłuszczeniowa choroba wątroby (NAFLD) – Rokowanie (ocena przewidywania wyniku leczenia)

Niealkoholowa stłuszczeniowa choroba wątroby (NAFLD) stała się najczęstszą przyczyną przewlekłej choroby wątroby na całym świecie, dotykając około 25-30% populacji ogólnej.¹²³ Choroba ta ma zróżnicowane rokowanie w zależności od postaci klinicznej, obecności powikłań oraz chorób współistniejących. Zrozumienie czynników prognostycznych NAFLD jest kluczowe dla odpowiedniego zarządzania leczeniem i monitorowania pacjentów.

Proste stłuszczenie vs NASH – różnice w rokowaniu

Rozróżnienie między prostym stłuszczeniem wątroby (NAFL) a niealkoholowym stłuszczeniowym zapaleniem wątroby (NASH) ma kluczowe znaczenie prognostyczne.¹² Pacjenci z prostym stłuszczeniem wątroby mają zasadniczo dobre rokowanie długoterminowe, z niskimi wskaźnikami chorobowości i śmiertelności związanej z wątrobą. Ta postać NAFLD zwykle charakteryzuje się łagodnym i nieprogresywnym przebiegiem.¹

Natomiast NASH wiąże się z istotnie gorszym rokowaniem i wyższym ryzykiem progresji choroby. Około 10-30% pacjentów z NAFLD rozwija NASH, który może prowadzić do zwłóknienia, marskości i raka wątrobowokomórkowego (HCC).¹ Pacjenci z NASH wykazują zwiększoną śmiertelność zarówno z przyczyn wątrobowych, jak i sercowo-naczyniowych.² Tempo progresji włóknienia szacuje się na jeden stopień na 7 lat w przypadku NASH i jeden stopień na 14 lat w przypadku NAFLD, z tendencją do przyspieszania.¹

Włóknienie wątroby jako kluczowy czynnik prognostyczny

Stopień włóknienia wątroby jest najważniejszym czynnikiem prognostycznym w NAFLD, niezależnie od nasilenia martwicy zapalnej.¹² Badania zgodnie wskazują, że zaawansowane włóknienie jest głównym predyktorem chorobowości i śmiertelności związanej z wątrobą.¹

Wyższe stopnie włóknienia wątroby silnie determinują śmiertelność ogólną u pacjentów z NAFLD, najprawdopodobniej z powodu wyraźnego wpływu na śmiertelność związaną z wątrobą. Z drugiej strony, choroby sercowo-naczyniowe odpowiadają za zwiększony odsetek śmiertelności na niższych etapach włóknienia.¹

Długoterminowe rokowanie u pacjentów z marskością wątroby w przebiegu NASH jest niekorzystne. Współczynnik 10-letniej śmiertelności wynosi 20% dla pacjentów z chorobą klasy A według Child-Pugh, a 45% pacjentów doświadczy dekompensacji w ciągu 10 lat od diagnozy.¹

Ryzyko rozwoju raka wątrobowokomórkowego

Pacjenci z NASH-marskością znajdują się w grupie znacznego ryzyka rozwoju raka wątrobowokomórkowego (HCC), które wynosi około 2,6% rocznie.¹ Skumulowana częstość występowania HCC u pacjentów z marskością związaną z NASH jest dość wysoka, wahając się od 2,4% w ciągu 7 lat do 12,8% w ciągu 3 lat.¹

Co istotne, mniej niż 10% osób z marskością alkoholową FLD rozwinie HCC, ale nawet do 45% osób z NASH bez marskości może rozwinąć raka wątrobowokomórkowego.¹ Ta obserwacja podkreśla potencjalnie niebezpieczny przebieg NASH, nawet przy braku zaawansowanego włóknienia.

Dekompensacja wątroby w przebiegu NAFLD

Wystąpienie dekompensacji wątroby stanowi istotny punkt zwrotny w przebiegu NAFLD. Według badań, częstość występowania zdekompensowanej marskości u pacjentów z NAFLD bez początkowej marskości wynosi około 5% po 5 latach i 10% po 10 latach od diagnozy.¹

W prospektywnym badaniu pacjentów z NAFLD z wykorzystaniem elastografii wątroby (LSM) zaobserwowano, że zdekompensowana choroba wątroby lub pierwotny rak wątroby wystąpiły u 17,1% pacjentów z wyjściowym LSM ≥13 kPa, u 5,9% pacjentów z LSM 9,5-13 kPa i u żadnego pacjenta z LSM <9,5 kPa podczas mediany obserwacji wynoszącej 50 miesięcy.¹

Podobnie, żaden pacjent z niskim ryzykiem według wskaźnika włóknienia NAFLD (NFS) nie rozwinął dekompensacji wątroby ani nie doszło u niego do zgonu z przyczyn wątrobowych. Wszyscy pacjenci, u których wystąpiły powikłania związane z wątrobą, zostali zakwalifikowani do kategorii wysokiego ryzyka NFS na końcu obserwacji.¹²

Śmiertelność w NAFLD

Pacjenci z NAFLD mają wyższą śmiertelność w porównaniu do populacji ogólnej. Badanie kohortowe wykazało, że pacjenci z NAFLD mieli o 34% wyższe ryzyko zgonu (standardowy współczynnik śmiertelności = 1,34; 95% CI, 1,003 do 1,76; P = 0,03) niż można by oczekiwać w populacji ogólnej.¹

Trzema głównymi przyczynami zgonu u pacjentów z NAFLD są:¹²

Choroby sercowo-naczyniowe
Nowotwory
Choroba wątroby

¹²

Wskaźnik 10-letniej przeżywalności dla osób dotkniętych NAFLD wynosił około 80%.¹ Jednak stratyfikacja ryzyka przy użyciu narzędzi oceny włóknienia wykazała wyższą śmiertelność specyficzną dla choroby u pacjentów z NASH, co potwierdza, że włóknienie jest najważniejszym predyktorem długoterminowego rokowania.¹

Rokowanie w zakresie powikłań sercowo-naczyniowych

NAFLD jest niezależnie związany ze zwiększonym ryzykiem chorób sercowo-naczyniowych i powikłań sercowo-naczyniowych, które stanowią główną przyczynę zgonów u pacjentów z NAFLD.¹²

W badaniu dotyczącym NAFLD jako niezależnego czynnika ryzyka migotania przedsionków wykazano, że pacjenci z NAFLD mieli większe prawdopodobieństwo rozwoju migotania przedsionków w czasie obserwacji w porównaniu do pacjentów bez NAFLD (współczynnik ryzyka (HR) 1,96 (95% CI) 1,29-2,97).¹

U pacjentów z niewydolnością serca (HF) współistniejącą z NAFLD obserwuje się znacząco zwiększone ryzyko niekorzystnych wyników złożonych (HR 1,61, 95% CI 1,25-2,07), śmiertelności całkowitej (HR 1,66, 95% CI 1,39-1,98) oraz hospitalizacji lub rehospitalizacji z powodu HF (HR 1,71, 95% CI 1,03-2,86) w porównaniu do pacjentów bez NAFLD.¹

Modele prognostyczne i nieinwazyjne narzędzia oceny ryzyka

Ze względu na inwazyjny charakter biopsji wątroby, która pozostaje złotym standardem w ocenie zaawansowania NAFLD, opracowano wiele nieinwazyjnych modeli prognostycznych do identyfikacji pacjentów z wysokim ryzykiem progresji choroby.¹²

Modele oparte na markerach surowiczych

Walidacji poddano kilka nieinwazyjnych testów włóknienia, takich jak:¹²

Wskaźnik włóknienia NAFLD (NFS)
FIB-4
Test wzmocnionego włóknienia wątroby (ELF)

¹²

Badanie porównujące cztery wskaźniki predykcji NAFLD (indeks stłuszczenia wątroby, indeks steatozy wątrobowej, produkt akumulacji lipidów i wynik tłuszczu wątrobowego NAFLD – LFS) wykazało, że LFS jest najlepszym nieinwazyjnym wskaźnikiem predykcyjnym dla NAFLD i może przewidywać śmiertelność.¹

Uczestnicy z wysokim wynikiem LFS (LFS ≥1,257) mieli wyższą śmiertelność sercowo-naczyniową i wątrobową niż uczestnicy z niskim (LFS ≤-1,413; sercowo-naczyniowy HR=2,24, 95% CI 1,03 do 4,88; wątrobowy HR=31,25, 95% CI 3,13 do 333,33) lub pośrednim (-1,413≤LFS≤1,257; sercowo-naczyniowy HR=2,3, 95% CI 1,19 do 4,48; wątrobowy HR=30,3, 95% CI 4 do 250) wynikiem LFS w pełni dostosowanym modelu.¹

Opracowano również prosty model obiektywny składający się z wieku, obecności cukrzycy i liczby płytek krwi, który może skutecznie identyfikować pacjentów z NAFLD o wysokim ryzyku rozwoju zdarzeń wątrobowych przed rozwojem klinicznie jawnej marskości.¹

Biomarkery mikroRNA

Obiecującym kierunkiem w nieinwazyjnej diagnostyce i prognozowaniu NAFLD są biomarkery oparte na mikroRNA (miRNA). Badania walidacyjne wykazały, że niektóre krążące mikroRNA (miR-27b, -34a, -22, -122, -192 i -21 są podwyższone, a miR-30c, -16 i -197 są obniżone) w surowicy pacjentów z zaawansowaną NAFLD.¹

Spośród tych mikroRNA, tylko trzy (miR-27b, -16 i -30c) wykazywały konsekwentne zmiany zarówno w NASH, jak i w zaawansowanym włóknieniu, co sugeruje ich potencjalną wartość jako biomarkerów diagnostycznych dla pacjentów z NAFLD obarczonych ryzykiem, szczególnie jako uzupełnienie i ulepszenie obecnych lub przyszłych algorytmów predykcyjnych.¹

Techniki obrazowania w prognozowaniu NAFLD

Elastografia wątroby jest nieinwazyjną metodą oceny sztywności wątroby, która koreluje ze stopniem włóknienia. Jest ona coraz częściej wykorzystywana do stratyfikacji ryzyka u pacjentów z NAFLD.¹

Badania wykazały, że absorpcjometria podwójnej energii promieniowania X (DXA) i związane z nią parametry mogą być wykorzystywane do przewidywania stłuszczenia wątroby. Stwierdzono istotne korelacje między tradycyjnymi pomiarami, takimi jak otyłość brzuszna określona przez stosunek obwodu talii do bioder (OR=2,50 (mężczyźni), 3,35 (kobiety)), stosunek android-gynoid (OR=3,35 (mężczyźni), 6,39 (kobiety)) i obwód talii (OR=1,79 (mężczyźni), 3,80 (kobiety)) a stłuszczeniem wątroby.¹

Badanie ultrasonograficzne pozostaje prostą i dostępną metodą przesiewową w kierunku NAFLD. Badania wykazały, że stłuszczenie wątroby stopnia II w badaniu USG jest niezależnym predyktorem cukrzycy ciążowej i poronień we wczesnym okresie ciąży.¹

Rokowanie w specjalnych populacjach pacjentów

NAFLD u pacjentów z cukrzycą

Pacjenci z współistniejącą NAFLD i cukrzycą typu 2 (T2DM) stanowią grupę szczególnie wysokiego ryzyka. Obciążenie NAFLD, z klinicznie istotnym włóknieniem dotykającym do 20% osób zarówno z NAFLD, jak i T2DM, wydaje się być ogromne, biorąc pod uwagę dużą liczbę pacjentów z T2DM na całym świecie.¹

Związek między cukrzycą a NAFLD jest znacznie silniejszy niż tylko związek, wskazuje na wspólną patofizjologię i jako stan kliniczny ma przebieg czasowy, w którym jedno może poprzedzać drugie przed współistnieniem.¹

NAFLD u osób starszych

NAFLD i starzenie się są silnie skorelowane, a starszy wiek jest jednym z najbardziej solidnych czynników epidemiologicznych dla NAFLD, NASH i włóknienia.¹

Starszy wiek nie tylko jest czynnikiem ryzyka stłuszczenia wątroby, ale także osoby starsze mają większe prawdopodobieństwo śmiertelności i progresji choroby do włóknienia i raka wątrobowokomórkowego.¹

NAFLD w ciąży

NAFLD może mieć istotne implikacje podczas ciąży. Wykazano, że NAFLD jest głównym czynnikiem ryzyka cukrzycy ciążowej (GDM) i poronień we wczesnym okresie ciąży.¹

Skumulowana częstość występowania poronień wśród pacjentek z różnymi stopniami stłuszczenia wątroby (FLG) wynosiła 35, 76 i 159 na 1000 ciąż odpowiednio dla FLG 0, I i II. Po dostosowaniu do wieku, rodności, ciśnienia krwi, poziomu cukru we krwi, hemoglobiny i BMI, FLG II pozostało jedynym niezależnym predyktorem poronień z wyższym poziomem istotności statystycznej (skorygowany OR 4,2, 95% CI (1,9 do 9,1).¹

Postępowanie w przypadku NAFLD w ciąży koncentruje się na interwencjach dotyczących stylu życia (zdrowe modyfikacje diety i odpowiednia aktywność fizyczna dozwolona podczas ciąży), ponieważ nie ma zatwierdzonych leków na NAFLD w ciąży.¹

Wpływ interwencji na rokowanie w NAFLD

Utrata masy ciała

Istotny korpus literatury wykazał, że utrata masy ciała powoduje kliniczną poprawę u pacjentów z NAFLD lub NASH. Utrata masy ciała może poprawić testy biochemiczne wątroby, histologię wątroby, poziomy insuliny w surowicy i jakość życia u pacjentów z NAFLD.¹

Chirurgia bariatryczna

Badania wykazały, że chirurgia bariatryczna i metaboliczna prowadzi do ustąpienia NAFLD/NASH u większości pacjentów (64,2% u pacjentów poddanych operacji pomostowania żołądkowego Roux-Y (RYGB) i 5,5% w gastrektomii rękawowej (SG)).¹

Meta-analiza 48 badań wykazała, że połączenie pioglitazonu i operacji pomostowania żołądkowego Roux-en Y miało najlepszy wpływ na wynik aktywności NAFLD.¹ Należy jednak zaznaczyć, że niewielka część pacjentów poddawanych operacji bariatrycznej i metabolicznej rozwija NASH lub cierpi z powodu zaostrzenia choroby (NAFLD/NASH/włóknienie wątroby) po operacji bariatrycznej.¹

Przyszłe trendy i obciążenie zdrowotne

Według obecnych prognoz, globalna częstość występowania NAFLD wśród populacji ogólnej może wynosić nawet miliard osób.¹ Przewidywany wzrost częstości występowania NASH wynosi 63%, co spowoduje 168% wzrost liczby pacjentów z zdekompensowaną marskością i 137% wzrost liczby pacjentów rozwijających HCC do 2030 roku.¹

NASH jest najszybciej rosnącą przyczyną przeszczepów wątroby w Stanach Zjednoczonych, Wielkiej Brytanii, a także w krajach rozwijających się.¹ NAFLD jest już drugą najczęstszą wskazówką do przeszczepu wątroby (LT) w USA i Europie.¹

Te trendy podkreślają pilną potrzebę opracowania skutecznych strategii przesiewowych i leczniczych, aby zapobiec wykładniczemu wzrostowi zachorowalności i śmiertelności związanej z NAFLD.¹²

Znaczenie wczesnego wykrywania

Wczesne wykrycie NAFLD jest ważne, aby można było przepisać pacjentom odpowiednią interwencję (np. modyfikację stylu życia i diety) przez pracowników służby zdrowia.¹

Stratyfikacja ryzyka włóknienia wątroby w warunkach pozahepatologicznych może zidentyfikować podgrupę pacjentów zagrożonych powikłaniami związanymi z wątrobą.¹ Biorąc pod uwagę rozpowszechnienie NAFLD, badania przesiewowe w kierunku NAFLD u pacjentów z niewydolnością serca mogą zapewnić skuteczne wykrycie choroby, wczesne interwencje i zmniejszyć ryzyko niekorzystnych wyników.¹

Rutynowa identyfikacja NAFLD za pomocą prostego, nieinwazyjnego badania ultrasonograficznego może pomóc we wczesnej identyfikacji matek wysokiego ryzyka, a tym samym we wczesnych interwencjach mających na celu poprawę zachorowalności matek.¹

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Materiały źródłowe

#1 Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00980-1
Given the increasing prevalence of diabetes and obesity worldwide, the deleterious effects of non-alcoholic fatty liver disease (NAFLD) are becoming a growing challenge for public health. […] In these patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH and NAFLD is mandatory. […] The prevalence of liver disease (NAFLD) has risen rapidly in Western countries, with a worldwide prevalence of 25%. […] Studies have shown the increased prevalence of cardiovascular disease (CVD) in patients with NAFLD, without and without diabetes. […] A significant body of literature has shown that weight loss induces a clinical improvement in patients with NAFLD or NASH. […] Weight loss can improve liver biochemical tests, liver histology, serum insulin levels, and quality of life in patients with NAFLD.
#1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology
https://fg.bmj.com/content/5/3/211
Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. […] The majority have simple steatosis, but approximately 10-30% develop NASH and the development of NASH cirrhosis is associated with a poor long-term prognosis. Patients with NASH have increased liver-related and cardiovascular mortality. […] The development of cirrhosis due to NASH is associated with a poor long-term prognosis. The 10-year mortality rate is 20% for subjects with Child-Pugh A disease and 45% will decompensate within 10 years of diagnosis. […] 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. Patients with NASH have a worse prognosis and should be included in clinical trials of new treatments for this condition.
#1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology
https://fg.bmj.com/content/5/3/211
Knowledge of whether a patient has simple steatosis or NASH is very important prognostically. Subjects with simple steatosis have a good long-term prognosis with low rates of liver-related morbidity and mortality, and therefore do not require specific liver-related treatment. However, patients with NASH can progress to cirrhosis and therefore should be more actively managed to try and prevent disease progression. […] The risk of NAFLD/NASH is directly related to the presence and severity of the metabolic syndrome. […] Simple steatosis carries a benign prognosis. […] NASH carries poor prognosis with increased liver-related and cardiovascular mortality.
#1 Fatty liver disease – Wikipedia
https://en.wikipedia.org/wiki/Fatty_liver_disease
Prognosis Good if treated early […] For people affected by NAFLD, the 10-year survival rate was about 80%. […] The rate of progression of fibrosis is estimated to be one per 7 years in NASH and one per 14 years in NAFLD, with an increasing speed. […] There is a strong relationship between these pathologies and metabolic illnesses (diabetes type II, metabolic syndrome). […] Less than 10% of people with cirrhotic alcoholic FLD will develop hepatocellular carcinoma, but up to 45% people with NASH without cirrhosis can develop hepatocellular carcinoma. […] The progression to cirrhosis may be influenced by the amount of fat and degree of steatohepatitis and by a variety of other sensitizing factors.
#1 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
Accumulation of excessive fat in the liver is the common denominator underlying the two most common and emerging causes of chronic liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), that are emerging public health issues globally. […] In NAFLD, death is most commonly due to cardiovascular disease and often non-hepatic cancers apart from liver disease. […] Presence and the grade of Fibrosis are most important prognostic determinant in NAFLD and NASH is classically considered to be the phenotype of NAFLD that underlie development of progressive liver disease, particularly fibrosis and therefore, is clinically relevant. […] The public health importance of NAFLD stems from its multifaceted impact on morbidity, mortality and health care utilization globally. NAFLD and particularly, NASH fibrosis is associated with an excess all-cause mortality and also liver related mortality in general population.
#1
https://www.xiahepublishing.com/2310-8819/JCTH-2019-00051
It appears that higher stages of liver fibrosis are a strong determinant of all-cause mortality in NAFLD, most likely because of the pronounced effect on liver-related mortality, whereas CVD accounts for an increased proportion of mortality at lower stages of fibrosis. Thus, compared with the general population, NAFLD increases the risk of liver-related, cardiovascular and all-cause mortality, and the impact of NAFLD on mortality appears to differ according to its severity. […] NAFLD is closely associated with several extrahepatic diseases, such as T2DM, CVD, malignancy, CKD, OSA, and PCOS. […] NAFLD has been associated with several extrahepatic malignancies. Malignancy is among the leading cause of death in NAFLD patients. […] The link between NAFLD and CKD has drawn considerable attention during recent times. Various studies have suggested that NAFLD can accelerate the development and progression of CKD independent of traditional risk factors.
#1
https://www.xiahepublishing.com/2310-8819/JCTH-2019-00051
According to current estimate, the global prevalence of NAFLD among the general population may be as high as one billion. […] The projected increase in the prevalence of NASH is 63%, which will cause a 168% increase in the number of patients with decompensated cirrhosis, and a 137% increase in the numbers of patients developing HCC by 2030. […] The cumulative incidence of HCC in patients with NASH-related cirrhosis is quite high, ranging from 2.4 % over 7 years to 12.8 % over 3 years. […] Multiple studies have found that the overall mortality in NAFLD patients is higher than that in matched individuals from a healthy population. […] Two recent longitudinal studies have uniformly found that stage of liver fibrosis irrespective of severity of hepatic necro-inflammation is independently associated with overall and disease-specific mortality in patients with NAFLD.
#1
https://link.springer.com/article/10.1007/s11606-020-05725-1
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA. […] We aimed to determine the time to develop hepatic events in patients with NAFLD and develop a simple model to identify patients at risk for hepatic decompensation. […] A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify at-risk patients. […] The degree of liver fibrosis is one of the most significant predictors of risk of cirrhosis and hepatic decompensation. […] The incidence of decompensated cirrhosis from NAFLD is on the rise with liver-related complications seen in up to 20% of NAFLD patients, and liver-related death or need for liver transplantation in up to 13%. […] Based on our study, the incidence of hepatic decompensation in NAFLD patients without cirrhosis is around 5% at 5 years and 10% at 10 years.
#1 Predicting Liver-Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests – PubMed
https://pubmed.ncbi.nlm.nih.gov/34783191/
It remains unclear whether screening for advanced fibrosis in the community can identify the subgroup of people with nonalcoholic fatty liver disease (NAFLD) at higher risk for development of liver-related complications. […] We aimed to determine the prognostic value of baseline noninvasive fibrosis tests for predicting liver-related outcomes and mortality in patients with NAFLD from type 2 diabetes (T2D) clinics or primary care. […] During a median follow-up of 50 months, decompensated liver disease or primary liver cancer occurred in 6 of 35 (17.1%) patients with baseline LSM 13 kPa, 1 of 17 (5.9%) patients with LSM 9.5-13 kPa, and in no patients with LSM 9.5 kPa. […] No patient with low-risk NFS developed liver decompensation or liver-related mortality. […] Following repeat NFSs at the end of follow-up, all patients with a liver-related complication were in the high-risk NFS category.
#1 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 community-based study of 420 patients with NAFLD found that these patients had a 34% higher risk of death (standard mortality ratio = 1.34; 95% CI, 1.003 to 1.76; P= .03) than would be expected in the general population; the three main causes of death were cancer, ischemic heart disease, and liver disease. […] A study of 817 patients with NAFLD echoed these results (hazard ratio = 1.038; 95% CI, 1.036 to 1.041; P.0001), with liver disease as the third leading cause of death after cardiovascular disease and malignancy. […] Further studies that stratified patients’ risk using fibrosis scoring tools found higher disease-specific mortality in those with NASH, indicating that fibrosis is the most important predictor of long-term outcomes.
#1 Non-Alcoholic Fatty Liver Disease as a Predictor of Atrial Fibrillation in Middle-Aged Population (OPERA Study) | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142937
Subjects in the NAFLD group had greater probability of developing atrial fibrillation during the follow-up time in comparison to the subjects in the non-NAFLD group (Hazard ratio (HR) 1.96 (95%CI) 1.292.97). […] In conclusion, the present study provides strong epidemiological evidence that NAFLD is an independent risk factor for atrial fibrillation.
#1 Non-alcoholic fatty liver disease is associated with a worse prognosis in patients with heart failure: A pool analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC10157242/
Non-alcoholic fatty liver disease (NAFLD) is associated with a higher risk of heart failure (HF) than those without NAFLD. […] The pooled analysis showed that HF patients with NAFLD were associated with a significantly increased risk of major composite adverse outcomes (HR 1.61, 95% CI 1.25-2.07), all-cause mortality (HR 1.66, 95% CI 1.39-1.98), and HF hospitalization or re-hospitalization (HR 1.71, 95% CI 1.03-2.86). […] NAFLD is associated with a worse prognosis in patients with HF. Effective screening and treatment strategies are needed to improve the prognosis in HF patients with NAFLD. […] The association of NAFLD with the risk of adverse outcomes in patients with confirmed HF was reported in total 6 studies, but they showed significant heterogeneity among them (I2 = 85%, p .001). Overall, we found a significantly increased risk of primary adverse outcomes (HR 1.61, 95% CI 1.25-2.07) when patients with HF coexisted with NAFLD.
#1 Non-invasive prediction of NAFLD severity: a comprehensive, independent validation of previously postulated serum microRNA biomarkers | Scientific Reports
https://www.nature.com/articles/s41598-018-28854-4
Liver biopsy is currently the only reliable method to establish nonalcoholic fatty liver disease (NAFLD) severity. […] Thus, non-invasive diagnostic markers for NAFLD are needed. […] In conclusion, the circulating microRNAs validated demonstrate a better diagnostic potential than conventional serum markers to identify NASH patients and could complement and improve current fibrosis prediction algorithms. […] NAFLD has a global prevalence of 24% and involves a high risk of liver-related morbidity and mortality along with metabolic comorbidities. […] NASH, with a prevalence among biopsied NAFLD patients of 59%, and advanced fibrosis have been associated with a risk of evolution to cirrhosis and hepatocellular carcinoma, and increased liver-related and cardiovascular mortality. […] Therefore, identifying patients with NASH is a key clinical issue.
#1 Non-invasive score identifies ultrasonography-diagnosed non-alcoholic fatty liver disease and predicts mortality in the USA | BMC Medicine | Full Text
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0154-x
Several non-invasive prediction scores for non-alcoholic fatty liver disease (NAFLD) have been developed, but their performance has not been compared and validated in the same population, and whether these prediction scores can predict clinical outcomes remains unknown. […] In this study, we aimed to validate and compare the performance of four NAFLD prediction scores: fatty liver index, hepatic steatosis index, lipid accumulation product, and NAFLD liver fat score (LFS), and to evaluate the ability of the best NAFLD prediction score to predict mortality. […] LFS is the best non-invasive prediction score for NAFLD, and people with a high LFS score have an increased risk for cardiovascular and liver-related mortality. […] During a median follow-up of 14.7 years (range 0.1 to 18.2 years) and 83,830.5 person-years, participants in the high LFS group (LFS 1.257) had a higher cardiovascular and liver-related mortality than participants in the low (LFS1.413; cardiovascular hazard ratio (HR)=2.24, 95% CI 1.03 to 4.88; liver HR=31.25, 95% CI 3.13 to 333.33) or intermediate (-1.413LFS1.257; cardiovascular HR=2.3, 95% CI 1.19 to 4.48; liver HR=30.3, 95% CI 4 to 250) LFS groups in the fully adjusted model.
#1
https://link.springer.com/article/10.1007/s11606-020-05725-1
Our model has excellent predictive ability to identify the development of hepatic decompensation in NAFLD patients up to 12 years from the time of diagnosis. […] A simple objective model composed of age, presence of diabetes, and platelet count may reliably help identify NAFLD patients at high risk of developing hepatic events before the development of clinically obvious cirrhosis.
#1 Non-invasive prediction of NAFLD severity: a comprehensive, independent validation of previously postulated serum microRNA biomarkers | Scientific Reports
https://www.nature.com/articles/s41598-018-28854-4
For these reasons, several clinical prediction rules and blood-based biomarkers have been developed as attractive and affordable non-invasive alternatives for identification of patients at risk for NASH and advanced fibrosis. […] The trend on miRNA biomarkers has not gone unnoticed to researchers focusing on NAFLD diagnosis and 14 studies on circulating miRNA biomarkers in NAFLD patients have been published in the last years. […] In the present study we have reexamined the predictive value for NASH and fibrosis of all the serum microRNAs postulated so far, and compared their performance with that of conventional serum-based clinical biomarkers and predictive algorithms, in a cohort of patients with biopsy proven NAFLD. […] In summary, from the 16 miRNAs previously postulated as biomarkers for NAFLD diagnosis and severity, we confirm that -27b, -34a, -22, -122, -192 and -21 are induced and -30c, -16 and -197 are repressed in the serum of severely diseased NAFLD patients.
#1 Non-invasive prediction of NAFLD severity: a comprehensive, independent validation of previously postulated serum microRNA biomarkers | Scientific Reports
https://www.nature.com/articles/s41598-018-28854-4
However, only three of them (-27b, -16 and -30c) were found consistently altered in both NASH and severe fibrosis. […] Our results support that the research in this field is still open and that the validated miRNAs of this study can become useful biomarkers for the diagnosis of NAFLD patients at risk, especially by complementing and improving current or future prediction algorithms.
#1 Machine learning prediction of hepatic steatosis using body composition parameters: A UK Biobank Study | npj Aging
https://www.nature.com/articles/s41514-023-00127-z
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease worldwide, yet detection has remained largely based on surrogate serum biomarkers, elastography or biopsy. […] We found several significant associations with traditional measurements such as abdominal obesity, as defined by waist-to-hip ratio (OR=2.50 (male), 3.35 (female)), android-gynoid ratio (OR=3.35 (male), 6.39 (female)) and waist circumference (OR=1.79 (male), 3.80 (female)) with hepatic steatosis. […] Overall, this study underscores the potential utility of DXA as a practical and potentially opportunistic method for the screening of hepatic steatosis. […] Lifestyle modification, as with other chronic diseases, is the cornerstone of NAFLD management regardless of the disease stage, so while end-stage liver disease has a poor prognosis, NAFLD is clinically manageable at its early onset.
#1 Non-alcoholic fatty liver disease (NAFLD): a significant predictor of gestational diabetes mellitus (GDM) and early pregnancy miscarriagesâprospective study in Rajarata Pregnancy Cohort (RaPCo) | BMJ Open Gastroenterology
https://bmjopengastro.bmj.com/content/9/1/e000831
Non-alcoholic fatty liver disease (NAFLD) is increasing globally with a mounting body of evidence on various adverse effects on pregnancy. […] In this rural south Asian community, NAFLD is shown to be a major risk factor for GDM and early pregnancy miscarriages. […] Fatty liver grade II is shown to be an independent predictor of GDM and early pregnancy miscarriages. […] Routine identification of NAFLD through simple non-invasive ultrasound scan may help in early identification of high-risk mothers, hence early interventions to improve maternal morbidity. […] The cumulative incidences of miscarriages among FLG 0, I, and II were 35, 76, and 159 per 1000 pregnancies. […] The adjusted OR for FLG II compared with both FLG 0 and FLG I was calculated after adjusting for age, parity, blood pressure, blood sugar, haemoglobin, and BMI, and FLG II remained the only independent predictor of miscarriages with a higher level of statistical significance even after adjusting for the above confounding factors (adjusted OR 4.2, 95% CI (1.9 to 9.1). […] FLG II, diagnosed by a simple USS, is a major predictor of GDM and early pregnancy miscarriage.
#1 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
The vast geographical spread of Asia, the regional diversity in terms of economic development, diet and lifestyle amongst different countries and also within countries along with possible genetic influences are factors that account for wide variation of NAFLD prevalence among Asian areas. […] NAFLD prevalence follows almost the similar trends with Asian countries bearing the brunt of the emerging burden of NAFLD. […] The burden of NAFLD, with clinically relevant fibrosis affecting up to 20% of those with both NAFLD and T2DM, seems to be enormous considering the huge number of patients with T2DM worldwide. […] The relationship between Diabetes and NAFLD is much tighter than an association alone, indicate shared pathophysiology and as a clinical condition have a temporal course in which either can predate before co existing.
#1 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
NAFLD and aging are strongly correlated and increasing age is one of the most robust epidemiological factors for NAFLD, NASH and fibrosis. […] Older age is not only a risk factor for hepatic steatosis, but also individuals with older age have a greater likelihood of mortality and disease progression to fibrosis and hepatocellular carcinoma. […] The influence of sex on NAFLD prevalence and course, however, is not so straightforward. […] Racial differences in prevalence of NAFLD have been most evident in the studies from USA that involved multiethnic populations. […] Lean NAFLD constitutes from 720% of NAFLD subjects in different studies. […] Well-designed prospective study on the incidence of lean NAFLD is scarce. […] NAFLD is the second commonest indication for liver transplant (LT) in USA and Europe. […] NAFLD prevalence is showing a fairly steady upslope in most of the populations over time in the last two decades. […] The epidemiological trends of NAFLD parallels the changes in prevalence of obesity, diabetes and other NCDs that accompany this social transition.
#1 Nonalcoholic Fatty Liver Disease (NAFLD)
https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/
Nonalcoholic fatty liver disease (now called MASLD) may be suspected if blood tests show higher than normal levels of liver enzymes. […] There are no medications approved yet for nonalcoholic fatty liver disease (now called MASLD). Eating a healthy diet and adding physical movement to your day may help prevent liver damage from starting or reverse it in the initial stages. […] While NAFLD (now called MASLD) can affect people of all ages, sexes, and ethnicities, it is important to consider its specific implications during pregnancy and in those intending to become pregnant. […] Once NAFLD is determined, management of the condition focuses on lifestyle interventions (health dietary modifications and appropriate physical activities permitted during pregnancy) as there are no approved medications for NAFLD in pregnancy. […] Ultimately, close monitoring during pregnancy is crucial to reduce risks and improve outcomes for both the mother and her child.
#1 Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00980-1
Bariatric and metabolic surgery has not been taken into account as treatment option in many meta-analyses to date, despite the increasing body of evidence and properly designed studies on this subject. […] Lassailly et al. found that bariatric and metabolic surgery results in resolution of NAFLD/NASH in the majority of the patients (64.2% in patients that underwent Roux-Y Gastric Bypass (RYGB) and 5.5% in Sleeve Gastrectomy (SG)). […] A meta-analysis on 48 studies showed that the combination of pioglitazone and Roux-en Y Gastric Bypass surgery had the best effects on the NAFLD Activity Score. […] It has to be said that a small proportion of the patients undergoing bariatric and metabolic surgery develop NASH or suffer from aggravation of the disease (NAFLD/NASH/ live fibrosis) after bariatric surgery.
#1 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
NASH is the fastest emerging cause of liver transplantation in the United states, UK and also in the developing countries. […] The excess cardiovascular risk in fatty liver has been reported even in populations with relatively low background adiposity as measured by BMI, indicating a biological link between the insulin resistance (IR) is the cellular abnormality that underlies the diverse disorders that are popularly placed under the term metabolic syndrome (MS). […] NAFLD epidemiology is intricately linked with the changing burden and epidemiology of NCD s that is currently underway globally. […] One of the important caveats of NAFLD epidemiology is non-availability of a disease-specific biomarker that is powerful and simple for large scale population-based studies. […] In general, studies requiring abnormal liver blood tests to make the diagnosis of NAFLD have reported much lower prevalence estimates compared with studies that use imaging methods.
#1
https://www.xiahepublishing.com/2310-8819/JCTH-2019-00051
Nonalcoholic fatty liver disease (NAFLD) is a systemic disorder with a complex multifactorial pathogenesis and heterogenous clinical manifestations. NAFLD, once believed to be an innocuous condition, has now become the most common cause of chronic liver disease in many countries worldwide. A subset of patients with NAFLD develops progressive liver disease leading to cirrhosis, hepatocellular carcinoma, and liver failure. NAFLD has emerged as one of the leading causes of cirrhosis and hepatocellular carcinoma in recent years. Compared with the general population, NAFLD increases the risk of liver-related, cardiovascular and all-cause mortality. […] The risk of developing progressive liver disease and associated extrahepatic diseases presents a challenge to the healthcare system to develop effective strategies in order to prevent an exponential increase in morbidity and mortality related to it.
#1 Machine learning prediction of hepatic steatosis using body composition parameters: A UK Biobank Study | npj Aging
https://www.nature.com/articles/s41514-023-00127-z
Early detection of NAFLD is important in order that timely intervention can be prescribed to patients (e.g., lifestyle and diet modification) by healthcare practitioners. […] As NAFLD cases rise to epidemic proportions, new tools that can potentially be used as opportunistic screening may be helpful particularly as early detection is important.
#1 Predicting Liver-Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests – PubMed
https://pubmed.ncbi.nlm.nih.gov/34783191/
Patients who developed liver-related complications were also more likely to have baseline high-risk FIB-4 scores or ELF test 9.8 compared to patients who did not develop liver outcomes. […] Liver fibrosis risk stratification in non-hepatology settings can identify the subset of patients at risk of liver-related complications. […] Although the rate of development of a decompensation event or hepatocellular carcinoma was low (2.1% per year) in our patients with compensated cirrhosis (LSM 13 kPa), these events are projected to lead to a substantial increase in NAFLD-related disease burden over the next decade due to the high prevalence of NAFLD in people with obesity and T2D.
#1 Non-alcoholic fatty liver disease is associated with a worse prognosis in patients with heart failure: A pool analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC10157242/
Furthermore, NAFLD was associated with a 66% increased risk of all-cause mortality (HR 1.66, 95% CI 1.39-1.98, I2 = 0%) in HF patients, and a 71% increased risk of HF hospitalization or re-hospitalization (HR 1.71, 95% CI 1.03-2.86, I2 = 91%) compared with those without NAFLD. […] Based on our findings, there are some clinical recommendations that should be proposed in the management of HF. Considering the prevalence of NAFLD, screening for NAFLD in patients with HF may provide effective detection of the disease, timely interventions and reduce the risk of adverse outcomes. […] NAFLD is associated with an increased risk of adverse outcomes in patients with HF. Effective screening and treatment strategies for NAFLD should be considered to improve the prognosis in HF patients.
#2 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. […] NAFL typically follows an indolent course, whereas patients with NASH are at higher risk of death from cardiovascular disease, cancer, and end-stage liver disease. […] Differentiating NAFL from NASH is important because they have different prognoses. NAFL follows a more indolent course, whereas patients with NASH are at risk of progression from fibrosis to cirrhosis and development of hepatocellular carcinoma. […] 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.
#2 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology
https://fg.bmj.com/content/5/3/211
Knowledge of whether a patient has simple steatosis or NASH is very important prognostically. Subjects with simple steatosis have a good long-term prognosis with low rates of liver-related morbidity and mortality, and therefore do not require specific liver-related treatment. However, patients with NASH can progress to cirrhosis and therefore should be more actively managed to try and prevent disease progression. […] The risk of NAFLD/NASH is directly related to the presence and severity of the metabolic syndrome. […] Simple steatosis carries a benign prognosis. […] NASH carries poor prognosis with increased liver-related and cardiovascular mortality.
#2
https://link.springer.com/article/10.1007/s11606-020-05725-1
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA. […] We aimed to determine the time to develop hepatic events in patients with NAFLD and develop a simple model to identify patients at risk for hepatic decompensation. […] A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify at-risk patients. […] The degree of liver fibrosis is one of the most significant predictors of risk of cirrhosis and hepatic decompensation. […] The incidence of decompensated cirrhosis from NAFLD is on the rise with liver-related complications seen in up to 20% of NAFLD patients, and liver-related death or need for liver transplantation in up to 13%. […] Based on our study, the incidence of hepatic decompensation in NAFLD patients without cirrhosis is around 5% at 5 years and 10% at 10 years.
#2 Predicting Liver-Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests – PubMed
https://pubmed.ncbi.nlm.nih.gov/34783191/
Patients who developed liver-related complications were also more likely to have baseline high-risk FIB-4 scores or ELF test 9.8 compared to patients who did not develop liver outcomes. […] Liver fibrosis risk stratification in non-hepatology settings can identify the subset of patients at risk of liver-related complications. […] Although the rate of development of a decompensation event or hepatocellular carcinoma was low (2.1% per year) in our patients with compensated cirrhosis (LSM 13 kPa), these events are projected to lead to a substantial increase in NAFLD-related disease burden over the next decade due to the high prevalence of NAFLD in people with obesity and T2D.
#2 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
Accumulation of excessive fat in the liver is the common denominator underlying the two most common and emerging causes of chronic liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), that are emerging public health issues globally. […] In NAFLD, death is most commonly due to cardiovascular disease and often non-hepatic cancers apart from liver disease. […] Presence and the grade of Fibrosis are most important prognostic determinant in NAFLD and NASH is classically considered to be the phenotype of NAFLD that underlie development of progressive liver disease, particularly fibrosis and therefore, is clinically relevant. […] The public health importance of NAFLD stems from its multifaceted impact on morbidity, mortality and health care utilization globally. NAFLD and particularly, NASH fibrosis is associated with an excess all-cause mortality and also liver related mortality in general population.
#2 Nonalcoholic Fatty Liver Disease (NAFLD)
https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/
Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the buildup of extra fat in liver cells that is not caused by alcohol. […] The more advanced form of NAFLD is nonalcoholic steatohepatitis (NASH), now called metabolic dysfunction-associated steatohepatitis (MASH). NASH causes the liver to swell and become damaged. […] Current medical recommendations suggest the importance of discussing the NAFLD/heart disease connection with a health care provider if you have NAFLD. Although you may be worried about your liver health, death from cardiovascular disease (CVD) is more common than liver complications among people with fatty liver. […] Nonalcoholic fatty liver disease (now called MASLD) can get worse and cause liver inflammation (enlargement or swelling) and damage called nonalcoholic steatohepatitis (NASH, which has been renamed MASH). Cirrhosis (scar buildup) can develop if NASH advances. Early diagnosis of NAFLD, along with following medical advice, can reduce a persons chance NAFLD progressing to NASH and cirrhosis.
#2 Predicting Liver-Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests – PubMed
https://pubmed.ncbi.nlm.nih.gov/34783191/
It remains unclear whether screening for advanced fibrosis in the community can identify the subgroup of people with nonalcoholic fatty liver disease (NAFLD) at higher risk for development of liver-related complications. […] We aimed to determine the prognostic value of baseline noninvasive fibrosis tests for predicting liver-related outcomes and mortality in patients with NAFLD from type 2 diabetes (T2D) clinics or primary care. […] During a median follow-up of 50 months, decompensated liver disease or primary liver cancer occurred in 6 of 35 (17.1%) patients with baseline LSM 13 kPa, 1 of 17 (5.9%) patients with LSM 9.5-13 kPa, and in no patients with LSM 9.5 kPa. […] No patient with low-risk NFS developed liver decompensation or liver-related mortality. […] Following repeat NFSs at the end of follow-up, all patients with a liver-related complication were in the high-risk NFS category.
#2 Machine learning prediction of hepatic steatosis using body composition parameters: A UK Biobank Study | npj Aging
https://www.nature.com/articles/s41514-023-00127-z
Early detection of NAFLD is important in order that timely intervention can be prescribed to patients (e.g., lifestyle and diet modification) by healthcare practitioners. […] As NAFLD cases rise to epidemic proportions, new tools that can potentially be used as opportunistic screening may be helpful particularly as early detection is important.
#3 Epidemiology of non-alcoholic and alcoholic fatty liver diseases – Mitra – Translational Gastroenterology and Hepatology
https://tgh.amegroups.org/article/view/5499/html_2
NASH is the fastest emerging cause of liver transplantation in the United states, UK and also in the developing countries. […] The excess cardiovascular risk in fatty liver has been reported even in populations with relatively low background adiposity as measured by BMI, indicating a biological link between the insulin resistance (IR) is the cellular abnormality that underlies the diverse disorders that are popularly placed under the term metabolic syndrome (MS). […] NAFLD epidemiology is intricately linked with the changing burden and epidemiology of NCD s that is currently underway globally. […] One of the important caveats of NAFLD epidemiology is non-availability of a disease-specific biomarker that is powerful and simple for large scale population-based studies. […] In general, studies requiring abnormal liver blood tests to make the diagnosis of NAFLD have reported much lower prevalence estimates compared with studies that use imaging methods.