Estimating global prevalence,incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis

Background:The increasing burden of non-alcoholic fatty liver disease (NAFLD) worldwide imposes an emerging public health issue. We perform the current study to estimate the global prevalence, incidence, disease progression, and clinical outcomes of NAFLD.Methods:A systematic search was conducted in Medline, Embase, Web of Science, Google Scholar, and Cochrane CENTRAL that screened articles in English language published from January 2000 to December 2021. NAFLD prevalence, incidence, rate of disease progression, and outcomes were calculated with the DerSimonian-Laird random effects model with arcsine transformation.Results:Our search identified 59,156 records, of which 578 studies fulfilled our inclusion criteria. The overall prevalence of NAFLD was 29.38% (95% confidence interval [CI] 28.09–30.69) regardless of the diagnostic techniques. Looking at the group in which the diagnosis was made by ultrasound exclusively, the pooled prevalence was 30.49% (95% CI 29.55–31.43). NAFLD has become more prevalent during the year 2011–2021 (31.63%, 95% CI 30.23–33.04) compared with year 2000–2010 (27.94%, 95% CI 26.23–29.69). The pooled estimation of non-alcoholic steatohepatitis prevalence was 8.26% (95% CI 1.13–21.01), 46.49% (95% CI 35.93–57.20), and 46.72% (95% CI 37.57–55.98) in general population, NAFLD patients, and severe/morbidly obese patients, respectively. Based on a total of 110,142 newly developed NAFLD patients, the pooled incident rate was estimated as 46.24 cases per 1000 person-years (95% CI 43.21–49.30). In patients with NAFLD, the incident rate of hepatocellular carcinoma was 1.46 (95% CI 0.90–2.03) cases per 1000 person-years. The overall pooled estimate of NAFLD related mortality was 23.91 (95% CI 13.55–37.18) death per 1000 person-years.Conclusions:The prevalence of NAFLD is increasing globally. It is contributing to poor clinical outcomes including hepatocellular carcinoma and death. Rising awareness and urgent actions are warranted to control the NAFLD pandemic across the globe.Registration:PROSPERO, No. CRD42020171104.     

Therapeutic developments in metabolic dysfunction-associated fatty liver disease

Metabolic dysfunction-associated fatty liver disease (MAFLD) has become one of the most prevalent chronic liver diseases worldwide, bringing risk of multiorgan disfunctions including cardiovascular events, complications of cirrhosis, and even malignance. In terms of health burden management, screening patients with high risk of MAFLD and providing individual comprehensive treatment is critical. Although there are numerous agents entering clinical trials for MAFLD treatment every year, there is s...     

杭州市下沙街道中老年居民非酒精性脂肪性肝病患病率流行病学调查

目的调查杭州市下沙街道中老年居民非酒精性脂肪性肝病患病率及其主要的危险因素。方法通过对下沙街道12个社区45～95岁居民进行调查,调查的内容涉及问卷调查、体格检查、生化检测及肝胆B超检查、心电图、胸透。结果 2660例成人（男性727例,女性1933例）完成健康体检,完全健康者305人（男性123人,女性182人）,患有各种慢性病的有2355人;其中有非酒精性脂肪性肝病786例（男性169例,女性617例）,患病率为29.54%,单因素分析结果显示,糖尿病、高血糖？高血脂、高血压、超重肥胖等指标与非酒精性脂肪性肝病密切相关。结论下沙街道中老年居民非酒精性脂肪性肝病患病率高,与糖尿病、高血糖？高血脂、超重肥胖及高血压关系密切。     

MAFLD vs. NAFLD: shared features and potential changes in epidemiology,pathophysiology, diagnosis,and pharmacotherapy

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, placing an increasing burden on human health. NAFLD is a complex multifactorial disease involving genetic, metabolic, and environmental factors. It is closely associated with metabolic syndrome, obesity, and type 2 diabetes, of which insulin resistance is the main pathophysiological mechanism. Over the past few decades, investigation of the pathogenesis, diagnosis, and treatments has revealed different aspects of NAFLD, challenging the accuracy of definition and therapeutic strategy for the clinical practice. Recently, experts reach a consensus that NAFLD does not reflect the current knowledge, and metabolic (dysfunction) associated fatty liver disease (MAFLD) is suggested as a more appropriate term. The new definition puts increased emphasis on the important role of metabolic dysfunction in it. Herein, the shared features and potential changes in epidemiology, pathophysiology, diagnosis, and pharmacotherapy of the newly defined MAFLD, as compared with the formerly defined NAFLD, are reviewed for updating our understanding.     

Primary non-alcoholic fatty liver disease in hypertensive patients

Background

Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease affecting 15–25% of the general population.

Aims

The aim of this study was to investigate the prevalence of NAFLD and the relationship between insulin sensitivity and NAFLD in grade III high and very high cardiovascular additional risk essential hypertensive patients according to the circadian blood pressure (BP) rhythm.

Method

This four-year prospective study was conducted at the Department of Internal Medicine at Cluj-Napoca’s Diagnosis and Treatment Centre in Romania. The study included grade III essential hypertensive patients. Hypertensive patients were divided into four groups according to the diurnal index (DI) from ABPM monitoring: dipper (D), non-dipper (ND), reverse-dipper (RD), and extreme-dipper (ED). All hypertensive patients underwent 24 ABPM, blood tests and abdominal ultrasonography for the diagnosis of fatty liver disease.

Results

Thirty-five hypertensive patients were included in the study, with 31.42% ND, 11.43% RD, 8.57% ED and 48.57% D. The prevalence of NAFLD was significantly higher in ND, RD and ED when compared to D. When compared to the dipper group of hypertensive patients a statistically significantly higher level of plasma insulin was observed: in non-dipper [86.3±17.9pmol/l vs. 62.2±203pmol/l, p<0.05], in reverse dipper [88.3±18.6pmol/l vs. 62.2±20.3pmol/l] and in extreme-dippers [86.7±16.88pmol/l vs. 62.2±20.3 pmol/l, p<0.05].

Conclusion

The altered dipping status (ND, RD, ED) of hypertension associated with a higher insulin resistance could be the pathogenetic link between the NAFLD and altered blood pressure status. Altered BP status could be a marker of NAFLD in hypertensive patients.     

Association between Serum Uric Acid to HDL-Cholesterol Ratio and Nonalcoholic Fatty Liver Disease Risk among Chinese Adults

Objective The aim of this case-control study was to explore the association between serum uric acid to high density lipoprotein cholesterol ratio(UHR) and the risk of nonalcoholic fatty liver disease(NAFLD) in Chinese adults.Methods A total of 636 patients with NAFLD and 754 controls were enrolled from the Affiliated Hospital of Qingdao University, China, between January and December 2016. All patients completed a comprehensive questionnaire survey and underwent abdominal ultrasound examination ...     

Retinol-binding protein-4 and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common as the global economy grows and living standards improve. Timely and effective preventions and treatments for NAFLD are urgently needed. Retinol-binding protein-4 (RBP4), the protein that transports retinol through the circulation, was found to be positively related to diabetes, obesity, cardiovascular disease, and other metabolic diseases. Observational studies on the association between serum RBP4 level and the prevalence of NAFLD found contradictory results. Some of the underlying mechanisms responsible for this association have been revealed, and the possible clinical implications of treating NAFLD by targeting RBP4 have been demonstrated. Future studies should focus on the predictive value of RBP4 on NAFLD development and its potential as a therapeutic target in NAFLD.     

Burden of Cirrhosis and Other Chronic Liver Diseases Caused by Specific Etiologies in China, 1990-2016:Findings from the Global Burden of Disease Study 2016

Objective To estimate the burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China.Methods Data from the Global Burden of Disease Study 2016(GBD 2016) were used. We evaluated the burden by analyzing age-sex-province-specific prevalence, mortality, and disability-adjusted lifeyears(DALYs) of 33 provinces in China.Results From 1990 to 2016, prevalence cases in thousands increased by 73.7% from 6833.3(95% UI:6498.0–7180.6) to 11869.6(95% UI: 11274.6–12504.7). Age-standardized mortality and DALY rates per100,000 decreased by 51.2% and 53.3%, respectively. Male and elderly people(aged ≥ 60 years)preponderance were found for prevalence, mortality, and DALYs. The number of prevalence cases,deaths, and DALYs due to hepatitis C virus(HCV) increased by 86.6%, 8.7%, and 0.9%, respectively. Also,age-standardized prevalence rates decreased in 31 provinces, but increased in Yunnan and Shandong.The Socio-demographic Index(SDI) values were negatively correlated with age-standardized mortality and DALY rates by provinces in 2016; the correlation coefficients were-0.817 and-0.828, respectively.Conclusion Cirrhosis and other chronic liver diseases remain a huge health burden in China, with the increase of population and the aging of population. Hepatitis B virus(HBV) remains the leading cause of the health burden in China.     

Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease

Abstract

Background. Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis.

Aims. The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied.

Methods. MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups.

Results. Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels.

Conclusions. The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.     

Association between nonalcoholic fatty liver disease and Helicobacter pylori infection in Dali City,China

Objectives:To investigate whether gastric Helicobacter pylori (H. pylori) infection is associated with the progress of nonalcoholic fatty liver disease (NAFLD) in Dali city, China.Methods:One thousand and one hundred eighty-five adults who had visited a health examination center were enrolled. Nonalcoholic fatty liver disease and H. pylori infection were assessed by abdominal color ultrasound and ¹³C-urea breath test, respectively. Serum lipid metabolic indices were compared between NAFLD subjects without and with H. pylori infection.Results:The prevalence rate of NAFLD for the entire study population (n=1185) was 44.6% (n=529), including 167 women and 362 men. Among 529 NAFLD subjects, H. pylori was confirmed as a significant and independent risk factor for NAFLD (95% CI 1.02-1.79, p=0.036, OR =1.35). Compared with H. pylori non-infected individuals (n=721), higher contents of LDL-C (p=0.012) along with TC (p=0.014) were also observed in H. pylori-infected individuals (n=464).Conclusion:A positive correlation is identified between H. pylori infection and NAFLD.     

Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016

INTRODUCTIONFew studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016.METHODSWe extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses.RESULTSThe prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status.CONCLUSIONThe prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.     

Age and gender differences in the prevalence of chronic diseases and atherosclerotic cardiovascular disease risk scores in adults in Riyadh city,Saudi Arabia

Objectives:To evaluate age and gender differences in the prevalence of chronic diseases and to calculate atherosclerotic cardiovascular disease (ASCVD) risk scores in adults aged 30-75 years in Riyadh city, Saudi Arabia.Methods:This cross-sectional, interview-based study was conducted with 2997 men and women, visiting primary health care centers in Riyadh, during the years 2015 to 2016. Serum glycosylated hemoglobin and lipid levels were measured by ion-exchange high-performance liquid chromatography and fully automated analyzer using enzymatic methods, respectively. The 10-year and lifetime ASCVD risk scores were calculated using an online calculator.Results:The mean age of men was 43.1 (±11.7) and women was 43.8 (± 10.9) years. Prevalence rates of diabetes mellitus, hypertension, hypercholesterolemia, and obesity in men versus women were 20.3% versus 24.8% (p=0.006), 15% versus 19.5% (p=0.003), 50.7% versus 53.4% (p=0.16), and 41.2% versus 56.7% (p<0.001), respectively. Majority of men and women with chronic diseases belonged to the age groups 30-39 and 50-59 years, respectively. High 10-year ASCVD risk was found in 32% men and 7.6% women, whereas lifetime risk was present in 67% and 51%, respectively.Conclusion:Women in the age group 50-59 years, with multiple risk factors are at a greater risk of developing cardiovascular diseases than men of same age. Young adults were at more risk for lifetime ASCVD, whereas the 10-year ASCVD risk increased with increasing age.     

多囊卵巢综合征中非酒精性脂肪肝患病情况及相关危险因素分析

目的研究宁夏汉族与少数民族多囊卵巢综合征(PCOS)患者中非酒精性脂肪肝(non-alcoholic fattyliver,NAFLD)患病情况及其发生相关因素。方法对2006年7月-2008年2月就诊我院生殖医学中心的137例血清病毒肝炎标志物阴性、无饮酒嗜好的PCOS患者,按肝脏B超分为非酒精性脂肪肝(NAFLD)与无脂肪肝组(N-NAFLD),比较组间各项临床、生化、代谢指标。结果 (1)PCOS患者中NAFLD发生率为34.31%;不同民族、婚育状况患者NAFLD发生率差异无统计学意义;肥胖患者NAFLD发生率62.96%(34/54)显著高于非肥胖患者15.6%(13/83),χ2=32.48,P<0.01。(2)NAFLD组年龄、不孕年限、BMI、睾酮、空腹胰岛素(FINS)、服糖2h胰岛素(2h-INS)、Homa-IR、甘油三酯(TG)、总胆固醇脂(CHOL)、谷丙、谷草转氨酶(AST、ALT)显著高于N-NAFLD组(t=3.49、2.54、6.81、3.27、4.483、.85、4.52、3.47、2.55、3.68、4.33,P<0.05);肥胖、肝功能异常、高睾酮血症、高TG、低HDL血症、空腹及服糖2h高胰岛素血症NAFLD组显著高于N-NAFLD组(χ2=32.48、25.051、0.70、19.68、8.91、20.47、14.23,P<0.01)。(3)NAFLD中肝功能异常者占31.91%(15/47),其年龄、睾酮、TG显著高于肝功能正常组(t=2.65、2.09、2.65,P<0.05)。结论 (1)PCOS患者NAFLD发生率34.31%;肥胖、胰岛素抵抗、高TG、高睾酮、高龄是PCOS患者发生NAFLD的危险因素;年龄增加、高睾酮、高TG与NAFLD病情进展有关。对所有PCOS包括未婚者,尤其是肥胖患者,均应注意肝脏B超检查,以便及早发现NAFLD,及时干预预防或延缓肝硬化的发生。     

体检人群非酒精性脂肪肝病的流行现状及其与代谢综合征的关系

目的了解体检人群非酒精性脂肪肝病（NAFLD）的患病现状及其与代谢综合征的关系。方法收集体检人群资料,进行统计学分析。结果①NAFLD总患病率9.1%,女性患病率高于男性（P〈0.05）;②腰围、甘油三酯、体重指数进入多因素Logistic（P〈0.05）;③NAFLD组中代谢综合征患病率16.1%,高于非NAFLD组的5.2%（P〈0.05）。结论体检人群NAFLD患病率高,其中女性、年龄增长、肥胖、腹型肥胖、高甘油三酯血症是其危险因素;NAFLD患者存在明显的代谢综合征各组分集聚的特征。     

肥胖性高血压患者并发非乙醇性脂肪性肝病的危险因素分析

目的探讨肥胖性高血压患者并发非乙醇性脂肪性肝病(NAFLD)的患病率及其危险因素。方法 732例肥胖性高血压患者住院期间经腹部超声检查和采集病史筛查NAFLD,观察其患病率及其危险因素。结果肥胖性高血压患者并发NAFLD的患病率为40.3%(295/732)。NAFLD组冠状动脉粥样硬化性心脏病(简称冠心病)、糖尿病、代谢综合征(MS)的患病率及血清总胆固醇、血尿酸、丙氨酸转氨酶水平均高于非NAFLD组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示冠心病和总胆固醇水平是肥胖性高血压患者NAFLD的相关危险因素。结论肥胖性高血压并发NAFLD患者与MS等多代谢异常密切相关,冠心病是其相关危险因素。     

体重指数与2型糖尿病患者非酒精性脂肪性肝病的关系

对我院健康体检中心311例新诊断2型糖尿病患者及从既往无糖尿病病史且糖耐量正常的体检者中随机选取的366例体检者（对照组）,进行病史询问、体检及血糖、肝肾功能、血脂、腹部彩色超声等检查,分析其非酒精性脂肪性肝病（NAFLD）患病情况。结果显示,对照组366例共检出NAFLD67例（患病率18．3％）,其中轻度51例（患病率13．9％）,中度15例（4．1％）,重度1例（0．3％）。311例新诊断的2型糖尿病患者中共检出NAFLD144例（患病率46．3％）,其中轻度85例（患病率27．3％）,中度53例（17．0％）,重度6例（1．9％）。糖尿病患者体重指数（BMI）〈23．0kg／m2组、23．0～24．9kg／m2组和25．0—29．9kg／m2组中NAFLD患病率及轻中重度脂肪肝患病率明显高于对照组（均P〈0．01）;当BMI≥30kg／m2时,两组NAFLD患病率差异无统计学意义（P〉0．05）。两组NAFLD的患病率均随BMI的增加而升高,当BMI≥25．0ks／m2时升高最为明显,明显高于BMI〈25kg／m2者（P〈0．01）。且随着BMI的增加,2型糖尿病患者合并代谢综合征的患病率亦明显升高。提示,2型糖尿病患者NAFLD患病率较高,伴肥胖患者更易发生NAFLD。     

2型糖尿病患者合并非酒精性脂肪肝的临床观察

目的：观察2型糖尿病患者（T2DM）合并非酒精性脂肪肝（NAFLD）的临床特点,分析T2DM合并NAFLD的危险因素。方法：选取138例住院的T2DM患者,分别测量血压、身高、体重,计算体质指数（BMI）;同时测定空腹血糖（FPG）、餐后2小时血糖（2hPG）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、空腹胰岛素（FINS）及餐后2小时胰岛素（PINS）。所有对象依B超检查结果是否脂肪肝分为NAFLD组（54例）和非脂肪肝（NFLD）组（84例）。对两组相关指标进行对比分析。结果：T2DM中NAFLD的患病率为39.2%,NAFLD组血清肝酶水平升高者为69.23%;T2DM合并NAFLD组患者BMI、TG、FINS、PINS水平明显升高（P＜0.05或P＜0.01）。结论：T2DM患者中NAFLD呈现较高的患病率;BMI、TG、FINS、PINS可能是T2DM合并NAFLD的主要危险因素。     

非肥胖型原发性高血压患者非酒精性脂肪性肝病的临床特点及危险因素分析

目的探讨非肥胖型原发性高血压(EH)非酒精性脂肪性肝病患者(NAFLD)的临床特点及其危险因素。方法非肥胖型EH患者377例住院期间经腹部超声检查和采集病史筛查NAFLD,观察其临床特点、肝酶学异常的比例及其危险因素。结果非肥胖型EH患者伴发NAFLD患者发生率为31.6%(119/377)。NAFLD组男性比例,糖尿病、代谢综合征的发生率,血清TG水平均高于非肥胖型EH患者未伴发NAFLD组(P<0.05,P<0.01)。多因素Logistic回归分析表明,男性、糖尿病、TG水平是非肥胖型EH患者伴发NAFLD的独立危险因素。结论非肥胖型EH伴发NAFLD患者与MS等多代谢异常密切相关,男性是其独立危险因素。     

非酒精性脂肪性肝病相关因素分析

目的：探讨非酒精性脂肪性肝病（Nonalcoholic fatty liver disease，NAFLD）的相关因素，提高对NAFLD的认识。方法：对进行常规体检的1836例体检者进行身高、体重、血压、血脂、血糖、肝脏功能及肝脏超声检查，提取NAFLD者的临床资料与非NAFLD者进行对照分析。结果：1836例体检者共检出NAFLD222例，占12．09％。其中，血清转氨酶增高者55倒，占24．77％，脂肪性肝硬化3例，占1．35％。年龄28岁～77岁，平均54．6岁，明显高于非NAFLD者的平均年龄38．8岁（P〈0．05）。男性108例，占48．65％；女性114例，占51．35％，排除性别构成的影响，男性NAFLD的患病率为12．05％，女性NAFLD的患病率为12．13％。两者比较，差异无统计学意义（P〉0．05）。NAFLD组与非NAFLD组比较，NAFLD组肥胖、高血糖、高血脂所占比例明显高于非NAFLD组（P〈0．05），而高血压者所占比例在两组无显著差异（P〉0．05）。结论：NAFLD的发生与年龄、肥胖、高血糖、高血脂有密切关系，临床上应加强对其相关因素的干预，预防NAFLD的发生。