Global burden of non-alcoholic fatty liver disease in 204 countries and territories from 1990 to 2019

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a growing epidemic linked to metabolic disease and is the most prevalent cause of chronic liver disease. We, therefore, designed the study to analyze the global and regional burden of NAFLD from 1990 to 2019.MethodsWe collected data on NAFLD from the Global Burden of Disease study 2019, aiming to conduct a systematic assessment of the changes and trends in NAFLD in 204 countries. Secondary analysis of NAFLD was conducted using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) to show the changing trends and development characteristics. Data statistics and visualization were executed with the R program.ResultsGlobally, incidence, deaths and disability-adjusted life years (DALYs) of NAFLD all showed an upward trend. Between 1990 and 2019, the incidence of NAFLD increased by 95.4%, from 88,177 to 172,330 cases. Meanwhile, the ASIR of the middle SDI region had the highest increase, followed by the low-middle SDI region. Of all countries, the most incident cases were in China, which accounted for approximately 23.6% of NAFLD. China was also the country with the largest cases of deaths and DALYs. And behavioral risk, metabolic factors, smoking and high fasting plasma glucose were the critical risk factors associated with the mortality and DALYs of NAFLD.ConclusionNAFLD has become a considerable health burden in many countries. Therefore, we should control the risk factors of NAFLD and take corresponding measures to achieve its early prevention and treatment.     

Global cardiovascular diseases burden attributable to high sodium intake from 1990 to 2019

Sodium intake shows a positive correlation with blood pressure, resulting in an increased risk for cardiovascular diseases (CVD). Salt reduction is a key step toward the WHO's goal of 25% reduction in mortality from non-communicable diseases (NCDs) by 2025. This study aims to assess the current condition and temporal changes of the global CVD burden due to high sodium intake (HSI). We extracted data from the Global Burden of Disease (GBD) study 2019. The numbers and age-standardized rates of mortality and disability-adjusted life-years (DALYs), stratified by location, sex, and socio-demographic Index (SDI), were used to assess the high sodium intake attributable CVD burden from 1990 to 2019. The relationship between the DALYs rates and related factors was evaluated by stepwise multiple linear regression analysis. Globally, in 2019, the deaths and DALYs of HSI-related CVD were 1.72 million and 40.54 million, respectively, increasing by 41.08% and 33.06% from 1990. Meanwhile, the corresponding mortality and DALYs rates dropped by 35.1% and 35.2%, respectively. The high-middle and middle SDI quintiles bore almost two-thirds of CVD burden caused by HSI. And the leading cause of HSI attributable CVD burden was ischemic heart disease. Universal health coverage (UHC) was associated with the DALYs rates after adjustment. From 1990 to 2019, the global CVD burden attributable to HSI has declined with spatiotemporal and sexual heterogeneity. However, it remains a major public health challenge because of the increasing absolute numbers. Improving UHC serves as an effective strategy to reduce the HSI-related CVD burden.     

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

Background and aimsDietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.Methods and resultsData on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.ConclusionsDiet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.     

Global burden of atrial fibrillation/flutter due to high systolic blood pressure from 1990 to 2019: estimates from the global burden of disease study 2019

Atrial fibrillation/atrial flutter (AF/AFL) has progressed to be a public health concern, and high systolic blood pressure (HSBP) remains the leading risk factor for AF/AFL. This study estimated the HSBP attributable AF/AFL burden based on the data from the Global Burden of Disease (GBD) study 2019. Numbers, age‐standardized rates (ASR) of deaths, disability‐adjusted life years (DALYs), and corresponding estimated annual percentage change (EAPC) were analyzed by age, sex, sociodemographic index (SDI), and locations. Gini coefficient was calculated to evaluate health inequality. Globally, HSBP‐related AF/AFL caused 107 091 deaths and 3 337 876 DALYs in 2019, an increase of 142.5% and 105.9% from 1990, respectively. The corresponding mortality and DALYs ASR declined by 5.8% and 7.7%. High‐income Asia Pacific experienced the greatest decrease in mortality and DALYs ASR, whereas the largest increase was observed in Andean Latin America. Almost half of the HSBP‐related AF/AFL burden was carried by high and high‐middle SDI regions, and it was experiencing a shift to lower SDI regions. A negative correlation was detected between EAPC and SDI. Females and elderly people tended to have a higher AF/AFL burden, whereas young adults (30–49 years old) experienced an annual increase in AF/AFL burden. The Gini index of DALYs rate decreased from 0.224 in 1990 to 0.183 in 2019. Despite improved inequality having been observed over the past decades, the HSBP‐related AF/AFL burden varied across regions, sexes, and ages. Cost‐effective preventive, diagnostic, and therapeutic tools are required to be implemented in less developed regions.     

Global,regional and national burden of pancreatic cancer, 1990 to 2017: Results from the Global Burden of Disease Study 2017

BackgroundThe global burden of pancreatic cancer (PCa) continues to grow. Detailed data on PCa epidemiology are essential for policy-making and appropriate healthcare resource allocation.MethodsEstimates of incidence, death and disability-adjusted life years (DALYs) of PCa from 1990 to 2017 were collected from the Global Burden of Disease Study 2017. Decomposition analysis was conducted to detect the contributing factors related to PCa incidence variation. The estimated annual percentage change (EAPC) was calculated to quantify the PCa epidemiology trends over a specified interval.ResultsGlobally, the incidence of PCa cases increased by 129.1% to 447 664 664 (95% uncertainty interval (UI) 438 597–456 295), death increased by 125.2% to 441 082 082 (95% UI 448 960–432 833), and DALYs increased by 107.3% to 9 080 004 (95% UI 8 894 128–9 256 346) between 1990 and 2017. Relatively higher sociodemographic index (SDI) regions were observed with greater incidences, more deaths and a greater number of DALYs of PCa, but relatively lower SDI regions experienced a sharply increasing trend in these measures. Decomposition analysis indicated that the global increase in PCa incidence was driven by the aging population from 2007 to 2017, especially in higher SDI regions. In addition, a significant negative correlation was found between EAPC and ASIR (in 1990) (r = −0.56, P < 0.001).ConclusionsPCa remains a major public health burden globally. The unfavorable trend in PCa suggesting that further study for prevention should be conducted to forestall the increase in pancreatic cancer.     

Epidemiological characteristics and management of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis in China: A narrative review

Aim

With industrialization and spread of the westernized lifestyle, the number of people affected by non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) is growing rapidly in China; this has become a major public health concern. To better understand the burden and characteristics of NAFLD/NASH in China, we aim to perform a narrative review of the literature published in this field.

Materials and Methods

We carried out a comprehensive electronic search of five English-language and three Chinese-language databases, to identify studies regarding NAFLD or NASH published from inception to November 30, 2022. Epidemiological studies of NAFLD/NASH in China were particularly noticed and summarized. We also searched the www.clinicaltrials.gov and www.chictr.org.cn websites for the registered trials on the treatment of the disease led by Chinese investigators or located in China.

Results

The increasing rate of NAFLD prevalence in China is strikingly high, reaching more than twice that in western countries. The prevalence of NAFLD is nearly 30% of the general Chinese population, making it the leading cause of chronic liver diseases. The prevalence of NAFLD/NASH varies between provinces/regions, age groups, sexes, and individuals with different metabolic profiles. NAFLD co-exists in many Chinese patients with chronic hepatitis B. Since 2020, more Chinese studies have used the term metabolic-associated fatty liver disease (MAFLD), emphasizing the underlying metabolic disorders that occur concurrently with this disease. Several clinical trials involving lifestyle interventions, antidiabetic drugs, or traditional Chinese medicines, registered by Chinese investigators, have been completed or are ongoing. Moreover, several innovative targeted therapies developed in China are revolutionizing the treatment of NAFLD/NASH.

Conclusions

NAFLD has cast a heavy burden on the Chinese healthcare system. Chinese scholars are making efforts to achieve the optimal management of this disease.     

Global disease burden of stroke attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2019: An analysis of the Global Burden of Disease Study

BackgroundHigh fasting plasma glucose (HFPG) is the leading risk factor contributing to the increase of stroke burden in the past three decades. However, the global distribution of stroke burden specifically attributable to HFPG was not studied in depth. Therefore, we analyzed the HFPG‐attributable burden in stroke and its subtypes in 204 countries and territories from 1990 to 2019.MethodsDetailed data on stroke burden attributable to HFPG were obtained from the Global Burden of Disease Study 2019. The numbers and age‐standardized rates of stroke disability‐adjusted life years (DALYs), deaths, years lived with disability, and years of life lost between 1990 and 2019 were estimated by age, sex, and region.ResultsIn 2019, the age‐standardized rate of DALYs (ASDR) of HFPG‐attributable stroke was 354.95 per 100 000 population, among which 49.0% was from ischemic stroke, 44.3% from intracerebral hemorrhage, and 6.6% from subarachnoid hemorrhage. The ASDRs of HFPG‐attributable stroke in lower sociodemographic index (SDI) regions surpassed those in higher SDI regions in the past three decades. Generally, the population aged over 50 years old accounted for 92% of stroke DALYs attributable to HFPG, and males are more susceptible to HFPG‐attributable stroke than females across their lifetime.ConclusionsSuccessful key population initiatives targeting HFPG may mitigate the stroke disease burden. Given the soaring population‐attributable fractions of HFPG for stroke burden worldwide, each country should assess its disease burden and determine targeted prevention and control strategies.     

Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip,knee, hand and other osteoarthritis in Australia

Background

Understanding population-level trends in osteoarthritis (OA) is critical for planning health services and disease prevention initiatives.

Aim

To examine trends in the burden of hip, knee, hand and other OA related conditions in Australia from 1990 to 2019 and consider the OA burden in the context of other common conditions associated with older age.

Methods

Global Burden of Disease Study 2019 data for Australia on OA prevalence, OA-related years lived with disability (YLDs) and OA-related YLDs attributable to high body mass index (BMI) were sourced for 1990–2019. Age-standardised YLD data for ischaemic heart disease, stroke, dementia, type 2 diabetes and chronic obstructive pulmonary disease were obtained for comparison.

Results

Overall, 3.20 million Australians were estimated to have OA in 2019, with substantial growth in the prevalence of hip (+171%), knee (+126%), hand (+110%) and other types of OA (+130%) from 1990 to 2019. Age-standardised prevalence rates reflect the contribution of population ageing. Concomitant growth in OA-related YLDs was also evident; knee OA and hand OA demonstrated the highest disease burden in 2019 (59 684 and 41 893 YLDs respectively). The proportion of knee OA burden attributable to high BMI was 36% in 2019. In 2019, age-standardised YLD rates were higher for OA (313 per 100 000 population) than other common conditions (range: 47 per 100 000 (ischaemic heart disease) to 284 per 100 000 (type 2 diabetes)).

Conclusions

OA is an increasingly prevalent, impactful condition with a high non-fatal disease burden relative to other health conditions. Growth in OA populations and OA-related disability underscore the need for enhanced investment in prevention and management.     

Burden of diabetes,hyperglycaemia in China from to 2016: Findings from the 1990 to 2016, global burden of disease study

AimsThe prevalence of diabetes in China is among the highest in the world. For this reason, findings from the 2016 Global Burden of Disease (GBD) study were used to calculate the burden of hyperglycaemia and diabetes in China.MethodsFollowing the general analytical strategy used in GBD 2016, diabetes prevalence and mortality were analyzed by age and gender. Trends in disability-adjusted life years (DALYs) due to diabetes were assessed in 33 province-level administrative units from 1990 to 2016, and similar data were provided for chronic kidney disease (CKD) related to diabetes and, as an overall summarizing measure, for hyperglycaemia expressed as high fasting plasma glucose (HFPG).ResultsFrom 1990 to 2016, all-age prevalence of diabetes rose from 3.7% to 6.6%, and all-age diabetes and diabetes-related CKD mortality rates increased by 63.5% and 33.3%, respectively, with both rates increasing more rapidly in diabetes patients aged 15–49 years than in any other age groups. In 2016, HFPG became China's sixth leading cause of DALYs, and the attributable DALYs burden was 1802.3/100,000 population. Although the number of diabetes DALYs increased by 95% from 1990 to 2016, age-standardized diabetes DALYs rates increased by only 2.3%. Also, from 1990 to 2016, rates of age-standardized DALYs due to diabetes decreased in 14 provinces, but increased in 19 provinces. High BMI Scores and diets low in whole grains, nuts and seeds were the most important risk factors for diabetes in 2016.ConclusionDiabetes and hyperglycaemia constitute a huge health burden in China. The substantial increase in diabetes-related burden represents an ongoing challenge, given the rapidly ageing Chinese population. Thus, a targeted control and preventative strategy needs to be developed at risk factor level to reduce this burden.     

Burden of pancreatic cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030

ObjectivesUnderstanding epidemiology trends and patterns of pancreatic cancer in China from 1990 to 2019 and predicting the burden to 2030 will provide foundations for future policies development.MethodsWe collected incidence, mortality, and disability-adjusted life-years (DALYs) data of pancreatic cancer in China from 1990 to 2019 based on the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change (EAPC) to depict the trends of pancreatic cancer burden and predicted the incidence and mortality in the next decade by using a Bayesian age-period-cohort analysis.ResultsThe number of incident cases sharply increased from 26.77 thousand in 1990 to 114.96 thousand in 2019, the age-standardized incidence rate (ASIR) nearly doubled from 3.17 per 100,000 in 1990 to 5.78 per 100,000 in 2019, with an EAPC of 2.32 (95% confidence interval [CI]: 2.12, 2.51). The mortality and DALYs presented a similar pattern with incidence. The dominant risk factor for pancreatic cancer was smoking, but the contribution of high body-mass index increased from 1990 to 2019. We projected that the incident cases and deaths of pancreatic cancer would increase to 218.79 thousand and 222.97 thousand, respectively, in 2030 with around 2 times growth.ConclusionsDuring the past three decades, the incidence, mortality and DALYs of pancreatic cancer gradually increased in China, and the absolute number and rate of pancreatic cancer burden would continue to rise over the next decade. Comprehensive policies and strategies need to be implemented to reduce the incidence and mortality.     

1990—2019年我国主要人体寄生虫病疾病负担变化趋势研究

目的　掌握1990—2019年我国主要人体寄生虫病疾病负担时间变化趋势,为完善寄生虫病防治策略提供参考。方法　在2019全球疾病负担研究（global burden of disease study 2019,GBD 2019）数据中,提取1990—2019年我国疟疾、肠道线虫感染、血吸虫病、食源性吸虫病、囊尾蚴病和棘球蚴病等寄生虫病伤残调整寿命年（disability⁃adjusted life years,DALYs）,对其DALYs从大到小进行排序,并描述年龄和性别分布。使用Joinpoint回归模型分析各病种DALYs平均年度变化百分比（average annual percent change,AAPC）。结果　2019年我国主要人体寄生虫病DALYs由大到小依次为：食源性吸虫病（643 836.42人·年）、囊尾蚴病（156 853.03人·年）、血吸虫病（79 764.62人·年）、肠道线虫感染（70 989.73人·年）、棘球蚴病（4 258.61人·年）和疟疾（264.86人·年）,男性DALYs（546 441.93人·年）高于女性（409 525.33人·年）,青壮年（14～65岁,684 780.84人年）高于儿童（≤ 14岁,35 437.38人·年）和老年（≥ 65岁,235 749.04人·年）。1990—2019年,我国食源性吸虫病DALYs在6种寄生虫病中一直居首位,囊尾蚴病由1990年的第4位上升至2019年的第2位,肠道线虫感染则由1990年的第2位下降至2019年的第4位。1990—2019年,我国主要人体寄生虫病DALYs总体呈下降趋势,疟疾DALYs下降速度最快（AAPC = -19.6%,P = 0.003）,其次是肠道线虫感染（AAPC = -8.2%,P < 0.001）和血吸虫病（AAPC = -3.1%,P < 0.001）,食源性吸虫病DALYs下降趋势较缓（AAPC = -1.0%,P < 0.001）,棘球蚴病DALYs下降不明显（AAPC = -0.5%,P = 0.264）,囊尾蚴病DALYs呈增长趋势（AAPC = 0.7%,P < 0.001）。结论　1990—2019年,我国血吸虫病、肠道线虫感染与疟疾等重点寄生虫病疾病负担显著降低,食源性寄生虫病疾病负担较高,棘球蚴病疾病负担下降不明显,囊尾蚴病疾病负担有上升趋势。建议我国以棘球蚴病防控为重点,在继续巩固其他重点寄生虫病防治成果的同时,加强食源性寄生虫病的监测和预防。     

Global burden of ischemic heart disease attributable to high sugar-sweetened beverages intake from 1990 to 2019

Background and aimsExcessive sugar-sweetened beverages (SSBs) intake is associated with a higher risk of ischemic heart disease (IHD). However, global patterns and trends in the burden of IHD attributable to high SSBs intake have not been systematically assessed.Methods and resultsWe retrieved data from the Global Burden of Disease Study (GBD) 2019. We obtained the numbers and age-standardized mortality rate (ASMR) and disability-adjusted life years (DALYs) rate (ASDR) of IHD attributable to high SSBs intake by sex, year, socio-demographic index (SDI), and country between 1990 and 2019. Furthermore, we used a validated decomposition algorithm to attribute changes to population growth, population aging, and epidemiologic changes in the 21 GBD regions. From 1990 to 2019, the global IHD mortality attributable to high SSBs intake, as quantified by ASMR and ASDR declined significantly, while the burden increased saliently in absolute numbers. Population decomposition suggested that changes in epidemiology in most GBD regions have reduced IHD mortality due to high SSBs intake, but this trend has been counteracted by population growth and aging.ConclusionsAlthough the age-standardized rate of IHD deaths and DALYs attributable to high SSBs intake decreased overall from 1990 to 2019, the absolute IHD burden remains high in some countries, especially in some developing countries in Asia and Oceania. Action is needed to enhance the prevention of diseases associated with high SSBs intake.     

Carga de Doenças Cardiovasculares Atribuível aos Fatores de Risco nos Países de Língua Portuguesa: Dados do Estudo “Global Burden of Disease 2019”

Background:The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known.Objectives:We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study.Methods:We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant.Results:Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 - -61.2) and in Brazil (-49.8%, 95%CI -52.5 - -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023).Conclusions:In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.     

Global burden attributable to high sodium intake from 1990 to 2019

Background and aimsHigh sodium intake is associated with a higher risk of a wide range of diseases. We aimed to estimate the pattern and trend of the global disease burden associated with high sodium intake from 1990 to 2019.Methods and resultsWe obtained numbers and rates of death and disability-adjusted life year (DALY) attributable to high sodium intake by sex, socio-demographic index, and country from the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change to evaluate the age-standardized rate (ASR) of the burden attributable to high sodium intake between 1990 and 2019. We further calculated the contribution of population growth, population aging, and age-specific rates of death and DALY to the net change in the total number of deaths and DALYs attributable to high sodium intake. From 1990 to 2019, global age-standardized rates of death and DALY attributable to high sodium intake substantially decreased for both sexes. However, there were significant increases in the total numbers of deaths and DALYs attributable to high sodium intake, which were driven by population growth and population aging. The attribution of population growth and population aging varied widely across countries, with a higher contribution of population growth in most developing countries and a higher contribution of population aging in countries with slow population growth.ConclusionsAlthough the global burden attributable to high sodium intake in terms of age-standardized rate declined from 1990 to 2019, the absolute burden increased significantly, which was driven by population growth and population aging.     

Burden of chronic diseases in the Palestinian health-care sector using disability-adjusted life-years

Background

Chronic diseases are the greatest public health concern worldwide, contribute to a large burden of disease in the developed world, and are increasing rapidly in prevalence in developing countries. The aim of this study was to quantify the burden of reported chronic diseases in the occupied Palestinian territory.

Global statistics on alcohol,tobacco and illicit drug use: 2017 status report

Aims

This review provides an up‐to‐date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future.

Methods

Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation.

Results

In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past‐year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High‐income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age‐standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age‐standardized tobacco mortality rates and DALYs were highest in Oceania.

Conclusions

In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low‐ and middle‐income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.     

The utility of Xenon-133 liver scan in the diagnosis and management of nonalcoholic fatty liver disease

BACKGROUND:

Nonalcoholic fatty liver disease (NAFLD) is an important and common condition affecting approximately 20% of the general population. Given the limitation of radiological investigations, diagnosis often requires a liver biopsy.

OBJECTIVE:

To compare Xenon-133 (Xe-133) liver scanning with ultrasonography in the diagnosis of NAFLD.

METHODS:

From January 2003 to February 2007, 258 consecutive patients with suspected NAFLD underwent Xe-133 liver scanning at Royal Victoria Hospital (Montreal, Quebec). Of these, 43 patients underwent ultrasonography and liver biopsy for the evaluation of NAFLD. Patients with other liver diseases and significant alcohol consumption were excluded. Two nuclear medicine physicians assessed liver Xe-133 uptake and measured the grade of steatosis using a standardized protocol. The degree of steatosis was determined from biopsy specimens assessed by two hepatopathologists.

RESULTS:

NAFLD was identified by liver biopsy in 35 of 43 patients (81.4%). Xe-133 scan demonstrated 94.3% sensitivity (95% CI 81.4% to 98.4%) and 87.5% specificity (95% CI 52.9% to 99.4%) for the presence of NAFLD. The positive and negative predictive values for detection of steatosis by Xe-133 scan were 97.1% (95% CI 85.1% to 99.8%) and 77.8% (95% CI 45.3% to 93.7%), respectively. The positive and negative likelihood ratios were 7.54 (95% CI 1.20 to 47.26) and 0.07 (95% CI 0.02 to 0.26), respectively. Two patients with NAFLD (5.7%) who had a negative Xe-133 scan result had histologically mild steatosis (<10%). The grade of steatosis on liver biopsy was highly correlated with the results of the Xe-133 scan (r=0.87; P<0.001). The sensitivity and specificity of ultrasound in diagnosing steatosis were 62.9% and 75%, respectively.

CONCLUSION:

Xe-133 liver scan proved to be a safe, reliable, non-invasive method for diagnosing and quantifying hepatic steatosis, and was superior to ultrasound.     

Serum uric Acid as a predictor for the development of nonalcoholic Fatty liver disease in apparently healthy subjects: a 5-year retrospective cohort study

Background/Aims

This study evaluated the relationship between hyperuricemia and nonalcoholic fatty liver disease (NAFLD) by comparing the incidence rates of NAFLD in relation to serum uric acid levels in apparently healthy subjects during a 5-year period.

Methods

Among 15,638 healthy Korean subjects who participated in a health-screening program in 2003 and 2008, respectively, 4954 subjects without other risk factors were enrolled in this study. We compared the incidence rates of NAFLD in 2008 with respect to baseline uric acid levels.

Results

In 2003, serum uric acid levels were categorized into the following quartiles: 0.6-3.9, 3.9-4.8, 4.8-5.9, and 5.9-12.6 mg/dL. The incidence of NAFLD in 2008 increased with the level of baseline uric acid (5.6%, 9.8%, 16.2%, and 20.9%, respectively; p<0.05). Multiple logistic regression analysis demonstrated that hyperuricemia was associated with the development of NAFLD. When compared to the subjects in quartile 1, the odds ratio (OR) for the incidence of NAFLD for quartiles 2, 3, and 4 were 1.53 (95% confidence interval [CI], 1.09-2.16; p=0.014], 1.69 (95% CI, 1.17-2.44; p=0.005), and 1.84 (95% CI, 1.25-2.71; p=0.002), respectively.

Conclusions

High serum uric acid levels appear to be associated with an increased risk of the development of NAFLD.     

Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system

Background

The main etiology of NAFLD and NASH after pancreatic resection is still unclear, and the therapeutic strategy has yet to be established. The focus of this review is how predict and prevent NAFLD/NASH after pancreaticoduodenectomy.

Methods

From April 2005 to October 2008, 54 patients who underwent pancreaticoduodenectomy in our institution were enrolled in this study. From the pre-, intra- and postoperative risk factors, we identified the most influential risk factors of postoperative NAFLD by uni- and multivariate analyses. Moreover, a postoperative NAFLD scoring system was proposed based on these risk factors.

Results

The incidence of postoperative NAFLD was 37.0% (20/54). Of these, 10% (2/20) of patients were diagnosed as having NASH by percutaneous liver biopsy. By multivariate analysis, pancreatic adenocarcinoma (p < 0.05), pancreatic resection line (p < 0.01) and postoperative diarrhea (p < 0.01) were identified as the most influential factors concerning postoperative NAFLD. Based on these results, we proposed a postoperative NAFLD scoring system (0–10) and evaluated the correlation between the score and decreasing rates of CT values, revealing a significant correlation (r = 0.829 p < 0.001). The prevalence of postoperative NAFLD in the patients with our scores of 0–3, 4–6 and 7–10 points was 0 (0/22), 35 (6/17) and 93% (14/15), respectively.

Conclusions

In conclusion, NAFLD develops frequently in patients who undergo PD, and some patients even progress to NASH. A postoperative NAFLD scoring system makes it possible to predict the occurrence of NAFLD after PD, and aggressive nutrition support is needed for patients with high scores.     

Risk of infections in non-alcoholic fatty liver disease: A nationwide population-based cohort study

Background and Aims

Previous literature suggests an association between non-alcoholic fatty liver disease (NAFLD) and infections. We aimed to determine the rate and risk of severe infections in NAFLD compared to the general population.

Methods

In this population-based cohort study, we used national registers to identify all patients with a hospital-based diagnosis of NAFLD in Sweden 1987–2020 (n = 14 869). The patients were matched with ≤10 comparators from the general population for age, sex, municipality, and calendar year (n = 137 145). Cox regression was used to estimate hazard ratios (HR) for infections in patients with NAFLD compared to comparators. Cumulative incidences were calculated while accounting for competing risks (non-infection death and liver transplantation).

Results

Severe infections leading to death or hospitalization occurred in 1990 (13.4%) patients with NAFLD and 9899 (7.2%) comparators during a median of 4.5 and 6.1 years of follow-up, respectively. The rate of severe infections per 1000 person-years was higher in patients with NAFLD (21.0) than comparators (9.1) independently of components related to the metabolic syndrome (adjusted HR 1.9, 95% CI = 1.8–2.0). Infection-related mortality was also higher in NAFLD compared to comparators (adjusted HR 1.8, 95% CI = 1.6–2.2). The 10-year cumulative incidence of severe infections was 16.6% (95% CI = 15.8–17.4) in NAFLD and 8.0% (95% CI = 7.8–8.2) in comparators.

Conclusion

NAFLD was associated with severe infections and infection-related mortality, independently of components associated with the metabolic syndrome. Increased clinical vigilance of severe infections in NAFLD may diminish the risk of premature death.