How common is non‐alcoholic fatty liver disease in the Asia–Pacific region and are there local differences?

Risk factors for development of non-alcoholic steatohepatitis include obesity, especially central adiposity, glucose intolerance or type 2 diabetes mellitus (T2DM), and dyslipidemia. Non-alcoholic fatty liver disease (NAFLD) is now considered a manifestation of metabolic syndrome. During the last two decades, NAFLD has become the most common chronic liver disease in North America and Europe, but until recently was thought to be uncommon (perhaps due to the lack of study) in Asia. Fatty liver can be identified on imaging modalities (ultrasonography, computed tomography scans, and magnetic resonance imaging) with high sensitivity, but steatohepatitis and fibrosis cannot be distinguished. Thus, an inherent drawback in studying the epidemiology of NAFLD is the lack of definitive laboratory tests, no uniform definition-with different studies using cut-off values of alcohol consumption from <20 g/week to 210 g/week, and case selections where biopsy was used for definition. In studies outside the region, the prevalence of NAFLD varies from 16% to 42% by imaging, and 15-39% of liver biopsies. The major risk factors for NAFLD, central obesity, T2DM, dyslipidemia, and metabolic syndrome, are now widely prevalent and are increasing geometrically in the Asia-Pacific region. It is therefore not surprising that NAFLD is common in this region. Estimates of current prevalence range from 5% to 30%, depending on the population studied. Central obesity, diabetes, and metabolic syndrome are the major risk factors. To date, however, data on the natural history and impact of NAFLD causing serious significant chronic liver disease are lacking and there is a need for prospective, cooperative studies.     

What are the risk factors and settings for non‐alcoholic fatty liver disease in Asia–Pacific?

The risk factors and settings for non-alcoholic fatty liver disease (NAFLD) in Asians are reviewed comprehensively. Based particularly on large community-based studies using ultrasonography, case-control series and prospective longitudinal studies, the prevalence of NAFLD in Asia is between 12% and 24%, depending on age, gender, locality and ethnicity. Further, the prevalence in China and Japan has nearly doubled in the last 10-15 years. A detailed analysis of these data shows that NAFLD risk factors for Asians resemble those in the West for age at presentation, prevalence of type 2 diabetes mellitus (T2DM) and hyperlipidemia. The apparent differences in prevalence of central obesity and overall obesity are related to criteria used to define waist circumference and body mass index (BMI), respectively. The strongest associations are with components of the metabolic syndrome, particularly the combined presence of central obesity and obesity. Non-alcoholic fatty liver disease appears to be associated with long-standing insulin resistance and likely represents the hepatic manifestation of metabolic syndrome. Not surprisingly therefore, Asians with NAFLD are at high risk of developing diabetes and cardiovascular disease. Conversely, metabolic syndrome may precede the diagnosis of NAFLD. The increasing prevalence of obesity, coupled with T2DM, dyslipidemia, hypertension and ultimately metabolic syndrome puts more than half the world's population at risk of developing NAFLD/non-alcoholic steatohepatitis/cirrhosis in the coming decades. Public health initiatives are clearly imperative to halt or reverse the global 'diabesity' pandemic, the underlying basis of NAFLD and metabolic syndrome. In addition, a perspective of NAFLD beyond its hepatic consequences is now warranted; this needs to be considered in relation to management guidelines for affected individuals.     

提高对非酒精性脂肪性肝病的认识,早期防治代谢紊乱

非酒精性脂肪性肝病(NAFLD)十分常见,在普通人群中患病率为10%～24%,在糖尿病人群中高达70%～80%,近年来在亚太地区和我国呈上升趋势,我国上海城市社区人群中NAFLD患病率已达15%.大量研究表明NAFLD是代谢综合征在肝脏的表现,NAFLD不仅与代谢综合征密切伴随,而且还可预测2型糖尿病和心血管疾病的发生.由于肝脏是调节和控制糖脂代谢的中枢器官,肝脏脂肪沉积在代谢紊乱相关疾病的发病中起着关键作用.对专科医生尤其是内分泌科医生来说,认识到NAFLD与糖尿病和心血管疾病的密切关系至关重要.对NAFLD应该及早正确诊断,并且及时评估这些患者糖尿病和心血管疾病的风险,这对于预防糖尿病和心血管疾病具有重要意义.     

Prevalence and risk factors for non-alcoholic fatty liver disease in Asian people who are not obese

Fatty liver (hepatic steatosis) is prevalent in industrialized countries. It is typically linked to obesity, central obesity and the presence of metabolic syndrome. With the introduction of a Westernized lifestyle and the increasing frequency of obesity in the Asia‐Pacific region, the prevalence of non‐alcoholic fatty liver disease (NAFLD) has been increasing over the past two decades. The risk factors are similar to those in other ethnic populations; but it is important to adopt the regional (ethnic‐specific) anthropometric criteria to define overweight, obesity (including central obesity) and metabolic syndrome. To be noted, even using strict ethnic‐specific criteria, a high percentage (15–21%) of Asia‐Pacific NAFLD subjects in some series have been found to be non‐obese, i.e. to have a normal body mass index (BMI) (17.5–22.4 kg/m²) or to be overweight (BMI 22.5–24.9 kg/m²). Differential distribution of visceral adipose tissue, recent increase in body weight, intake of high cholesterol diet and genetic background are factors likely associated with the development of NAFLD in these non‐obese (but often overweight) Asia‐Pacific subjects. Furthermore, insulin resistance may be the underlying key mechanism. In addition, since NAFLD may be the hepatic manifestation of metabolic syndrome, the presence of NAFLD is a predictor of future type 2 diabetes, metabolic syndrome and cardiovascular disease. Therefore, interventions at the public health level are indicated to halt the trend of overweight as well as obesity in Asia‐Pacific region, particularly among those with relevant family history. Since the pathophysiology of NAFLD is closely related to metabolic derangement, lifestyle modification remains the cornerstone of management.     

Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults

Background and Aim: Differences in the prevalence of non‐alcoholic fatty liver disease (NAFLD) between Eastern and Western populations are primarily attributable to differences in definitions and biased population selection. Thus, the aim of the present study was to accurately determine the actual prevalence of NAFLD by sonography and to characterize the risk factors for NAFLD. Methods: The present cross‐sectional study was performed with data obtained from 6648 subjects, all of whom were older than 20 years of age (3530 men and 3118 women). The term ‘non‐drinker’ was applied to men who consumed less than 30 g alcohol/day and to women who consumed less than 20 g alcohol/day. Non‐alcoholic fatty liver disease was defined as a sonographically detected fatty liver in the absence of viral hepatitis in a non‐drinker. Results: Of the 1613 subjects who were diagnosed with sonographic fatty liver, 1240 were non‐drinkers and had no viral hepatitis. Overall, the unadjusted and age‐adjusted prevalences of NAFLD were 18.7% (23% in men, 13.7% in women) and 16.1% (21.6% in men, 11.2% in women), respectively. Multivariate analysis revealed that several risk factors were profoundly associated with the prevalence of NAFLD, including obesity, insulin resistance, hyperlipidemia and hyperglycemia in both genders, as well as age, menopausal status and estrogen medication in women only. Conclusions: These results demonstrate that the prevalence of NAFLD in Korean adults, according to sonographic surveys, is comparable to that seen in more developed countries. From the perspective of increasing obesity, the high prevalence rates noted in the study may herald an increased burden of chronic liver disease in the Korean population.     

Non‐alcoholic steatohepatitis in the Asia–Pacific region: Future shock?

Clinicians in both the developed and also the newer industrial economies in the Asia-Pacific region will encounter non-alcoholic fatty liver disease (NAFLD) with increasing frequency. Although the region has been a significant contributor to the current state of knowledge, the spectrum of NAFLD, its severity and the potential for significant future morbidity and health costs are not widely recognized. Lifestyle changes, the epidemic of childhood and adult obesity and type 2 diabetes sweeping the Asia-Pacific represent the key substrates for the rising prevalence of NAFLD. Physicians in all disciplines need to be aware of clinical clues to the presence of NAFLD in the absence of other liver disease and in those with chronic viral hepatitis and they should be able to identify subsets at risk for liver-related morbidity. Given the scope of the problem, efforts should focus primarily on preventing or ameliorating the impact of risk factors; the key one is insulin resistance and its associates of diabetes and central obesity. Pharmacotherapy may play a role in selected individuals. A regional agenda for case definition, future study and public health initiatives is urgently required.     

非酒精性脂肪性肝病国内外诊疗指南的区别及治疗展望

非酒精性脂肪性肝病(NAFLD)是一种与胰岛素抵抗和遗传易感性密切相关的、肝脏脂肪过度堆积的代谢应激性肝脏损伤。据估计,目前世界上25%的人口被诊断患有NAFLD,对社会经济发展和人们的健康水平造成巨大影响。基于不同地区的生活习俗和人群基因差异,NAFLD在各国/地区的流行率不同,并且在NAFLD诊断标准和治疗方案上各国/地区诊疗指南给出的推荐也存在一定差异。该综述旨在对比国内外最新指南在NAFLD诊断与治疗方面的异同点,汇总最新诊疗手段研究进展,以期对NAFLD的临床诊疗提供借鉴。     

Non-alcohol fatty liver disease in Asia: Prevention and planning

AIM: To review all of epidemiological aspects of non-alcoholic fatty liver disease (NAFLD) and also prevent this disease is examined.METHODS: We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.RESULTS: NAFLD is the most common liver disorder in worldwide, with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide. The prevalence of NAFLD in Asia, depending on location (urban vs rural), gender, ethnicity, and age is variable between 15%-20%. According to the many studies in the world, the relationship between NAFLD, obesity, diabetes mellitus, and metabolic syndrome (MS) is quiet obvious. Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but, it has increased recently due to the rise of obesity, type 2 diabetes and MS in this region. One of the main reasons for the increase in obesity, diabetes and MS in Asia is a lifestyle change and industrialization. Today, NAFLD is recognized as a major chronic liver disease in Asia. Therefore, prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, type 2 diabetes and MS.CONCLUSION: Prevention of NAFLD is very important in Asian countries particularly in Arab countries because of high prevalence of obesity, diabetes and MS.     

Nonalcoholic fatty liver disease,metabolic risk factors,and hepatocellular carcinoma: An open question

Non-alcoholic liver disease(NAFLD) defines liver abnormalities ranging from simple steatosis to nonalcoholic steatohepatitis with or without cirrhosis development, occurring in the absence of significant alcohol consumption, use of teratogenic medication, or hereditary disorders. The association between NAFLD and metabolic syndrome is well documented and widely recognized. Obesity, type 2 diabetes mellitus(T2DM), and dyslipidemia are the most common metabolic risk factors associated with NAFLD. Among the components of metabolic syndrome, current evidence strongly indicates obesity and diabetes as hepatocellular carcinoma(HCC) risk factors. There is also growing evidence that suggests an increased risk of HCC in NAFLD patients, even surpassing other etiologies in some high-income countries. Epidemiologic data demonstrate a parallel rise in prevalence of obesity, diabetes, NAFLD, and HCC. As obesity and its related diseases have steadily afflicted larger populations, HCC incidence is expected to increase in the future. Pathophysiologic mechanisms that underlie NAFLD development and subsequent progression to nonalcoholic steatohepatitis and cirrhosis(insulin resistance and hyperinsulinemia, oxidative stress, hepatic stellate cell activation, cytokine/adipocytokine signaling pathways, and genetic and environmental factors) appear to play a significant role in the development of NAFLD-related HCC. However, a comprehensive view of molecular mechanisms linking obesity, T2 DM, and NAFLD-related HCC, as well as the exact sequence of molecular events, is still not understood in its entirety. Good-quality data are still necessary, and efforts should continue towards better understanding the underlying carcinogenic mechanisms of NAFLD-related HCC. In this paper, we aimed to centralize the most important links supporting these relationships, focusing on obesity, T2 DM, and NAFLD-related HCC, as well as point out the major gaps in knowledge regarding the underlying molecular mechanisms behind them.     

自噬在肝脏脂质代谢中的意义及其与胰岛素抵抗的关系

非酒精性脂肪性肝病(NAFLD)是一种与胰岛素抵抗、脂质代谢紊乱、慢性炎症以及遗传易感性强烈关联的获得性代谢应激性肝损伤,疾病谱包括单纯性脂肪肝、脂肪性肝炎及其相关纤维化、肝硬化。由于肥胖症和代谢综合征在全球的流行,近20年亚洲国家和地区NAFLD增长迅速,导致疾病谱变迁,NAFLD现已成为欧美发达国家(流行率17%~33%)以及我国经济较发达地区的第一大慢性肝病。近几年研究发现,自噬作为一种细胞程序,在介导脂质代谢过程中具有非常关键的作用,结合NAFLD的流行病学、发病机制,本文就自噬在肝脏脂质代谢中的作用意义及其与IR的关系研究现状作一综述。     

Current treatment of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in Western World and frequently associated with insulin resistance and overweight and occurs often with type 2 diabetes. Interestingly, NAFLD is not only regarded as a hepatic component of the metabolic syndrome but also as an independent risk factor and a marker for increase in cardiovascular disease (CVD). Significantly, NAFLD is associated with an increased risk of all-cause mortality and predicts future CVD events independent of age, sex, LDL-cholesterol and features of metabolic syndrome. Although there was initial concern about drug toxicity with NAFLD, increasing evidence suggests that commonly used drugs such as metformin and statins do not cause harm and the thiazolidinediones (TZDs) may even confer a therapeutic benefit in NAFLD. Interestingly, medical and surgical treatments of obesity show potential benefit in treating NAFLD. In this review, we have focused on the safety and therapeutic impact of TZDs, statins, metformins and obesity medications in NAFLD. The potential benefit of bariatric surgery and the role of weight loss per se in treating NAFLD are also discussed.     

Non-alcoholic fatty liver disease--a common and benign finding in octogenarian patients.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), a common entity in the general population, has been shown to be linked with insulin resistance and metabolic syndrome. Several of the components of the metabolic syndrome are more common in the aged population. The aims of the current study were to determine in the aged, the prevalence and the clinical presentation of NAFLD, as well as the relation to the underlying metabolic abnormalities. METHOD: In this prospective study, we evaluated 91 octogenarians with a mean age of 85.56+/-3.76 years, who were admitted to the rehabilitation departments of a geriatric hospital. Clinical evaluation included: abdominal ultrasound (US), fasting glucose and lipid levels, serum liver enzymes, ferritin, iron and transferrin saturation. Elderly patients with NAFLD were compared with 46 young patients with NAFLD. RESULTS: NAFLD diagnosed by US was a common finding in this aged population, is present in 42/91 patients (46.2%). No significant differences were observed between the patients with or without NAFLD in the following: age, gender, chronic illnesses, anthropometric parameters, lipid profile, fasting glucose levels, metabolic syndrome prevalence, serum levels of transaminases, ferritin and iron. Young patients with NAFLD had significantly higher serum levels of triglycerides and a significantly higher prevalence of glucose intolerance, obesity and the metabolic syndrome compared with the elderly patients with NAFLD. CONCLUSIONS: NAFLD was a common finding in our group of elderly patients and the prevalence was higher than reported in the general population. In contrast to the well-described association between the metabolic syndrome and NAFLD in the general population, we did not find this association in the aged group. In addition, none of the patients had stigmata of advanced liver disease. These data suggest that NAFLD is a common and benign finding in the elderly population, but is not associated with the metabolic syndrome.     

Nonalcoholic fatty liver disease in a district general hospital: clinical presentation and risk factors

Introduction Nonalcoholic fatty liver disease (NAFLD) affects one-fifth of the adult population and is currently the commonest liver problem in the western world. The prevalence of NAFLD is likely to rise over the coming decades in parallel to the obesity and diabetes epidemics. A retrospective study was undertaken in a UK. district general hospital (DGH) to determine the clinical and laboratory features of patients with NAFLD. Methods and findings A total of 48 patients with NAFLD were identified. Most (54%) were asymptomatic on presentation and 90% had an echogenic liver on ultrasonography (USS). Liver tests were elevated in the majority, but did not distinguish between simple steatosis and steatohepatitis. Having features of the metabolic syndrome and a low platelet count (P = 0.028) may help identify patients with advanced hepatic fibrosis. Conclusions NAFLD is common in the DGH and should be considered in all patients with metabolic risk factors. A liver biopsy should be considered in those with low platelets, type II diabetes mellitus, and the metabolic syndrome.     

Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population

Background and Aims:  Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in the Asia–Pacific region. However, its prevalence and risk factors in Asian (especially South Asian) communities is poorly studied. In this study, the aim was to determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population.
Methods:  The study population consisted of 35–64-year-old adults, selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined.
Results:  Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD.
Conclusion:  The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome.     

The liver and the waistline: Fifty years of growth

Fifty years of the Gastroenterological Society of Australia have witnessed the changing appearance of Australians. Asian immigration has transformed the dominant urban culture from European to Eurasian, with some unique Australian attributes. Meanwhile, global conditions have altered body shape, and our sports-proud country is now fat! Thus, as in North America, Europe, China, and affluent Asia–Pacific countries, prosperity and lifestyle, cheap processed foods coupled with reduced physical activity have created an epidemic of over-nutrition resulting in overweight/obesity. Additional genetic factors are at the core of the apple shape (central obesity) that typifies over-nourished persons with metabolic syndrome. Indigenous Australians, once the leanest and fittest humans, now have exceedingly high rates of obesity and type 2 diabetes, contributing to shorter life expectancy; Asian Australians are also at higher risk. Like non-steroidal anti-inflammatory drugs (NSAIDs) and cigarette smoking, obesity now contributes much to gastrointestinal morbidity and mortality (gastroesophageal reflux disease, cancers, gallstones, endoscopy complications). This review focuses on Australian research about fatty liver, particularly roles of central obesity/insulin resistance in non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH). The outputs include many highly cited original articles and reviews and the first book on NAFLD. Studies have identified community prevalence, clinical outcomes, association with insulin resistance, metabolic syndrome and hypoadiponectinemia, developed and explored animal models for mechanisms of inflammation and fibrosis, conceptualized etiopathogenesis, and demonstrated that NASH can be reversed by lowering body weight and increasing physical activity. The findings have led to development of regional guidelines on NAFLD, the first internationally, and should now inform daily practice of gastroenterologists.     

Transition of an acronym from nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is a global public health concern owing to its substantial contribution to chronic liver diseases. The disease is closely linked to metabolic syndrome(MS), suggesting a common biological pathway and shared disease mechanism for both ailments. Previous studies revealed a close relationship of NAFLD with the components of MS including abdominal obesity,dyslipidemia, hypertension, and hyperglycemia. Hence, a group of experts recently renamed NAFLD as metabolic dysfunction-associated fatty liver disease(MAFLD) in order to encompass a more appropriate pathogenesis of the disease.NAFLD was first named to describe a condition similar to alcoholic hepatitis in absence of significant alcohol consumption. However, knowledge pertaining to the etiopathogenesis of the disease has evolved over the past four decades. Recent evidence endorses NAFLD as a terminology of exclusion and suggests that it may often leads to misdiagnosis or inappropriate management of patients, particularly in clinical practice. On the other hand, the new definition is useful in addressing hepatic steatosis with metabolic dysfunction, which ultimately covers most of the patients with such illness. Therefore, it seems to be helpful in improving clinical diagnosis and managing high-risk patients with fatty liver disease. However, it is imperative to validate the new terminology at the population level to ensure a holistic approach to reduce the global burden of this heterogeneous disease condition.     

成人非酒精性脂肪肝与代谢综合征相关性分析

目的分析成人非酒精性脂肪肝病（NAFLD）和代谢综合征（MS）的关系。方法对2007年6月～10月广元市北街社区3180例20岁以上居民进行体格检查及肝脏B超检查,并检测空腹血糖（FBG）、血脂和丙氨酸氨基转氨酶（ALT）。结果（1）NAFLD患病率为13．5％,MS患病率为16．5％,丽病共患率为9．5％。（2）MS、中心性肥胖、血压升高、FBG升高、高甘油三酯（TG）、高密度脂蛋白（HLD—C）降低,各组NAFLD患病风险是对照组的12．7～24．1倍。（3）以NAFLD取代诊断MS的5个组分中的任何一个后,与原诊断定义相比有较高的一致性。结论该社区中1／8以上人群患有NAFLD或MS,且NAFLD与MS密切相关,NAFLD可能是MS的重要组成成分。     

Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH): diagnosis and clinical course

Non-alcoholic fatty liver disease (NAFLD) is a frequent syndrome encompassing fatty liver alone and steatohepatitis (NASH). Often asymptomatic, the suspicion arises because of abnormal aminotransferases or a bright liver on abdominal ultrasound. It should be suspected during evaluation of associated conditions as obesity, diabetes or dyslipidaemia. The diagnostic evaluation must exclude other potential causes of liver disease and may include a liver biopsy, the only method able to confirm features of necroinflammation and fibrosis that define NASH and its prognostic implications. Indeed, the presence of necroinflammation has been associated with a significant risk of progression to cirrhosis and eventually hepatocellular carcinoma. Age >45 years, obesity and diabetes have also been associated with an increased risk of liver fibrosis and progression to cirrhosis. Given the high prevalence of NAFLD, general measures of life-style changes, focusing on exercise, diet, and total alcohol abstinence, should be implemented before a liver biopsy is considered.     

Non-alcoholic fatty liver disease and type 2 diabetes mellitus: The liver disease of our age?

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that might affect up to one-third of the adult population in industrialised countries. NAFLD incorporates histologically and clinically different non-alcoholic entities; fatty liver (NAFL, steatosis hepatis) and steatohepatitis (NASH-characterised by hepatocyte ballooning and lobular inflammation ± fibrosis) might progress to cirrhosis and rarely to hepatocellular cancer. NAFL increasingly affects children (paediatric prevalence is 4.2%-9.6%). Type 2 diabetes mellitus (T2DM), insulin resistance (IR), obesity, metabolic syndrome and NAFLD are particularly closely related. Increased hepatic lipid storage is an early abnormality in insulin resistant women with a history of gestational diabetes mellitus. The accumulation of triacylglycerols in hepatocytes is predominantly derived from the plasma nonesterified fatty acid pool supplied largely by the adipose tissue. A few NAFLD susceptibility gene variants are associated with progressive liver disease, IR, T2DM and a higher risk for hepatocellular carcinoma. Although not approved, pharmacological approaches might be considered in NASH patients.     

High prevalence of non-alcoholic fatty liver disease and metabolic risk factors in Guatemala: A population-based study

Background

There are no data on the prevalence of non-alcoholic fatty liver disease (NAFLD) in general population samples in Guatemala or in other Central American countries. The prevalence and distribution of NAFLD and its associated risk factors were evaluated in a population-based sample of adults in Guatemala.