Changing clinical management of NAFLD in Asia

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, affecting approximately 25% of the world's population. Recently, because of the sedentary lifestyle and overnutrition resulting from urbanisation, the burden of NAFLD has rapidly increased in many Asian countries. Currently, the prevalence of NAFLD in Asia is approximately 30%, as is the case in many Western countries. In Asia, the prevalence and presentation of NAFLD vary widely across regions because of the substantial diversity in race, socioeconomic status and living environment. Furthermore, the dual aetiology of fatty liver, particularly with viral hepatitis in Asia, makes it complex and challenging to manage. Because Asians are likely to have central adiposity and insulin resistance, approximately 7%-20% of non-obese Asians with body mass indexes of less than 25 kg/m 2 are estimated to have NAFLD.Accumulating evidence indicates that NAFLD is associated with various extrahepatic comorbidities such as cardiovascular disease, chronic kidney disease, malignancy, in addition to liver-specific complications. Therefore, NAFLD should be managed as a multisystem disease in conjunction with metabolic syndrome. Lifestyle modification remains the basis of NAFLD management, but few patients can achieve adequate weight loss and maintain it long term. While various pharmacological agents are in phase 3 trials for steatohepatitis, Asian patients are underrepresented in most trials.

Nonalcoholic Fatty Liver Disease in Lean/Nonobese and Obese Individuals: A Comprehensive Review on Prevalence, Pathogenesis, Clinical Outcomes, and Treatment

“…According to a meta-analysis comparing ultrasound findings to histopathologic findings, abdominal ultrasound had a sensitivity of 85% and a specificity of 94% for moderate to severe fatty liver diagnosis. 48 However, pitfalls of ultrasound include dependence on the ultrasound technician and decreased accuracy in patients with morbid obesity or hepatic steatosis of less than 20%. 48 TE is a more sensitive method than ultrasound alone for detecting liver steatosis with low-fat content.…”

“…48 However, pitfalls of ultrasound include dependence on the ultrasound technician and decreased accuracy in patients with morbid obesity or hepatic steatosis of less than 20%. 48 TE is a more sensitive method than ultrasound alone for detecting liver steatosis with low-fat content. The controlled attenuation parameter (CAP) measurement by TE allows for the quantification of liver fat via evaluation of ultrasound attenuation in the liver.…”

“…As a result, this method is more sensitive than ultrasound alone and can detect histopathological grade 1 steatosis (5-33% fat content in the liver) with a sensitivity of 69% and a specificity of 82%. 48 MRI-based diagnostic tools for quantifying liver steatosis include MRI Elastography (MRE), MRI proton density fat fraction (MRI-PDFF), and proton magnetic spectroscopy (MRS). MRE has been shown to demonstrate a higher diagnostic accuracy compared to TE for the detection of individual stages of fibrosis.…”

The changing epidemiology of liver diseases in Asia

“…In Asia, the prevalence and presentation of non‐alcoholic fatty liver disease (NAFLD) vary widely across regions because of the substantial diversity in ethnicity, socioeconomic status and environmental triggers. In this special issue, Takuma Nakatsuka et al reviewed the epidemiological trends, clinical features, optimal assessment and current management practices for NAFLD in Asia 5 . Approximately 7%–20% non‐obese Asians with body mass index (BMI) less than 25 kg/m 2 are estimated to have NAFLD.…”

Correlation between nonalcoholic fatty liver disease and early left ventricular diastolic dysfunction in non-obese adults: a cross-sectional study

“…In Asia, about 30% of NAFLD population were non-obese [9] . The prevalence of NAFLD is about 7-19% [10,11] and 8-20% among people with BMI < 25kg/m 2 in Asia and China respectively [12,13] , which is increasing with years [14] .…”