Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis

Li, Jie; Zou, Biyao; Yeo, Yee Hui; Feng, Yuemin; Xie, Xiaoyu; Lee, Dong Hoon; Fujii, Hideki; Wu, Yuankai; Kam, Leslie Y.; Ji, Fanpu; Li, Xiaohe; Chien, Nicholas; Wei, Mike; Ogawa, Eiichi; Zhao, Changqing; Wu, Xia; Stave, Christopher D; Henry, Linda; Barnett, Scott D.; Takahashi, Hirokazu; Furusyo, Norihiro; Eguchi, Yuichiro; Hsu, Yao Chun; Lee, Teng‐Yu; Ren, Wei; Qin, Chengyong; Jun, Dae Won; Toyoda, Hidenori; Wong, Vincent W. S.; Cheung, Ramsey; Zhu, Qiang; Nguyen, Mindie H.

doi:10.1016/s2468-1253(19)30039-1

Cited by 757 publications

(693 citation statements)

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“…434 Therefore, when a patient without obesity has abnormal anthropometric and laboratory measurements, and as the environment in Asia-Pacific continues to change, such awareness might become even more prudent. 240 The prevalence of NAFLD in the Asia-Pacific is following similar trends to the prevalence reported in high-income countries, indicating that NAFLD is a global disease warranting the attention of primary care physicians, specialists, and health policy makers (panel 2). The high frequency of metabolic comorbidities in patients with NAFLD indicates that management of the increasing number of these patients might increase the strain on health systems.…”

Section: Prevention Of Nafld and Its Modifiable Risk Factorsmentioning

confidence: 74%

“…In summary, data on NALFD epidemiology in the Asia-Pacific region indicate a rapid increase in the disease's burden over the past three decades, which is supported by a systematic review and meta-analysis that assessed the prevalence, incidence, and outcomes of NAFLD in Asia. 240 The analysis estimated that the overall prevalence of NAFLD was 29·62% (95% CI 28·13-31·15), with prevalence increasing significantly over time. 240 Obesity and NAFLD are being increasingly recognised and are an emerging epidemic in the region, irrespective of country or regional income.…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

“…240 The analysis estimated that the overall prevalence of NAFLD was 29·62% (95% CI 28·13-31·15), with prevalence increasing significantly over time. 240 Obesity and NAFLD are being increasingly recognised and are an emerging epidemic in the region, irrespective of country or regional income. South Asia and the Indian subcontinent are currently undergoing rapid economic and social change.…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

“…A systematic review and meta-analysis assessing the prevalence, incidence, and outcome of NAFLD disease in Asia found that even in people without obesity, the prevalence of NAFLD was 11·76%. 240 A 2018 study suggested that so-called lean patients with NAFLD are more likely to develop progressive liver disease and die from causes related to…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

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Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

394

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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Section: Prevention Of Nafld and Its Modifiable Risk Factorsmentioning

confidence: 74%

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

See 2 more Smart Citations

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

394

303

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“…The burden of nonalcoholic fatty liver disease (NAFLD) in Asia and China is enormous . Our data provided the most up‐to‐date information revealing the alarming status of NAFLD in China from 2008 to 2018 to facilitate effective decision making for controlling NAFLD.…”

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confidence: 95%

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Zhou

Wang

et al. 2019

Hepatology

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Effects of Time-Restricted Eating on Nonalcoholic Fatty Liver Disease

et al. 2023

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ImportanceThe efficacy and safety of time-restricted eating (TRE) on nonalcoholic fatty liver disease (NAFLD) remain uncertain.ObjectiveTo compare the effects of TRE vs daily calorie restriction (DCR) on intrahepatic triglyceride (IHTG) content and metabolic risk factors among patients with obesity and NAFLD.Design, Setting, and ParticipantsThis 12-month randomized clinical trial including participants with obesity and NAFLD was conducted at the Nanfang Hospital in Guangzhou, China, between April 9, 2019, and August 28, 2021.InterventionsParticipants with obesity and NAFLD were randomly assigned to TRE (eating only between 8:00 am and 4:00 pm) or DCR (habitual meal timing). All participants were instructed to maintain a diet of 1500 to 1800 kcal/d for men and 1200 to 1500 kcal/d for women for 12 months.Main Outcomes and MeasuresThe primary outcome was change in IHTG content measured by magnetic resonance imaging; secondary outcomes were changes in body weight, waist circumference, body fat, and metabolic risk factors. Intention-to-treat analysis was used.ResultsA total of 88 eligible patients with obesity and NAFLD (mean [SD] age, 32.0 [9.5] years; 49 men [56%]; and mean [SD] body mass index, 32.2 [3.3]) were randomly assigned to the TRE (n = 45) or DCR (n = 43) group. The IHTG content was reduced by 8.3% (95% CI, −10.0% to −6.6%) in the TRE group and 8.1% (95% CI, −9.8% to −6.4%) in the DCR group at the 6-month assessment. The IHTG content was reduced by 6.9% (95% CI, −8.8% to −5.1%) in the TRE group and 7.9% (95% CI, −9.7% to −6.2%) in the DCR group at the 12-month assessment. Changes in IHTG content were comparable between the 2 groups at 6 months (percentage point difference: −0.2; 95% CI, −2.7 to 2.2; P = .86) and 12 months (percentage point difference: 1.0; 95% CI, −1.6 to 3.5; P = .45). In addition, liver stiffness, body weight, and metabolic risk factors were significantly and comparably reduced in both groups.Conclusions and RelevanceAmong adults with obesity and NAFLD, TRE did not produce additional benefits for reducing IHTG content, body fat, and metabolic risk factors compared with DCR. These findings support the importance of caloric intake restriction when adhering to a regimen of TRE for the management of NAFLD.Trial RegistrationClinicalTrials.gov Identifiers: NCT03786523 and NCT04988230

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Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis

Cited by 757 publications

References 31 publications

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

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Effects of Time-Restricted Eating on Nonalcoholic Fatty Liver Disease

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