The burden and sexual dimorphism with nonalcoholic fatty liver disease in Asian children: A systematic review and meta‐analysis

Abstract

Background: Despite substantial attention paid to the epidemic of nonalcoholic fatty liver disease (NAFLD) in adults, data on the burden and sexual dimorphism of NAFLD in Asian children have not yet been synthesized. Methods:We conducted a literature search of 735 references up to April 2021.Pooled analyses, stratified analyses and meta-regression were all performed.Results: Thirty-three study populations were finally included. Nine of them comprising 20 595 children showed an overall NAFLD prevalence of 5.53% (95% CI 3.46%-8.72%), in which, 36.64% (95% CI, 27.99%-46.26%) NAFLD subjects had elevated levels of ALT. The prevalence rate of NAFLD increased about 1.6-fold from 2004 to 2010 to the last decade. Male predominant trends were observed in paediatric NAFLD (boys: 8.18%, 95% CI 4.93%-13.26%; girls: 3.60%, 95% CI 1.60%-7.87%).Moreover, meta-analysis showed that after 10 years of age, boys were more prone to have NAFLD than girls (OR = 1.75; P = .0012). In addition, the pooled prevalence of NAFLD increased sequentially in normal-weight (1.49%, 95% CI 0.88%-2.51%, n = 2610), overweight (16.72%, 95% CI 7.07%-34.65%, n = 1265) and obese children (50.13%, 95% CI 41.99%-58.27%, n = 6434 individuals). After full covariate adjustment, the multivariate meta-regression also showed that boy percentage (P = .0396) and body mass index (P < .0001) were positively correlated with prevalent NAFLD. Conclusions:In Asia, paediatric NAFLD is becoming prevalent over the recent decades, particularly among obese children and boys after 10 years old. The hormonal and chromosomal origins of paediatric NAFLD dimorphism need further investigation.

From MAFLD to hepatocellular carcinoma and everything in between

“…[ 27 ] In Asia, the prevalence of pediatric MAFLD has been increasing, particularly in obese male population over the age of 10. [ 28 ] In the US, as reported in the “Study of Child and Adolescent Liver Epidemiology (SCALE)”, MAFLD is present in 5% to 10% of children/adolescents aged 2 to 19 years. [ 26 ] A meta-analysis by Anderson et al [ 27 ] found that MAFLD prevalence in the general pediatric population ranged from 9% to 37%.…”

“…Interestingly, the prevalence of MAFLD in pediatric populations differs between regions with the highest prevalence in Asia [27] . In Asia, the prevalence of pediatric MAFLD has been increasing, particularly in obese male population over the age of 10 [28] . In the US, as reported in the “Study of Child and Adolescent Liver Epidemiology (SCALE)”, MAFLD is present in 5% to 10% of children/adolescents aged 2 to 19 years [26] .…”

The changing epidemiology of liver diseases in Asia

“…Regarding pediatric NAFLD, Zou et al implemented a systematic review and found that more than one‐third of children with NAFLD had elevated levels of ALT, indicating high proportion of possible nonalcoholic steatohepatitis (NASH) in children 6 . Boys were more prone to have NAFLD than girls after 10 years old.…”

Metabolic dysfunction-associated fatty liver disease: from basic research to clinical application

“…The pooled prevalence of NAFLD in Asian children increased from those with normal weight (1.5%) to those who were overweight (16.7%) or obese (50.1%). [ 2 ]…”

“…The pooled prevalence of NAFLD in Asian children increased from those with normal weight (1.5%) to those who were overweight (16.7%) or obese (50.1%). [2] A recent study suggested that NAFLD is not uncommon in lean Chinese adults with a normal waist circumstance. Metabolic risk factors, rather than genetic factors, may play an important role in the development of lean NAFLD, [3] and the hepatic and extra-hepatic complications can also develop in lean patients, which reinforces the importance of considering metabolic phenotype in the assessment of NAFLD, rather than using body mass index-based approaches.…”