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

Abstract

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. Nonalcoholic 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.

Association between non-alcoholic fatty liver disease and arterial stiffness in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population

“…The diagnosis of MS was based on the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria (Fan et al, 2007). Therefore, it was defined by the presence of any three or more of the following factors: (1) central obesity: WC ≥90 cm for men, ≥80 cm for women, and/or BMI ≥25 kg/m 2 in both sexes; (2) hypertriglyceridemia: TG ≥1.7 mmol/L; (3) reduced HDL-C: HDL-C <1.03 mmol/L for men and <1.29 mmol/L for women; (4) elevated blood pressure: blood pressure ≥130/85 mmHg; (5) elevated FPG: FPG ≥5.6 mmol/L, or previously diagnosed type 2 diabetes.…”

Nonalcoholic Fatty Liver Disease, the Gut Microbiome, and Diet

“…The disease can progress to cirrhosis and eventual hepatocellular carcinoma (3). The reported prevalence of NAFLD is 30% in Western countries (1,4) and 12-24% in Asia (5), which shows the global importance of understanding the disease pathology. In addition to genetic background, environmental factors such as diet and the intestinal microbiome should be considered critical factors in the development of NAFLD (6,7).…”

Factors Associated With Nonalcoholic Fatty Liver Disease in Obese Adolescents

“…Nowadays NAFLD has become a major public health hazard worldwide. The prevalence rates range from 24% to 42% in Western countries and 5% to 40% in Asian countries [12][13][14]. Hispanics having the highest prevalence (45-58%), followed by Caucasians (33-44%) and African Americans (24-35%) [15][16].…”