Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, China.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
Lancet Gastroenterol Hepatol. 2019 May;4(5):389-398. doi: 10.1016/S2468-1253(19)30039-1. Epub 2019 Mar 20.
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden.
We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468.
Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13-31·15). NAFLD prevalence increased significantly over time (25·28% [22·42-28·37] between 1999 and 2005, 28·46% [26·70-30·29] between 2006 and 2011, and 33·90% [31·74-36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8-57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8-3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5-11·4).
NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men.
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非酒精性脂肪性肝病（NAFLD）是全球最常见的慢性肝病。亚洲是一个地域广阔、情况多样的地区，其社会经济地位和肥胖症患病率存在很大差异。我们旨在评估亚洲人群中 NAFLD 的流行率、发病率和结局，以帮助利益相关者了解 NAFLD 的疾病负担。
我们检索了 PubMed、EMBASE 和 Cochrane 图书馆，检索时间截至 2019 年 1 月 17 日，以获取报道亚洲地区 NAFLD 流行率、发病率或结局的研究。我们仅纳入了使用影像学、基于血清的指标或肝活检诊断 NAFLD 的患者的横断面和纵向观察性研究。排除了纳入重叠肝病患者或未筛查过量饮酒的研究。两名研究者独立筛选并提取数据。主要结局为汇总的 NAFLD 流行率、发病率、NAFLD 患者的肝细胞癌发病率和总体死亡率。使用随机效应模型计算汇总估计值。本研究已在 PROSPERO 注册，编号 CRD42018088468。
在纳入的 4995 条记录中，有 237 项研究（13044518 名参与者）纳入分析。无论采用何种诊断方法，NAFLD 的总体流行率为 29.62%（95%CI 28.13%-31.15%）。NAFLD 的流行率随时间显著上升（1999-2005 年为 25.28%[22.42%-28.37%]，2006-2011 年为 28.46%[26.70%-30.29%]，2012-2017 年为 33.90%[31.74%-36.12%]；P<0.0001）。汇总的年 NAFLD 发病率为 50.9 例/1000 人年（95%CI 44.8-57.4）。在 NAFLD 患者中，肝细胞癌的年发病率为 1.8 例/1000 人年（0.8-3.1），总死亡率为 5.3 例/1000 人年（1.5-11.4）。
亚洲地区的 NAFLD 流行率正在上升，且与不良结局相关，包括肝细胞癌和死亡。亚洲必须制定有针对性的公共卫生策略，针对这一不断上升的流行疾病及其相关并发症的驱动因素，特别是在老年肥胖男性等高危人群中，采取行动。
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