Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Institute of Model Animal of Wuhan University, Wuhan, China.
Hepatology. 2020 May;71(5):1851-1864. doi: 10.1002/hep.31150.
With dramatic changes in lifestyles over the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the most prevalent liver disorder in China but has not received sufficient attention. NAFLD-related advanced liver disease and its mortality along with its overall disease burden are expected to increase substantially. There is thus an imperative need to clarify the epidemiological features of NAFLD to guide a holistic approach to management. We summarize eight epidemiological features of NAFLD in China over the past two decades using systematic review and meta-analysis methodology. Our data reveal a rapid growth in the NAFLD population, especially among younger individuals. Importantly, there is a strong ethnic difference in body mass index (BMI) and genetic risk of NAFLD compared with the US population. The etiology of advanced liver disease and its complications (e.g., hepatocellular carcinoma) has been altered because of a Westernized lifestyle and the implementation of effective vaccination strategies against viral hepatitis. Regional epidemiological patterns of NAFLD indicate that economics, environment, and lifestyle are critical factors in disease progression. The analysis also indicates that a large number of patients remain undiagnosed and untreated because of the inadequacy of diagnostic tools and the absence of effective pharmacologic therapies. Given the burden of NAFLD, future policy and research efforts need to address knowledge gaps to mitigate the risk burden.
在过去的 20 年中，生活方式发生了巨大变化，非酒精性脂肪性肝病（NAFLD）已成为中国最常见的肝脏疾病，但尚未得到足够重视。NAFLD 相关的晚期肝病及其死亡率以及整体疾病负担预计将大幅增加。因此，迫切需要阐明 NAFLD 的流行病学特征，以指导整体管理方法。我们使用系统评价和荟萃分析方法总结了过去 20 年中国 NAFLD 的八个流行病学特征。我们的数据显示，NAFLD 人群，尤其是年轻人，呈快速增长趋势。重要的是，与美国人群相比，NAFLD 的体重指数（BMI）和遗传风险存在明显的种族差异。由于西方化的生活方式和有效的病毒性肝炎疫苗接种策略的实施，晚期肝病及其并发症（如肝细胞癌）的病因已经发生改变。NAFLD 的区域性流行病学模式表明，经济、环境和生活方式是疾病进展的关键因素。分析还表明，由于诊断工具不足和缺乏有效的药物治疗，大量患者未被诊断和治疗。鉴于 NAFLD 的负担，未来的政策和研究工作需要解决知识差距，以减轻风险负担。
