Eguchi Yuichiro, Wong Gabriel, Lee Emma I-Heng, Akhtar Omar, Lopes Ricardo, Sumida Yoshio
Liver Center, Saga University Hospital, Saga University Saga Japan.
Gilead Sciences, Inc. Foster City California USA.
JGH Open. 2020 May 5;4(5):808-817. doi: 10.1002/jgh3.12349. eCollection 2020 Oct.
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) represent a growing unmet medical need and an increasingly prevalent cause of cirrhosis, hepatocellular carcinoma (HCC), and death in Japan. The aim of this review was to characterize the epidemiology of NAFLD and NASH in Japan. An English and Japanese literature search was conducted in PubMed, Embase, and ICHUSHI Web, identifying 6553 studies, 67 of which were included. Prevalence of NAFLD in the Japanese population rose from the early 1990s (12.6-12.9%) to the early 2000s (24.6-34.7% of the population). Japanese NASH prevalence is estimated to be 1.9-2.7%. NAFLD and NASH are more common among males than females; however, females experience more severe disease than males. While obese patients had higher prevalence of NAFLD/NASH, nonobese individuals (body mass index [BMI] <25 kg/m) consistently comprised 20% to >35% of NAFLD and NASH patients. The evidence shows that, despite obesity being linked with worse disease stages, "lean-NASH" also plays an important role in NASH epidemiology. Besides obesity, diabetes and metabolic syndrome appeared to be reliably associated with disease severity. The prevalence of advanced fibrosis or cirrhotic disease was the highest in patients with NASH-HCC (44-80% with stage F3/F4 disease), while 21-50% of patients with NASH had F3/F4 disease. NAFLD/NASH is common in the Japanese population, and the prevalence of these conditions has tripled in the last two decades. Furthermore, these NAFLD/NASH patients have a high comorbidity burden. Early and efficient identification of safe and effective treatments for NAFLD/NASH patients is urgently needed.
非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）在日本代表着日益增长的未被满足的医疗需求，且是肝硬化、肝细胞癌（HCC）及死亡越来越常见的原因。本综述的目的是描述日本NAFLD和NASH的流行病学特征。在PubMed、Embase和ICHUSHI Web上进行了英文和日文文献检索，共识别出6553项研究，其中67项被纳入。日本人群中NAFLD的患病率从20世纪90年代初的12.6% - 12.9%上升至21世纪初的24.6% - 34.7%。据估计，日本NASH的患病率为1.9% - 2.7%。NAFLD和NASH在男性中比在女性中更常见；然而，女性所患疾病比男性更严重。虽然肥胖患者中NAFLD/NASH的患病率更高，但非肥胖个体（体重指数[BMI]<25 kg/m²）在NAFLD和NASH患者中始终占20%至超过35%。证据表明，尽管肥胖与更严重的疾病阶段相关，但“瘦型NASH”在NASH流行病学中也起着重要作用。除肥胖外，糖尿病和代谢综合征似乎与疾病严重程度有可靠关联。NASH - HCC患者中晚期纤维化或肝硬化疾病的患病率最高（F3/F4期疾病患者占44% - 80%），而21% - 50%的NASH患者有F3/F4期疾病。NAFLD/NASH在日本人群中很常见，在过去二十年中这些疾病的患病率增加了两倍。此外，这些NAFLD/NASH患者有很高的合并症负担。迫切需要尽早并有效地识别针对NAFLD/NASH患者的安全有效治疗方法。
