Yip Terry Cheuk-Fung, Vilar-Gomez Eduardo, Petta Salvatore, Yilmaz Yusuf, Wong Grace Lai-Hung, Adams Leon A, de Lédinghen Victor, Sookoian Silvia, Wong Vincent Wai-Sun
Medical Data Analytics Center, Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Hong Kong.
State Key Laboratory of Digestive Disease , The Chinese University of Hong Kong , Hong Kong.
Hepatology. 2023 Apr 1;77(4):1404-1427. doi: 10.1002/hep.32774. Epub 2022 Oct 11.
NAFLD has become a major public health problem for more than 2 decades with a growing prevalence in parallel with the epidemic of obesity and type 2 diabetes (T2D). The disease burden of NAFLD differs across geographical regions and ethnicities. Variations in prevalence of metabolic diseases, extent of urban-rural divide, dietary habits, lifestyles, and the prevalence of NAFLD risk and protective alleles can contribute to such differences. The rise in NAFLD has led to a remarkable increase in the number of cases of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and liver-related mortality related to NAFLD. Moreover, NAFLD is associated with multiple extrahepatic manifestations. Most of them are risk factors for the progression of liver fibrosis and thus worsen the prognosis of NAFLD. All these comorbidities and complications affect the quality of life in subjects with NAFLD. Given the huge and growing size of the population with NAFLD, it is expected that patients, healthcare systems, and the economy will suffer from the ongoing burden related to NAFLD. In this review, we examine the disease burden of NAFLD across geographical areas and ethnicities, together with the distribution of some well-known genetic variants for NAFLD. We also describe some special populations including patients with T2D, lean patients, the pediatric population, and patients with concomitant liver diseases. We discuss extrahepatic outcomes, patient-reported outcomes, and economic burden related to NAFLD.
二十多年来，非酒精性脂肪性肝病（NAFLD）已成为一个主要的公共卫生问题，其患病率随着肥胖症和2型糖尿病（T2D）的流行而不断上升。NAFLD的疾病负担因地理区域和种族而异。代谢性疾病患病率的差异、城乡差距的程度、饮食习惯、生活方式以及NAFLD风险和保护性等位基因的患病率都可能导致这种差异。NAFLD的增加导致了与NAFLD相关的肝硬化、肝细胞癌、肝失代偿和肝脏相关死亡率病例的显著增加。此外，NAFLD与多种肝外表现有关。其中大多数是肝纤维化进展的危险因素，从而恶化了NAFLD的预后。所有这些合并症和并发症都会影响NAFLD患者的生活质量。鉴于NAFLD患者群体规模庞大且不断增长，预计患者、医疗系统和经济都将承受与NAFLD相关的持续负担。在本综述中，我们研究了NAFLD在不同地理区域和种族中的疾病负担，以及一些已知的NAFLD基因变异的分布情况。我们还描述了一些特殊人群，包括T2D患者、瘦型患者、儿童人群以及合并肝脏疾病的患者。我们讨论了与NAFLD相关的肝外结局、患者报告的结局和经济负担。
