Prevalence of nonalcoholic fatty liver disease (NAFLD) across the world [4].

Prevalence of nonalcoholic fatty liver disease (NAFLD) across the world [4].

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Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver damage from the more prevalent (75%–80%) and nonprogressive nonalcoholic fatty liver (NAFL) category to its less common and more ominous subset, nonalcoholic steatohepatitis (NASH). NAFLD is now the most common cause of chronic liver disease in the developed world and is...

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... the prevalence of NAFLD in Asia, Europe, and North America was found to be 27.4%, 23.7%, and 24.1% respectively [4]. Figure 1 summarizes the prevalence of NAFLD across the world. The US population has seen a similar trend with the National Health and Nutrition Examination Survey (NHANES), demonstrating a doubling in the prevalence of NAFLD in the US from 5.5% (1988)(1989)(1990)(1991)(1992)(1993)(1994) to 11% (2005-2008) [1]. ...
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... the prevalence of NAFLD in Asia, Europe, and North America was found to be 27.4%, 23.7%, and 24.1% respectively [4]. Figure 1 summarizes the prevalence of NAFLD across the world. The US population has seen a similar trend with the National Health and Nutrition Examination Survey (NHANES), demonstrating a doubling in the prevalence of NAFLD in the US from 5.5% (1988)(1989)(1990)(1991)(1992)(1993)(1994) to 11% (2005-2008) [1]. ...
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... increasing prevalence of NAFLD in the US parallels the increase in prevalence of NAFLD-related risk factors, which include insulin resistance, obesity, hypertension, and dyslipidemia. Figure 1. Prevalence of nonalcoholic fatty liver disease (NAFLD) across the world [4]. ...

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... The incidence of nonalcoholic fatty liver disease (NAFLD) has been increasing worldwide, making it the most common cause of chronic liver disease in developed countries (1)(2)(3). Although most patients with NAFLD have no specific symptoms, some develop nonalcoholic steatohepatitis (NASH), advanced fibrosis, or cirrhosis (4)(5)(6). Recent studies have demonstrated that insulin resistance is inti-mately involved in the development of NAFLD, leading to the progression from NAFLD to more severe liver disease, such as NASH (7). NAFLD is caused by ectopic fat accumulation in the liver and is an indicator of insulin resistance (8); therefore, NAFLD is often described as a hepatic manifestation of metabolic syndrome (9). ...
Article
Objective To predict fatty liver disease (FLD), including nonalcoholic FLD (NAFLD) and metabolic dysfunction-associated FLD (MAFLD), from blood tests and anthropometric measurements, the fatty liver index (FLI) and triglyceride glucose-body mass index (TyG-BMI) have been reported as promising indicators. We evaluated the predictive ability of several indices, including the waist circumference, BMI, FLI and TyG-BMI, that might predict FLD in non-obese individuals undergoing health checkups. Methods This retrospective observational study enrolled non-obese subjects who underwent abdominal ultrasonography between May 1, 2015, and June 30, 2021. Obesity was defined as a BMI <25 kg/m². FLD was diagnosed by abdominal ultrasonography. Using a receiver operating characteristic analysis, we examined the predictive validity of indices for NAFLD and MAFLD by calculating the area under the curve (AUC). Results Of the 24,825 subjects (mean age 44.3±10.0 years old; 54% men) enrolled in this examination of the association of indices, including FLI and TyG-BMI, with NAFLD, NAFLD was diagnosed in 3,619 (27%) men and 733 (6%) women. In both men and women, the FLI and TyG-BMI had significantly higher AUC values for NAFLD prediction than the other indicators (FLI: 0.786 for men and 0.875 for women, TyG-BMI: 0.783 for men and 0.868 for women). In analyses of subjects with a BMI <23 kg/m², the superiority of the FLI and TyG-BMI remained unchanged. The FLI and TyG-BMI also had significantly higher AUC values for MAFLD prediction than the other indicators. Conclusion The FLI and TyG-BMI had a particularly high predictive ability for NAFLD and MAFLD in non-obese subjects.
... In the case of antidiabetics, the increased likelihood of NAFLD screening may also be attributed to the known link between NAFLD and type 2 diabetes. Type 2 diabetes is a signifcant risk factor for NAFLD, with an estimated 58% of patients with diabetes estimated to have NAFLD [3,27,28]. Interestingly, preexisting diabetes was not a signifcant predictor of NAFLD screening in this cohort. However, this may imply that screening for NAFLD or ALT testing is more likely when diabetes treatment is required (i.e., more advanced disease or drug-related liver monitoring) versus simply a diagnosis of diabetes. ...
... Additional predictors of NAFLD screening included being female, older age, having a higher BMI, and living in an urban setting. Unsurprisingly, we found that patients with NAFLD risk factors (i.e., older age and higher BMI) are more likely to be screened for NAFLD [3,27,30]. However, not all predictors can be explained with this reasoning. ...
... Tere were signifcantly more female patients screened for NAFLD than male patients, despite a higher proportion of male patients in the total eligible population as previously described [26]. Although the relationship between NAFLD and sex is complex, male sex is a commonly reported risk factor for NAFLD [3,27,30]. Specifcally, in pediatric populations, adolescent males have been found to be at signifcantly increased risk for NAFLD compared to females [30,31]. By understanding who is being screened and why, educational initiatives and quality improvement initiatives can be tailored to boost screening rates of pediatric NAFLD. ...
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Background: Nonalcoholic fatty liver disease (NAFLD) is the most common pediatric chronic liver disease, and children with a body mass index (BMI) ≥95th percentile are recommended to be screened for NAFLD by liver enzymes. Objectives: This study aimed to determine the frequency and predictors of screening for NAFLD among children with obesity in Canada and to evaluate a sample of children with suspected NAFLD. Methods: This cross-sectional study used data from the Canadian Primary Care Sentinel Surveillance Network, a repository of electronic medical record data from Canadian primary care practices. Results: Of n = 110,827 children aged 9-18 years, 13.9% (n = 9,888) had a BMI ≥95th percentile. Only 8.7% (n = 859) of these patients were screened for NAFLD in the last year, and 23.6% (n = 2336) were ever screened. Using logistic regression, screening in the last year was associated with demographic and clinical characteristics, including previous liver enzyme assessment, prior antidiabetic prescription, and prior anxiolytic prescription. Among children with suspected NAFLD (n = 1,046), 34.7% had a BMI ≥99th percentile and approximately 8% were at increased risk of significant liver disease. Conclusion: The study revealed low screening rates for NAFLD in Canadian primary care and highlighted the important role of primary care providers in identifying and managing pediatric NAFLD.
... Non-alcoholic fatty liver disease (NAFLD) is a condition where the accumulation of lipids exceeds 5% of hepatocytes and is not generated by alcohol, drug consumption or does not damage hepatocytes (1). The global prevalence of NAFLD is increasing, with ~20-30% of patients presenting with early-stage disease (2,3). This disease is currently of great concern as it may increase the risk of developing other subsequent anomalies, as for example type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) (4). ...
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Non‑alcoholic fatty liver disease (NAFLD) is an increasingly prevalent ailment worldwide. Moreover, de novo lipogenesis (DNL) is considered a critical factor in the development of NAFLD; hence, its inhibition is a promising target for the prevention of fatty liver disease. There is evidence to indicate that AMP‑activated protein kinase (AMPK) and sirtuin 1 (SIRT1) may play a crucial role in DNL and are the regulatory proteins in type 2 diabetes mellitus, obesity and cardiovascular disease. Therefore, AMPK and SIRT1 may be promising targets for the treatment of NAFLD. The present review article thus aimed to summarize the findings of clinical studies published during the past decade that suggested the beneficial effects of AMPK and SIRT1, using their specific activators and their combined effects on fatty liver disease.
... No pharmaceutical approaches for NAFLD have been approved to date, and the cornerstone in the prevention and treatment of NAFLD and its severe forms is represented by lifestyle modifications, including diet-related factors [14,16]. Some attempts have been made to clarify the association between dietary components and NAFLD in the general population. ...
... Furthermore, data regarding dietary habits were collected only once and, consequently, could be prone to seasonal fluctuation and recall bias. Finally, NASH was detected by an indirect index currently accepted by NAFLD guidelines [16,55]. This index, although not specifically developed for people with diabetes was, however, validated in people with obesity who share several metabolic and clinical features with T2D (obesity, excess of visceral fat, insulin resistance and high prevalence of NASH), [15]. ...
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Background: There are still open questions with respect to the optimal dietary treatment in patients with type 2 diabetes (T2D) and coexisting non-alcoholic steatohepatitis (NASH). The aim of this study is to investigate, in patients with T2D, the association between NASH, dietary component intake, food groups and adherence to the Mediterranean diet. Methods: Cross-sectional analysis of 2026 people with T2D (1136 men and 890 women). The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. NASH was identified by the Index Of NASH (ION). Based on the cluster analysis two dietary patterns were identified: the NASH and the NO-NASH pattern. Results: The macronutrient composition of the diet was similar in the two patterns. However, the NASH pattern compared with the NO-NASH pattern was characterized by a significantly lower content of fibre (p < 0.001), β-carotene (p < 0.001), vitamin C (p < 0.001), vitamin E (p < 0.001), polyphenols (p = 0.026) and antioxidant capacity (p < 0.001). With regard to food consumption, the NASH pattern compared with NO-NASH pattern was characterized by higher intake of rice (p = 0.021), potatoes (p = 0.013), red (p = 0.004) and processed meat (p = 0.003), and a lower intake of wholegrain bread (p = 0.019), legumes and nuts (p = 0.049), vegetables (p = 0.047), fruits (p = 0.002), white meat (p = 0.001), fatty fish (p = 0.005), milk and yogurt (p < 0.001). Conclusions: NO-NASH dietary pattern was characterized by a food consumption close to the Mediterranean dietary model, resulting in a higher content of polyphenols, vitamins, and fibre. These finding highlight the potential for dietary components in the prevention/treatment of NASH in people with T2D.
... Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with a prevalence rate of ∼25-30%, constantly increasing (1)(2)(3). Patients with NAFLD often progress to fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and ultimately death (4). In the coming decades, NAFLD could emerge as the leading cause of mortality due to end-stage liver disease (5). ...
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Background Several studies have revealed a positive correlation between a Helicobacter pylori (HP) infection and the risk of non-alcoholic fatty liver disease (NAFLD). This meta-analysis was conducted to explore further the relationship between HP infection and NAFLD in the Asian and non-Asian populations. Methods Relevant studies published from inception to July 22, 2021, in the following databases: PubMed, EMBASE, the Cochrane library, and Web of Science were comprehensively searched. The odds ratio (OR) and hazard ratio (HR) with a 95% confidence interval (95%CI) were pooled by the random-effects model or fixed-effects model. Additionally, subgroup and sensitivity analyses were performed. The funnel plot and the Egger test were used to estimate publication bias. Results This meta-analysis included 25 studies involving 107,306 participants. Positive associations between HP infection and NAFLD were found both for the Asian (OR = 1.30, 95% CI: 1.13–1.49, P < 0.01; I ² = 94.30%, P < 0.01) and non-Asian populations (OR = 1.42, 95% CI: 1.04–1.94, P = 0.03; I ² = 44.90%, P = 0.09). Moreover, similar results were observed in the Asian female group (OR = 1.31, 95% CI: 1.17–1.46, P < 0.01; I ² = 46.30%, P = 0.07) but not for the Asian male group. Subgroup analyses for the Asian population showed that there were differences in the association among NAFLD diagnosis methods ( P < 0.01) and the study design ( P < 0.01). However, subgroup and sensitivity analyses results showed that the association for the non-Asian population was not stable enough. Conclusions The data obtained in this systematic review and meta-analysis suggested that an HP infection was associated with an increased risk of NAFLD for Asian and non-Asian populations. However, the association was not found for Asian males. Further studies are required to establish the causal association, especially for the non-Asian population. Systematic review registration Identifier: CRD42021266871.
... This link between NAFLD and dyslipidemia has been deeply investigated in the last 20 years [30][31][32]; in fact, it has been reported that 69% of NAFLD patients and 72% of those with NASH have dyslipidemia or hyperlipidemia [33,34]. Similarly, the prevalence of NAFLD has been investigated in high risk groups [35], ranging between 60 and 70% in the Italian population to 42.6% in the UK population with T2DM [36][37][38][39], 78.8% among patients with metabolic syndrome [37], and 50% in patients with dyslipidemia [40]. ...
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Familial combined hyperlipidemia (FCH) is a very common inherited lipid disorder, characterized by a high risk of developing cardiovascular (CV) disease and metabolic complications, including insulin resistance (IR) and type 2 diabetes mellitus (T2DM). The prevalence of non-alcoholic fatty liver disease (NAFLD) is increased in FCH patients, especially in those with IR or T2DM. However, it is unknown how precociously metabolic and cardiovascular complications appear in FCH patients. We aimed to evaluate the prevalence of NAFLD and to assess CV risk in newly diagnosed insulin-sensitive FCH patients. From a database including 16,504 patients, 110 insulin-sensitive FCH patients were selected by general practitioners and referred to the Lipid Center. Lipid profile, fasting plasma glucose and insulin were determined by standard methods. Based on the results of the hospital screening, 96 patients were finally included (mean age 52.2 ± 9.8 years; 44 males, 52 females). All participants underwent carotid ultrasound to assess carotid intima media thickness (cIMT), presence or absence of plaque, and pulse wave velocity (PWV). Liver steatosis was assessed by both hepatic steatosis index (HSI) and abdomen ultrasound (US). Liver fibrosis was non-invasively assessed by transient elastography (TE) and by fibrosis 4 score (FIB-4) index. Carotid plaque was found in 44 out of 96 (45.8%) patients, liver steatosis was found in 68 out of 96 (70.8%) and in 41 out of 96 (42.7%) patients by US examination and HSI, respectively. Overall, 72 subjects (75%) were diagnosed with steatosis by either ultrasound or HSI, while 24 (25%) had steatosis excluded (steatosis excluded by both US and HSI). Patients with liver steatosis had a significantly higher body mass index (BMI) compared to those without (p < 0.05). Steatosis correlated with fasting insulin (p < 0.05), liver stiffness (p < 0.05), BMI (p < 0.001), and inversely with high-density lipoprotein cholesterol (p < 0.05). Fibrosis assessed by TE was significantly associated with BMI (p < 0.001) and cIMT (p < 0.05); fibrosis assessed by FIB-4 was significantly associated with sex (p < 0.05), cIMT (p < 0.05), and atherosclerotic plaque (p < 0.05). The presence of any grade of liver fibrosis was significantly associated with atherosclerotic plaque in the multivariable model, independent of alcohol habit, sex, HSI score, and liver stiffness by TE (OR 6.863, p < 0.001). In our cohort of newly diagnosed, untreated, insulin-sensitive FCH patients we found a high prevalence of liver steatosis. Indeed, the risk of atherosclerotic plaque was significantly increased in patients with liver fibrosis, suggesting a possible connection between liver disease and CV damage in dyslipidemic patients beyond the insulin resistance hypothesis.
... Tissue samples can be obtained through a variety of techniques, including transvenous or percutaneous image-guided biopsy or laparoscopic biopsy [7,8]. However, these procedures are relatively resource intensive and invasive compared to imaging diagnosis, carrying a risk of complication, particularly in patients who may be at elevated bleeding risk due to liver impairment [9][10][11]. ...
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Purpose To assess the diagnostic performance of quantitative and qualitative imaging features of hepatic cirrhosis on CT. Methods A single-center retrospective cohort study was performed on all patients who had undergone non-targeted liver biopsy < 3 months following abdominal CT imaging between 2007 and 2020. Histopathology was required as a reference standard for hepatic cirrhosis diagnosis. Two readers independently assessed all CT quantitative and qualitative features, blinded to the clinical history and the reference standard. The diagnostic performance of each imaging feature was assessed using multivariate regression and logistic regression in a recursive feature elimination framework. Results 98 consecutive patients met inclusion criteria including 26 with histopathologically confirmed hepatic cirrhosis, and 72 without cirrhosis. Liver surface nodularity (p < 0.0001), lobar redistribution (p < 0.0001), and expanded gallbladder fossa (p < 0.0016) were qualitative CT features associated with liver cirrhosis consistent between both reviewers. Liver surface nodularity demonstrated highest sensitivity (73–77%) and specificity (79–82%). Falciform space width was the only quantitative feature associated with cirrhosis, for a single reviewer (p < 0.04). Using a recursive feature elimination framework, liver surface nodularity and falciform space width were the strongest performing features for identifying cirrhosis. No feature combinations strengthened diagnostic performance. Conclusion Many quantitative and qualitative CT imaging signs of hepatic cirrhosis have either poor accuracy or poor inter-observer agreement. Qualitative imaging features of hepatic cirrhosis on CT performed better than quantitative metrics, with liver surface nodularity the most optimal feature for diagnosing hepatic cirrhosis. Graphical abstract
... Unfortunately, there are conflicting conclusions in the literature around the role of gender in the occurrence of NAFLD. Many studies stated a higher prevalence rate in men whereas others proposed the opposite [16]. ...
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Background: Liver inflammation is deliberated a risk factor for the ongoing liver damage including non-alcoholic steatohepatitis, cirrhosis, and hepatoma. CD14, an effectual mediator for the monocytes activation, has been postulated as a marker of liver inflammation and fibrosis. This study is constructed to detect the alterations in the CD14 serum levels in 40 NAFLD cases and 14 healthy controls along with to analyze the role of CD14 polymorphisms in the causation and severity of Non-Alcoholic Fatty Liver Disease (NAFLD). Liver enzymes, glycated hemoglobin, together with lipid profile were estimated in all included subjects. The diagnosis of NAFLD depends largely on ultrasonography. NAFLD fibrosis score and FIB-4 score were calculated. Serum CD14 was quantified by EnzymeLinked Immunosorbent Assay (ELISA) and C14-159C/T SNP was genotyped via Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphisms (RFLP). Results: Serum CD14 was markedly higher in the diabetic subjects either lean or overweight/obese than the controls (P<0.05). Receiver Operating Characteristic (ROC) curve showed that the optimum cutoff for CD14 was 2.97 ng/ml for discriminating NAFLD patients from their healthy counterparts with a sensitivity of 76.3% and specificity of 78.6%. There was no discrepancy in the prevalence of CD14 genotypes among NAFLD cases and controls. Moreover, the frequency of the CD14 genotypes was analogous in NAFLD patients with NFS≤0.676 and patients with NFS>0.676 (P=1.000). Conclusion: The former observations advocate the potential role of CD14 in both the pathogenesis and progression of NAFLD. Yet, it didn't correlate with the NFS, consequently it couldn't forecast the severity of the disease. Furthermore, no association was distinguished linking CD14 C-(159) T polymorphism and the risk of NAFLD occurrence.
... The incidence of NAFLD has increased in proportion to the increase in DM2 cases worldwide [5][6] . The T2DM existence seems to quicken the sequence of disease of liver in NAFLD 7 . The augmented incidence in DM2 patients with NAFLD and its grave clinical consequences are of apprehension. ...
Article
Though non-alcoholic fatty liver disease (NAFLD) is associated strongly with type-II diabetes mellitus (T2DM), the NAFLD analysis in patients with Type-II DM remainders an issue. Aim: This analysis was designed to examine the pervasiveness and NAFLD risk factors in T2DM patients. Study Design: A retrospective, cross-sectional study Place and duration: In the department of Medicine, Mardan Medical Complex and Northwest General Hospital & Research Centre Hayatabad, Peshawar for six-months duration from May 2021 to October 2021. Methods: This study includes 420 patients with DM2 presented and treated for glycaemic control. Targeted patients were selected and separated using strict exclusion criteria. Patients with NAFLD (study group) and patients without NAFLD (control group) were divided into two groups. Then, comparison of thirty-four factors amid the 2 groups were done. In addition, NAFLD risk factors multivariate analysis was executed by means of logistic regression. Lastly, the combined predictive indicator (CPI) as well as the analytical significance of the biochemical predictors for NAFLD were assessed by receiver operational characteristic curve (ROC) analysis. Results: The general incidence of NAFLD in this study among DM2 patients was 53.6%. 17 patient target factors were recognised using univariate analysis NAFLD analysis, and eight factors turned out to be important forecasters of NAFLD by means of a binary logistic regression model. Moreover, C-peptide and CPI have augmented analytical importance for NAFLD in patients with T2DM. Conclusion: This analysis delivers a thorough analysis of NAFLD risk factors in subjects with DM2. This information can be cast-off to ensure the effective treatment and timely analysis of NAFLD. Keywords: NAFLD, metabolism, routine examination, obesity, screening, type-II diabetes
... There are currently no approved therapies for the treatment of NAFLD [8][9][10][11]. Several risk factors might increase the likelihood of developing NAFLD, including metabolic syndrome (MetS), obesity, diabetes, increased cholesterol levels, sedentary lifestyle, and genetic predisposition [12][13][14]. ...
Article
Background. Hepatic steatosis with inflammation, inflated hepatocytes, and potential fibrosis defines non-alcoholic steatohepatitis (NASH), which can possibly lead to liver cirrhosis. Although liver biopsy is still the gold standard for diagnosing NASH, numerous non-invasive surrogate markers have been investigated to reduce the need for this invasive technique. In this review we present several currently assessed biomarkers, scores, and indexes in assessing NASH Methods. A search in the main medical literature databases was conducted. We searched for observational studies evaluating non-invasive markers, scores, and panels in predicting NASH. Results. Several proinflammatory markers, inflammation and apoptosis biomarkers, as well as complex models have been studied in predicting NASH. Proinflammatory markers include C-reactive protein, ferritin, tumor necrosis factor-α, interleukin-6, pentraxin-3, and neutrophil extracellular traps. Inflammation and apoptosis biomarkers include cytokineratin-18, adipocytokines, lipid oxidation panels, plasminogen activator inhibitor-1, and products of free radical-mediated oxidation of linoleic acid. Moreover, several studied complex models such as NashTest, NashTest-2, pairing CK18 fragments with other biomarkers such as ALT and the presence of MetS, the HAIR model, acNASH, NAFIC score, Visceral Adiposity Index have also been studied. Conclusion. A variety of diagnostic panels have shown good predictive values for diagnosing NASH. Nevertheless, non-invasive surrogate markers are currently unable to replace liver biopsy. However, their clinical significance is mainly in triaging patients for liver biopsy, reducing the financial burden associated with the procedure.