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Sara Ashtari, Mohamad Amin Pourhoseingholi, Mohamad Reza Zali
Sara Ashtari, Mohamad Amin Pourhoseingholi, Mohamad
Reza Zali, Gastroenterology and Liver Disease Research Center,
Research Institute for Gastroenterology and Liver Diseases, Shahid
Beheshti University of Medical Science, Tehran 1985717413, Iran
Author contributions: Pourhoseingholi MA and Zali MR
designed the research; Ashtari S performed the research and
writes the paper.
Supported by Gastroenterology and Liver Disease Research
Center, Research Institute for Gastroenterology and Liver Diseases,
Shahid Beheshti University of Medical Science.
Conflict-of-interest statement: The authors have not declared
any conflicts-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was
selected by an in-house editor and fully peer-reviewed by external
reviewers. It is distributed in accordance with the Creative
Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this
work non-commercially, and license their derivative works on
different terms, provided the original work is properly cited and
the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/4.0/
Correspondence to: Sara Ashtari, MSc, Gastroenterology
and Liver Disease Research Center, Research Institute for Gastro-
enterology and Liver Diseases, Shahid Beheshti University
of Medical Science, Tabnak St, Yaman Ave, Velenjak, Tehran
1985717413, Iran. sara_ashtari@yahoo.com
Telephone: +98-21-22432515
Fax: +98-21-22432517
Received: October 11, 2014
Peer-review started: October 13, 2014
First decision: October 28, 2014
Revised: December 3, 2014
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 8, 2015
Abstract
AIM: To review all of epidemiological aspects of non-
alcoholic fatty liver disease (NAFLD) and also prevent
this disease is examined.
METHODS: W e co ndu cted a syst ema tic rev iew
according to the PRISMA guidelines. All searches for
writing this review is based on the papers was found
in PubMed (MEDLINE), Cochrane database and Scopus
in August and September 2014 for topic of NAFLD in
Asia and the way of prevention of this disease, with no
language limitations. All relevant articles were accessed
in full text and all relevant materials was evaluated and
reviewed.
RESULTS: NAFLD is the most common liver disorder in
worldwide, with an estimated with 20%-30% prevalence
in Western countries and 2%-4% worldwide. The
prevalence of NAFLD in Asia, depending on location
(urban
vs
rural), gender, ethnicity, and age is variable
between 15%-20%. According to the many studies in
the world, the relationship between NAFLD, obesity,
diabetes mellitus, and metabolic syndrome (MS) is
quiet obvious. Prevalence of NAFLD in Asian countries
seems to be lower than the Western countries but, it
has increased recently due to the rise of obesity, type 2
diabetes and MS in this region. One of the main reasons
for the increase in obesity, diabetes and MS in Asia is
a lifestyle change and industrialization. Today, NAFLD
is recognized as a major chronic liver disease in Asia.
Therefore, prevention of this disease in Asian countries
is very important and the best strategy for prevention
and control of NAFLD is lifestyle modifications. Lifestyle
modification programs are typically designed to change
bad eating habits and increase physical activity that is
associated with clinically significant improvements in
obesity, type 2 diabetes and MS.
CONCLUSION: Prevention of NAFLD is very important
SYSTEMATIC REVIEWS
Submit a Manuscript: http://www.wjgnet.com/esps/
Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx
DOI: 10.4254/wjh.v7.i13.1788
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World J Hepatol 2015 July 8; 7(13): 1788-1796
ISSN 1948-5182 (online)
© 2015 Baishideng Publishing Group Inc. All rights reserved.
Non-alcohol fatty liver disease in Asia: Prevention and
planning
in Asian countries particularly in Arab countries because
of high prevalence of obesity, diabetes and MS.
Key words: Non-alcoholic fatty liver disease; Metabolic
risk factors; Asian countries; Prevention
© The Author(s) 2015. Published by Baishideng Publishing
Group Inc. All rights reserved.
Core tip: Today non-alcoholic fatty liver disease (NAFLD)
is one of the main concerns of the medical world. NAFLD
is identified as a main risk factor for chronic liver disease
across the world. NAFLD is clearly linked with obesity,
type 2 diabetes and metabolic syndrome (MS). The
prevalence of NAFLD is lower in Asian countries than
Western countries but, it has increased dramatically in
recent years because of increasing rate of obesity, type
2 diabetes and MS in this region. The high prevalence of
obesity with diabetes, and MS would increase the risk of
NAFLD in recent years. So, prevention of these factors is
the key strategy to reduce the incidence of NAFLD.
Ashtari S, Pourhoseingholi MA, Zali MR. Non-alcohol fatty
liver disease in Asia: Prevention and planning. World J Hepatol
2015; 7(13): 1788-1796 Available from: URL: http://www.
wjgnet.com/1948-5182/full/v7/i13/1788.htm DOI: http://dx.doi.
org/10.4254/wjh.v7.i13.1788
INTRODUCTION
Nowadays, non-alcoholic fatty liver disease (NAFLD) is a
major health concern worldwide which is characterized
by abnormal fat accumulation in liver cells[1,2]. The
development process of NAFLD can be started from
simple steatosis (NAFLD) to non-alcoholic steatohepatitis
(NASH) and nally leads to cirrhosis and hepatocellular
carcinoma in absence excessive alcohol intake[3,4].
NAFLD is one of the main cause of chronic liver disease
in industrializes countries[5,6]. According to the American
Association for the Study of Liver Disease Guidelines[7],
liver biopsy is the gold standard for the diagnosis of
NAFLD, nevertheless ultrasonography is more commonly
used particularly in developing countries, because of
increased health risks and high expenditures associated
with liver biopsies[2]. So, the prevalence of NAFLD varies
according to the method used to diagnosis and study
population[7-9]. In generally, the prevalence of NAFLD
ranges is from 6.3% to 33% worldwide, and prevalence
of NASH is from 3% to 5% in general population[7,10].
Despite the low prevalence of NAFLD in Asian countries
(12%-24%)[11], than in Western countries (> 20%)[12], it
is identied as a main risk factor for chronic liver disorder
in all over world[13]. In Asian countries, the prevalence of
NAFLD varies in different countries, and is related to the
age, gender, locality and ethnicity[11]. NAFLD prevalence
increases with age[6], and also men (40-49 years) tend
to get NAFLD earlier than women (over 50 years)[11,14].
According to the other studies especially in South-East
region of Asia[15-18], more men than women had NAFLD.
For diagnosis of NASH, liver biopsy is required and it’s
costly especially in low-income countries so the establish
the prevalence of NASH is difficult. More than 30% of
obese patients may have NASH and 12%-25% have
brosis[2,19,20]. In predictors and diagnosis of NASH and
brosis, diabetes and insulin resistance are the two main
factors than body mass index (BMI)[21,22].
MATERIALS AND METHODS
We conducted a systematic review according to the
PRISMA guidelines. All searches for writing this review is
based on the papers was found in PubMed (MEDLINE),
Cochrane database and Scopus in August and September
2014 for topic of NAFLD in Asia and the way of prevention
of this disease, with no language limitations. All relevant
articles were accessed in full text and all relevant
materials was evaluated and reviewed. We extracted data
on epidemiology of NAFLD, Burden and prevalence of
NAFLD, risk factors characteristics association NAFLD, and
prevention of NAFLD. We analyzed the data and reported
the results in the tables and text.
RESULTS
Based on systematic reviews, defines NAFLD as a
compound disorder delineated by a set of metabolic
syndrome (MS) risk factors, usually related to obesity,
diabetes, hypertension and dyslipidemia[3,11,23,24]. Insulin
resistance is the main factor in NAFLD pathogenesis,
because of association between NAFLD and MS[11].
The presence of obesity and type 2 diabetes mellitus
(T2DM) significantly increases the risk of NAFLD[11].
Available data from previous studies indicate that the
prevalence of NAFLD likely increases 65%-70%[2,25-27]
in T2DM populations and greater than 75% and 90%
in obese people[28,29] and morbidly obese patients[30,31],
respectively. In addition, NAFLD can be increase the
risk of cardiovascular events in obese and diabetic
people[2,32].
Obesity
Obesity has doubled worldwide since 1980. In Asia also,
based on several national health surveys[33-36] prevalence
of overweight and obese subjects has increased in the
past few decades, but it varies between countries[37] [Table
1: Provides the 2010 World Health Organization (WHO);
Global status report on non-communicable disease
statistics for overweigh and obesity prevalence in Asian
countries, Data adjusted for 2008 for comparability].
The prevalence of obesity in eastern Asia (e.g., China,
Japan, South Korea and Taiwan), Southern Asia (e.g.,
Bangladesh, India, Pakistan and Sri Lanka), and South-
Eastern Asia (e.g., Malaysia, Philippines, Singapore,
Thailand and Vietnam) is quite low compared with
developed countries such as the United States[38-40]. The
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Ashtari S
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. NAFLD in Asia
highest rate of obesity in these regions of Asia are in
Malaysia and Thailand, where 14% and 8.8% of adults
are reported to be obese, respectively[41]. The lowest
obesity rates in these regions are in the less developed
parts of Asia: 1.1% in Bangladesh, 1.7% in Vietnam and
1.9% in India[36,41]. In contrast to these regions of Asia,
in West Asian countries (Middle East countries; e.g., Iran,
Iraq, Bahrain, Egypt, Kuwait, Saudi Arabia, Oman and
Qatar) prevalence of obesity is very high and almost is
equal with the Western developed countries. So that in
countries such as Kuwait (42%), Saudi Arabia (33.3%),
Qatar (33.2%) and Egypt (33.1%), the prevalence of
obesity is higher than United States (33%)[41]. Except in
Japan, Rates of obesity among women are twice that of
men in all Asian countries.
NAFLD prevalence is much higher estimates in
obese people[42]. Population-based survey from Iran
reported that obesity and MS are the most predictive
factors of NAFLD[43]. In addition, in the other Population-
based study conducted China, the relationship between
NAFLD and obesity have been reported so that, among
661 patients with fatty liver, 611 (92%) patients were
obese[44]. The high prevalence of obesity in the West of
Asia also increases the risk of NAFLD[11].
Diabetes mellitus
Diabetes mellitus is present as one of the biggest
public health problems of the recent century[45]. The
International diabetes federation (IDF)[46] estimated the
global burden diabetes was 382 million (comparative
prevalence: 8.3%) in 2013 and it would be likely more
than double to 592 million (comparative prevalence:
8.8%) by 2035. Approximately 175 million people
worldwide living with diabetes are unaware of their
disease[46]. According to the 6th edition of the Diabetes
Atlas in 2013[46], Saudi Arabia (24%), Kuwait (23.1%)
and Qatar (2.9%) are among the world’s top ten
countries with the highest prevalence of diabetes in
20-79 years population are in the Middle-East countries.
And also from the ten countries with the highest
number of diabetic people (20-79 years), ve countries
are located in Asia that which includes; China, India,
Indonesia, Egypt and Japan. T2DM consist 85% to 95%
in high-income countries and even higher percentage
in low and middle income countries[47]. It is one of the
major health problems in the world, and also is known
as an important risk factor for NAFLD[48,49]. T2DM
prevalence is increasing in the world[50] and also in Asian
countries the prevalence rate of it has increased during
the past three decades[51]. Increasing the T2DM in Asian
countries for the following reasons is different from the
countries because of the short time spread, and that can
be seen in a younger age group and people with much
lower BMI[37]. Many ethnic studies on Asian population
pointed out, that they have more abdominal obesity
and visceral fat (3%-5%) than other ethnic groups[52-54].
Improper accumulation of fat in abdominal and visceral
adiposity can cause to increase hepatic insulin resistance
and T2DM, which can cause an abnormal accumulation
of fat in the liver[55,56]. This rapidly-growing prevalence of
T2DM among the Asian countries is related to the rapid
economic developments, aging, urbanization, changes
in nutrition, and increases in sedentary lifestyles, and
also increases with increasing prevalence of obesity and
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Country Overweight1Obesity2
Males Females Total Males Females Total
Kuwait 78.4 79.5 78.8 37.5 49.8 42.0
Saudi Arabia 69.1 68.8 69.0 28.6 39.1 33.3
Qatar 73.1 70.2 72.3 31.3 38.1 33.2
Egypt 60.4 75.3 67.9 21.4 44.5 33.1
Bahrain 70.9 70.3 70.6 29.5 38.0 32.9
UAE 71.3 71.2 71.3 30.0 39.0 32.7
Turkey 59.7 64.1 61.9 21.7 34.0 27.8
Lebanon 66.1 57.9 61.8 25.8 29.0 27.4
Iraq 59.5 65.1 62.3 20.6 33.4 27.0
Oman 56.9 54.2 55.8 18.9 23.8 20.9
Iran 46.0 56.8 51.4 12.4 26.5 19.4
Malaysia 42.1 46.3 44.2 10.4 17.6 14.0
Thailand 26.5 37.4 32.2 5.0 12.2 8.8
South Korea 34.3 29.2 31.8 7.2 8.3 7.7
Singapore 33.9 26.4 30.2 7.0 7.1 7.1
Philippines 24.6 28.4 26.5 4.6 8.0 6.3
China 25.5 25.4 25.4 4.7 6.7 5.7
Pakistan 19.1 27.1 23.0 3.3 7.8 5.5
Japan 30.1 19.2 24.4 5.8 4.4 5.0
India 9.9 12.2 11.0 1.3 2.4 1.9
Vietnam 9.5 10.9 10.2 1.2 2.1 1.7
Bangladesh 7.4 7.8 7.6 0.9 1.3 1.1
Table 1 Prevalence of overweight and obesity in Asian countries, estimates for 2008 (%)
1Overweight: The percentage of the population aged 20 or older having a body mass index (BMI) ≥ 25
kg/m2; 2Obesity: The percentage of the population aged 20 or older having a BMI ≥ 30 kg/m2. Adapted
from World Health Organization, non-communicable diseases report[41]. UAE: United Arab Emirates.
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kg/m2), hypertriglyceridemia (≥ 150 mg/dL) or high
density lipoprotein cholesterol (HDL-C) values (< 35 in
males and < 40 in females) and microalbuminuria (≥ 20
μg/min)[65-67]. On the other hand, in 2001, the National
Cholesterol Education Program Adult Treatment Panel
Ⅲ (NCEP-ATP Ⅲ) published a new set of criteria of MS
that included waist circumference as define obesity
(≥ 102 cm in males and ≥ 88 cm in females), arterial
hypertension (≥ 130/85 mmHg), fasting glucose(≥
110 mg/dL) and blood lipids as HDL-C values (< 40
mg/dL in males and < 50 mg/dL in females) and
hypertriglyceridemia (≥ 150 mg/dL)[68]. The NCEP-ATP
Ⅲ denitions differed from WHO and European Group for
the study of Insulin Resistance denitions in that insulin
resistance is not necessary for diagnostic. In 2005, the
IDF published other criteria to define the MS which
proposed abdominal obesity as the essential components
of the diagnosis of MS, abdominal obesity (Europe men:
≥ 94 cm, Europe women ≥ 80 cm and for Asian men:
≥ 90 cm, Asian women ≥ 80 cm), arterial hypertension
(≥ 130/85 mmHg), fasting glycaemia (≥ 100 mg/dL),
HDL-C values (< 40 mg/dL in males and < 50 mg/dL in
females) and hypertriglyceridemia (≥ 150 mg/dL)[69-72].
The American Heart Association/National Heart Lung
and Blood Institute (AHA/NHLBI) published a new set of
criteria of MS that abdominal obesity is not required as
a risk factor. The denition provided by the AHA/NHLBI
of abdominal obesity with IDF guidelines was quite
different[70,73]. So, in recent years AHA/NHLBI and IDF
offered a new denition of criteria that two side agreed
that abdominal obesity is 1 of 5 criteria for identifying
MS[57,58].
Middle East region, particularly Arab speaking
countries have some of the highest rate of diabetes in
the world[59]. The prevalence of T2DM has increased
dramatically in this region over the last three decades
because of industrial development. Most of countries
in the Middle East such as Kuwait, Saudi Arabia, Qatar,
Bahrain and the United Arab Emirates are the world’s
leaders in term of T2DM prevalence[60]. In both developed
and developing countries diabetes is the main cause of
NAFLD, and also the prevalence of NAFLD is higher in
people with diabetes than in non-diabetic[61] (Table 2:
Provides the 2013 IDF statistics for diabetes prevalence
in Asian countries).
MS
MS is known as a collection of interrelated abnormalities
that increase the risk of T2DM and NAFLD[62]. According
to the available data, experimental and epidemiological
studies describe the NAFLD as the hepatic manifestation
of MS[63,64]. Today prevalence of MS is increasing and
the main risk factors associated with MS are abdominal
obesity, hypertension, dyslipdemia, insulin resistance
and glycemia intolerance[24]. Different criteria have
been introduced in recent years to detect MS. The
first criteria definition of MS was published in 1998
by WHO, according to this definition impaired glucose
tolerance, and impaired fasting glucose, T2DM or insulin
resistance are known as essential components of the
MS, along with at least two of the following parameters:
hypertension (> 140/90 mmHg), obesity (BMI = 30
Table 2 Prevalence of diabetes in Asian countries, estimates for 2013
Country Adult population
(20-79) in 1000s
Diabetes cases
(20-79) in 1000s
Diabetes national
prevalence (%)
1Diabetes comparative
prevalence (%)
Diabetes related
deaths (20-79)
Saudi Arabia 18056.84 3650.89 20.22 23.87 22113
Kuwait 2293.74 407.53 17.77 23.09 1122
Qatar 1796.42 282.53 15.73 22.87 651
Bahrain 974.96 168.66 17.30 21.84 706
UAE 7443.81 745.94 10.02 18.98 1385
Egypt 48276.39 7510.60 15.56 16.80 86478
Lebanon 3295.49 478.96 14.53 14.99 6637
Oman 2493.25 199.78 8.01 14.24 1214
Malaysia 18919.44 1913.24 10.11 10.85 24049
Singapore 4058.27 498.19 12.28 10.42 4134
Iran 52145.45 4395.93 8.43 9.94 38002
Iraq 16473.21 1226.22 7.44 9.50 17643
India 760429.73 65076.36 8.56 9.09 1065053
China 1023050.42 98407.38 9.62 9.02 1271003
Yemen 11568.55 708.12 6.12 8.45 9892
Taiwan 17605.38 1721.06 9.78 8.30 -
Afghanistan 12619.61 794.70 6.30 8.27 18864
Pakistan 99369.82 6712.70 6.76 7.90 87354
South Korea 37365.67 3323.90 8.90 7.48 30836
Philippines 54210.53 3256.21 6.01 6.86 54535
Bangladesh 92271.61 5089.04 5.52 6.31 102139
Vietnam 61387.55 3299.11 5.37 5.81 54953
Thailand 49049.75 3150.67 6.42 5.67 66943
Japan 95304.38 7203.78 7.56 5.12 64680
1All comparisons between countries should be done using the comparative prevalence, which is adjusted to the world population.
Adapted from International Diabetes Institute[46]. UAE: United Arab Emirates.
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but is not essential for diagnosis[74] (Table 3: Provides the
criteria for clinical diagnosis of the MS).
Prevalence of MS varies and depends on the criteria
used in different denitions[75,76]. And it is increasing in
different region like Asia[77] and developing countries[78],
it has been reported 12.8% to 41.1% in different part
of the world[79]. Prevalence of MS depends on criteria
used is different for example the IDF guidelines with
a lower abdominal obesity cut-off (90 cm for men, 80
cm for women) identify a greater prevalence of MS
than the NCEP-ATP Ⅲ[80-83]. In 2007, the prevalence of
MS in the Iran was reported by IDF and ATPⅢ criteria
32.1% and 33.2% respectively[84]. According to 2005
version of IDF criteria, China[67], Taiwan[85,86], Hong
Kong[87], and Thailand[88] had prevalence rates ranging
between 10%-15% (in 2008). On the other hand, rates
for Koreans[89], approximately one quarter, were higher
than the Chinese and Thais. India[90] had significantly
high prevalence rates compared to the rest of Asia.
Unfortunately, no many studies have been done in the
eld of MS in Arab countries[81]. Because of increasing
prevalence of obesity and diabetes in Middle-East
countries particularly in Arab countries, increased risk of
MS is high[91,92].
The major reason for the higher rate using in
the new definition is because of focus on abdominal
obesity, which is the most common component in Arab
countries[81]. The increased prevalence of MS was shown
in both genders, whereas the increased prevalence is
higher in women in Arab populations[91,93]. And also the
other components of the MS, diabetes is more common
among the Arab population than other regions of the
world and is estimated to have increased rapidly in the
region[81,91]. Approximately 50% of patients with T2DM
also suffer from MS, whereas the risk of NAFLD in these
patients is higher more than the other persons[94].
DISCUSSION
Due to the increasing rate of NAFLD, prevention of
this is one of the most important issues of the world.
Prevention methods of NAFLD that is limited to the
prevention of risk factors, because the pathogenesis of
this disease is unknown. So prevention of the risk factors
of NAFLD such as obesity, insulin resistance, T2DM and
MS is the key strategy to reduce the incidence rate of
NAFLD in the world[95]. Today, due to drastic changes in
lifestyle and desire to in sedentary lifestyle, because of
rapid economic and social changes in many countries,
including Asian countries, prevalence of obesity, T2DM
and MS are on the rise, which are important risk factors
for NAFLD.
Hence, the key management of NAFLD is lifestyle
modifications. Lifestyle modification programs are
typically designed to change bad eating habits and
increase physical activity that is associated with clinically
significant improvements in obesity, T2DM and MS.
Many studies indicate that lifestyle modication, including
a reduction in intake of saturated fat and refined car-
bohydrates and sweetened beverages, may reduce
aminotransferases and improve hepatic steatosis[96-99].
Earlier studies suggested that reduction of body weight
by 10% can normalize liver test, but recent studies have
shown that loss of at least 3%-5% of body weight can
achieve improvement in hepatic steatosis[100,101]. Control
and reduce the incidence of insulin resistance and MS is
another important aspect of prevention and management
of NAFLD[7,14]. Early detection, appropriate treatment,
and also care programs with essential training can be
an effective step in control and reduce the incidence of
MS, insulin resistance and also cardiovascular disease
and diabetes. Not only Lifestyle changes, weight loss and
regular physical activity are essential rst steps for the
prevention and treated patients with NAFLD, but also the
prevention of metabolic risk factors, such as diabetes,
dyslipidemia, hypertension is also very important[4].
However, in addition to lifestyle changes for the treatment
of patients with NAFLD, are there specic pharmacologic
therapies such as insulin sensitizers (metformin and
thiazolidinediones)[102-105], weight loss drugs (orlistat and
sibutramine)[106], antioxidants (vitamin E)[107], and have
also considered bariatric surgery for morbidly obese
patients[4,108].
ACKNOWLEDGMENTS
This project was completely supported and funded
by Gastroenterology and Liver Diseases Research
Table 3 American Heart Association/National Heart, Lung
and Blood Institute metabolic syndrome diagnostic criteria
Measure Categorical cut points
Elevated waist circumference1Population and country specic
denition
Elevated triglycerides ≥ 150 mg/dL (1.7 mmol/L) or drug
treatment for high triglycerides (i.e.,
brates or nicotinic acid)
Low HDL-C2< 40 mg/dL (1.0 mmol/L) in males
< 50 mg/dL (1.3 mmol/L) in females
Or drug treatment for low HDL-C (i.e.,
brates or nicotinic acid)
Elevated blood pressure Systolic ≥ 130 mmHg
Diastolic ≥ 85 mmHg
Or drug treatment for hypertension
Elevated fasting glucose ≥ 100 mg/dL
Or drug treatment for elevated glucose
1Waist circumference for abdominal obesity by different organization for
each population or country specic: (1) Asian (WHO) ≥ 90 cm men or ≥
80 cm women; (2) Japanese (Japanese obesity society) ≥ 85 cm men or ≥
90 cm women; (3) China (Cooperative Task Force) ≥ 85 cm men or ≥ 80
cm women; (4) Mediterranean and Middle East (Arab) population (IDF) ≥
94 cm men or ≥ 80 cm women; (5) United States (AHA/NHLBI) ≥ 102 cm
men or ≥ 88 cm women; (6) South and Central American (WHO) ≥ 90 cm
men or ≥ 80 cm women; (7) European (European Cardiovascular Societies)
≥ 102 cm men or ≥ 88 cm women; and (8) Sub-Saharan African (IDF) ≥ 94
cm men or ≥ 80 cm women; 2High density lipoprotein cholesterol indicates
high-density lipoprotein cholesterol. Adapted from Alberti et al[74]. AHA/
NHLBI: American Heart Association/National Heart, Lung and Blood
Institute; WHO: World Health Organization; IDF: International diabetes
federation.
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Center, Research Institute for Gastroenterology and
Liver Diseases, Shahid Beheshti University of Medical
Sciences.
COMMENTS
Background
Non-alcoholic fatty liver disease (NAFLD) is a major health concern worldwide
which is characterized by abnormal fat accumulation in liver cells. Today,
NAFLD is identied as a main cause of chronic liver disease in Asia. Due to the
increasing rate of NAFLD, prevention of this is one of the most important issues
of the world. Prevention methods of NAFLD that is limited to the prevention of
risk factors, because the pathogenesis of this disease is unknown.
Research frontiers
The objective of this study was to review systematically all of aspects of NAFLD
in Asia, provides updated epidemiological data on NAFLD and its etiology and
also this study has examined the current and future possibilities of prevention of
this disease in Asian countries.
Innovations and breakthroughs
Based on systematic reviews, NAFLD is tightly linked with obesity, type 2
diabetes mellitus (T2DM) and the presence of metabolic syndrome (MS).
Because of increasing prevalence of obesity, T2DM and MS in Asian countries
particularly in Arab countries, increased risk of NAFLD is high in this region. So,
by increasing the prevalence and incidence of NAFLD in this region prevention
of this disease is very important.
Applications
Prevention of NAFLD should be considered in the Asian countries, because it is
increasingly recognized as a major chronic liver disease in these regions.
Terminology
NAFLD is characterized by abnormal fat accumulation in liver cells. The
development process of NAFLD can be started from simple steatosis (NAFLD)
to non-alcoholic steatohepatitis and nally leads to cirrhosis and hepatocellular
carcinoma, in absence excessive alcohol intake.
Peer-review
This is a well-written and comprehensive review of the epidemiology of
nonalcoholic fatty liver disease in Asia.
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P- Reviewer: Rajeshwari K, Tziomalos K S- Editor: Tian YL
L- Editor: A E- Editor: Liu SQ
Ashtari S
et al
. NAFLD in Asia
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