The global epidemiology of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): A systematic review

Background and aims: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of liver-related morbidity and mortality. The authors assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach.
Approach and results: PubMed and Ovid Medline were searched for NAFLD population-based studies from 1990 to 2019 survey year (last published 2022) per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analysis was conducted using random-effects models. Bias risk assessment was per Joanna Briggs Institute. Of 2585 studies reviewed, 92 studies (n = 9,361,716) met eligibility criteria. Across the study period (1990–2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% confidence interval [CI]: 27.88–32.32%) and 30.69% (28.4–33.09%), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59–29.33%) in 1990–2006 to 38.00% (33.71–42.49%) in 2016–2019 (p < 0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46–31.87%) in 1990–2006 to 34.59% (29.05–40.57%) (p = 0.029). The highest NAFLD prevalence was in Latin America (44.37%, 30.66–59.00%), then Middle East and North Africa (MENA; 36.53%, 28.63–45.22%), South Asia (33.83%, 22.91–46.79%), South-East Asia (33.07%, 18.99–51.03%), North America (31.20%, 25.86–37.08%), East Asia (29.71%, 25.96–33.76%), Asia Pacific (28.02%, 24.69–31.60%), Western Europe (25.10%, 20.55–30.28%). Among the NAFLD cohort diagnosed without a liver biopsy, pooled mortality rate per 1000 person-years was 12.60 (6.68–23.67) for all-cause mortality, 4.20 (1.34–7.05) for cardiac-specific mortality, 2.83 (0.78–4.88) for extrahepatic cancer-specific mortality, and 0.92 (0.00–2.21) for liver-specific mortality.

Conclusions: Non-alcoholic fatty liver disease (NAFLD) global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.

Z.M. Younossi, M.D., Inova Medicine, Inova Health System, Department of Medicine, Inova Fairfax Medical Campus, Betty and Guy Beatty Center for Integrated Research, Falls Church, VA, USA,
E-Mail: zobair.younossi@inova.org

DOI: 10.1097/hep.0000000000000004

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