2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis

Michael H Le; Yee Hui Yeo; Xiaohe Li; Jie Li; Biyao Zou; Yuankai Wu; Qing Ye; Daniel Q Huang; Changqing Zhao; Jie Zhang; Chenxi Liu; Na Chang; Feng Xing; Shiping Yan; Zi Hui Wan; Natasha Sook Yee Tang; Maeda Mayumi; Xinting Liu; Chuanli Liu; Fajuan Rui; Hongli Yang; Yao Yang; Ruichun Jin; Richard H X Le; Yayun Xu; David M Le; Scott Barnett; Christopher Donald Stave; Ramsey Cheung; Qiang Zhu; Mindie H Nguyen

doi:10.1016/j.cgh.2021.12.002

2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis

Clin Gastroenterol Hepatol. 2022 Dec;20(12):2809-2817.e28. doi: 10.1016/j.cgh.2021.12.002. Epub 2021 Dec 7.

Authors

Michael H Le¹, Yee Hui Yeo², Xiaohe Li³, Jie Li⁴, Biyao Zou⁵, Yuankai Wu⁶, Qing Ye⁷, Daniel Q Huang⁸, Changqing Zhao⁹, Jie Zhang¹⁰, Chenxi Liu¹⁰, Na Chang¹⁰, Feng Xing⁹, Shiping Yan¹⁰, Zi Hui Wan¹¹, Natasha Sook Yee Tang¹¹, Maeda Mayumi¹, Xinting Liu¹², Chuanli Liu⁴, Fajuan Rui⁴, Hongli Yang⁴, Yao Yang¹⁰, Ruichun Jin¹³, Richard H X Le¹, Yayun Xu⁴, David M Le¹, Scott Barnett¹, Christopher Donald Stave¹⁴, Ramsey Cheung¹⁵, Qiang Zhu¹⁰, Mindie H Nguyen¹⁶

Affiliations

¹ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
³ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Division of Infectious Disease, The Third People's Hospital of Shenzhen, Shenzhen, China.
⁴ Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China.
⁵ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California.
⁶ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; The Third Central Clinical College of Tianjin Medical University, Tianjin; Department of Hepatology of The Third Central Hospital of Tianjin; Tianjin Key Laboratory of Artificial Cells, Tianjin, China.
⁸ Department of Medicine, Yong Loo Lin School of Medicine and Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
⁹ Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, China.
¹⁰ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China.
¹¹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹² Medical School of Chinese People's Liberation Army, Beijing, and Department of Pediatrics, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
¹³ Jining Medical University, Jining, Shandong, China.
¹⁴ Lane Medical Library, Stanford University School of Medicine, Palo Alto, California.
¹⁵ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
¹⁶ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California. Electronic address: [email protected].

PMID: 34890795
DOI: 10.1016/j.cgh.2021.12.002

Abstract

Background & aims: The increasing rates of obesity and type 2 diabetes mellitus may lead to increased prevalence of nonalcoholic fatty liver disease (NAFLD). We aimed to determine the current and recent trends on the global and regional prevalence of NAFLD.

Methods: Systematic search from inception to March 26, 2020 was performed without language restrictions. Two authors independently performed screening and data extraction. We performed meta-regression to determine trends in NAFLD prevalence.

Results: We identified 17,244 articles from literature search and included 245 eligible studies involving 5,399,254 individuals. The pooled global prevalence of NAFLD was 29.8% (95% confidence interval [CI], 28.6%-31.1%); of these, 82.5% of included articles used ultrasound to diagnose NAFLD, with prevalence of 30.6% (95% CI, 29.2%-32.0%). South America (3 studies, 5716 individuals) and North America (4 studies, 18,236 individuals) had the highest NAFLD prevalence at 35.7% (95% CI, 34.0%-37.5%) and 35.3% (95% CI, 25.4%-45.9%), respectively. From 1991 to 2019, trend analysis showed NAFLD increased from 21.9% to 37.3% (yearly increase of 0.7%, P < .0001), with South America showing the most rapid change of 2.7% per year, followed by Europe at 1.1%.

Conclusions: Despite regional variation, the global prevalence of NAFLD is increasing overall. Policy makers must work toward reversing the current trends by increasing awareness of NAFLD and promoting healthy lifestyle environments.

Keywords: Epidemiology; Nonalcoholic Fatty Liver Disease; Population-Based; Worldwide.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / epidemiology
Humans
Mass Screening
Non-alcoholic Fatty Liver Disease* / epidemiology
Obesity / epidemiology
Prevalence