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Semin Liver Dis 2022; 42(03): 401-412
DOI: 10.1055/a-1862-9088
Review Article

Nonalcoholic Fatty Liver Disease: Current Global Burden

Mohamed El-Kassas
1   Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
,
Joaquín Cabezas
2   Gastroenterology and Hepatology Department, University Hospital Marques de Valdecilla, Santander, Spain
3   Department of Gastroenterology and Hepatology, Research Institute Valdecilla (IDIVAL), Santander, Spain
,
Paula Iruzubieta Coz
2   Gastroenterology and Hepatology Department, University Hospital Marques de Valdecilla, Santander, Spain
3   Department of Gastroenterology and Hepatology, Research Institute Valdecilla (IDIVAL), Santander, Spain
,
Ming-Hua Zheng
4   NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
5   Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
,
Juan Pablo Arab
6   Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
7   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
,
Abeer Awad
8   Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
› Institutsangaben Funding None.
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Abstract

The map and global disease burden of chronic liver diseases are markedly changing, with nonalcoholic fatty liver disease (NAFLD) becoming the most common cause of liver diseases coinciding with the current epidemics of obesity, type 2 diabetes, and metabolic syndrome. Understanding the incidence and prevalence of NAFLD is critical because of its linkage to a significant economic burden of hospitalization and changing patterns in consequences, such as liver transplantation. Moreover, the long-term average health care expenses of NAFLD patients have exceeded those of other liver diseases. To lessen the imminent burden of NAFLD, immediate actions to raise worldwide awareness and address metabolic risk factors are required. This review summarizes key data about the global disease burden of NAFLD, modifiable and nonmodifiable risk factors, and current preventive approaches.

Keywords

NAFLD - steatosis - fatty liver disease - disease burden - prevention - epidemiology - prevalence


Publikationsverlauf

Accepted Manuscript online:
26. Mai 2022

Artikel online veröffentlicht:
24. August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Tomic D, Kemp WW, Roberts SK. Nonalcoholic fatty liver disease: current concepts, epidemiology and management strategies. Eur J Gastroenterol Hepatol 2018; 30 (10) 1103-1115
    CrossrefPubMedGoogle Scholar
  • 2 Polyzos SA, Kang ES, Tsochatzis EA. et al. Commentary: nonalcoholic or metabolic dysfunction-associated fatty liver disease? The epidemic of the 21st century in search of the most appropriate name. Metabolism 2020; 113: 154413
    CrossrefPubMedGoogle Scholar
  • 3 Eslam M, Newsome PN, Sarin SK. et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol 2020; 73 (01) 202-209
    CrossrefPubMedGoogle Scholar
  • 4 Lazarus JV, Mark HE, Anstee QM. et al; NAFLD Consensus Consortium. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022; 19 (01) 60-78
    CrossrefPubMedGoogle Scholar
  • 5 Lin S, Huang J, Wang M. et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int 2020; 40 (09) 2082-2089
    CrossrefPubMedGoogle Scholar
  • 6 Younossi ZM. Non-alcoholic fatty liver disease - a global public health perspective. J Hepatol 2019; 70 (03) 531-544
    Google Scholar
  • 7 Estes C, Anstee QM, Arias-Loste MT. et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol 2018; 69 (04) 896-904
    CrossrefPubMedGoogle Scholar
  • 8 Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64 (01) 73-84
    CrossrefPubMedGoogle Scholar
  • 9 Le MH, Yeo YH, Li X. et al. 2019 Global NAFLD Prevalence: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2021; S1542–3565 (21) 1280-1285
    PubMedGoogle Scholar
  • 10 Bambha K, Belt P, Abraham M. et al; Nonalcoholic Steatohepatitis Clinical Research Network Research Group. Ethnicity and nonalcoholic fatty liver disease. Hepatology 2012; 55 (03) 769-780
    CrossrefPubMedGoogle Scholar
  • 11 Ge X, Zheng L, Wang M, Du Y, Jiang J. Prevalence trends in non-alcoholic fatty liver disease at the global, regional and national levels, 1990-2017: a population-based observational study. BMJ Open 2020; 10 (08) e036663
    CrossrefPubMedGoogle Scholar
  • 12 Mitra S, De A, Chowdhury A. Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Transl Gastroenterol Hepatol 2020; 5: 16
    CrossrefPubMedGoogle Scholar
  • 13 Popkin BM. Nutrition transition and the global diabetes epidemic. Curr Diab Rep 2015; 15 (09) 64-64
    CrossrefPubMedGoogle Scholar
  • 14 Baker P, Machado P, Santos T. et al. Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers. Obes Rev 2020; 21 (12) e13126
    CrossrefPubMedGoogle Scholar
  • 15 Huse O, Reeve E, Baker P. et al. The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: a descriptive review. Obes Rev 2022; 23 (04) e13412
    CrossrefPubMedGoogle Scholar
  • 16 Younossi Z, Anstee QM, Marietti M. et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018; 15 (01) 11-20
    Google Scholar
  • 17 Lazo M, Hernaez R, Eberhardt MS. et al. prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 2013; 178 (01) 38-45
    CrossrefPubMedGoogle Scholar
  • 18 Kanwal F, Kramer JR, Duan Z, Yu X, White D, El-Serag HB. Trends in the burden of nonalcoholic fatty liver disease in a united states cohort of veterans. Clin Gastroenterol Hepatol 2016; 14 (02) 301-308 .e1, 2
    CrossrefPubMedGoogle Scholar
  • 19 Schneider AL, Lazo M, Selvin E, Clark JM. Racial differences in nonalcoholic fatty liver disease in the U.S. population. Obesity (Silver Spring) 2014; 22 (01) 292-299
    CrossrefPubMedGoogle Scholar
  • 20 Saab S, Manne V, Nieto J, Schwimmer JB, Chalasani NP. Nonalcoholic fatty liver disease in Latinos. Clin Gastroenterol Hepatol 2016; 14 (01) 5-12 , quiz e9–e10
    CrossrefPubMedGoogle Scholar
  • 21 Browning JD, Szczepaniak LS, Dobbins R. et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40 (06) 1387-1395
    CrossrefPubMedGoogle Scholar
  • 22 Arab JP, Dirchwolf M, Álvares-da-Silva MR. et al. Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease. Ann Hepatol 2020; 19 (06) 674-690
    CrossrefPubMedGoogle Scholar
  • 23 Feijó SG, Lima JM, Oliveira MA. et al. The spectrum of non alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors. Acta Cir Bras 2013; 28 (11) 788-793
    CrossrefPubMedGoogle Scholar
  • 24 Kotronen A, Westerbacka J, Bergholm R, Pietiläinen KH, Yki-Järvinen H. Liver fat in the metabolic syndrome. J Clin Endocrinol Metab 2007; 92 (09) 3490-3497
    CrossrefPubMedGoogle Scholar
  • 25 Cholongitas E, Pavlopoulou I, Papatheodoridi M. et al. Epidemiology of nonalcoholic fatty liver disease in Europe: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34 (03) 404-414
    PubMedGoogle Scholar
  • 26 Llop E, Iruzubieta P, Perelló C. et al. High liver stiffness values by transient elastography related to metabolic syndrome and harmful alcohol use in a large Spanish cohort. United European Gastroenterol J 2021; 9 (08) 892-902
    CrossrefPubMedGoogle Scholar
  • 27 Goldberg D, Ditah IC, Saeian K. et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology 2017; 152 (05) 1090-1099 .e1
    CrossrefPubMedGoogle Scholar
  • 28 Zhou J, Zhou F, Wang W. et al. Epidemiological features of NAFLD from 1999 to 2018 in China. Hepatology 2020; 71 (05) 1851-1864
    CrossrefPubMedGoogle Scholar
  • 29 Zhou YJ, Li YY, Nie YQ. et al. Prevalence of fatty liver disease and its risk factors in the population of South China. World J Gastroenterol 2007; 13 (47) 6419-6424
    CrossrefPubMedGoogle Scholar
  • 30 Li H, Wang YJ, Tan K. et al. Prevalence and risk factors of fatty liver disease in Chengdu, Southwest China. Hepatobiliary Pancreat Dis Int 2009; 8 (04) 377-382
    PubMedGoogle Scholar
  • 31 Chen CH, Huang MH, Yang JC. et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol 2006; 40 (08) 745-752
    CrossrefPubMedGoogle Scholar
  • 32 Jeong EH, Jun DW, Cho YK. et al. Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea. Clin Mol Hepatol 2013; 19 (03) 266-272
    CrossrefPubMedGoogle Scholar
  • 33 Onyekwere CA, Ogbera AO, Balogun BO. Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community. Ann Hepatol 2011; 10 (02) 119-124
    CrossrefPubMedGoogle Scholar
  • 34 Olusanya TO, Lesi OA, Adeyomoye AA, Fasanmade OA. Non alcoholic fatty liver disease in a Nigerian population with type II diabetes mellitus. Pan Afr Med J 2016; 24: 20
    CrossrefPubMedGoogle Scholar
  • 35 Kruger FC, Daniels C, Kidd M. et al. Non-alcoholic fatty liver disease (NAFLD) in the Western Cape: a descriptive analysis. S Afr Med J 2010; 100 (03) 168-171 [published correction appears in S Afr Med J. 2010 May;100(5):266]
    CrossrefPubMedGoogle Scholar
  • 36 Almobarak AO, Barakat S, Khalifa MH, Elhoweris MH, Elhassan TM, Ahmed MH. Non alcoholic fatty liver disease (NAFLD) in a Sudanese population: what is the prevalence and risk factors?. Arab J Gastroenterol 2014; 15 (01) 12-15
    CrossrefPubMedGoogle Scholar
  • 37 Das K, Das K, Mukherjee PS. et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010; 51 (05) 1593-1602
    CrossrefPubMedGoogle Scholar
  • 38 Lu FB, Zheng KI, Rios RS, Targher G, Byrne CD, Zheng MH. Global epidemiology of lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Gastroenterol Hepatol 2020; 35 (12) 2041-2050
    CrossrefPubMedGoogle Scholar
  • 39 Zimmermann E, Gamborg M, Holst C, Baker JL, Sørensen TI, Berentzen TL. Body mass index in school-aged children and the risk of routinely diagnosed non-alcoholic fatty liver disease in adulthood: a prospective study based on the Copenhagen School Health Records Register. BMJ Open 2015; 5 (04) e006998
    CrossrefPubMedGoogle Scholar
  • 40 Fitzpatrick E, Dhawan A. Childhood and adolescent nonalcoholic fatty liver disease: is it different from adults?. J Clin Exp Hepatol 2019; 9 (06) 716-722
    CrossrefPubMedGoogle Scholar
  • 41 Yu EL, Golshan S, Harlow KE. et al. Prevalence of nonalcoholic fatty liver disease in children with obesity. J Pediatr 2019; 207: 64-70
    CrossrefPubMedGoogle Scholar
  • 42 VanWagner LB, Armstrong MJ. Lean NAFLD: a not so benign condition?. Hepatol Commun 2018; 2 (01) 5-8
    CrossrefPubMedGoogle Scholar
  • 43 Anderson EL, Howe LD, Jones HE, Higgins JP, Lawlor DA, Fraser A. The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis. PLoS One 2015; 10 (10) e0140908
    CrossrefPubMedGoogle Scholar
  • 44 Suomela E, Oikonen M, Pitkänen N. et al. Childhood predictors of adult fatty liver. The Cardiovascular Risk in Young Finns Study. J Hepatol 2016; 65 (04) 784-790
    CrossrefPubMedGoogle Scholar
  • 45 Lin YC, Wu CC, Ni YH. New perspectives on genetic prediction for pediatric metabolic associated fatty liver disease. Front Pediatr 2020; 8: 603654
    CrossrefPubMedGoogle Scholar
  • 46 Ayonrinde OT, Adams LA, Mori TA. et al. Sex differences between parental pregnancy characteristics and nonalcoholic fatty liver disease in adolescents. Hepatology 2018; 67 (01) 108-122
    CrossrefPubMedGoogle Scholar
  • 47 Suzuki A. NASH in special populations. Gastroenterol Hepatol (N Y) 2014; 10 (04) 262-264
    PubMedGoogle Scholar
  • 48 Shaheen M, Schrode KM, Pan D. et al. Sex-specific differences in the association between race/ethnicity and NAFLD among US population. Front Med (Lausanne) 2021; 8: 795421
    CrossrefPubMedGoogle Scholar
  • 49 Fracanzani AL, Valenti L, Bugianesi E. et al. Risk of nonalcoholic steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease and low visceral adiposity. J Hepatol 2011; 54 (06) 1244-1249
    CrossrefPubMedGoogle Scholar
  • 50 Tan EX, Lee JW, Jumat NH. et al. Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study. Metabolism 2022; 126: 154911
    CrossrefPubMedGoogle Scholar
  • 51 Hamurcu Varol P, Kaya E, Alphan E, Yilmaz Y. Role of intensive dietary and lifestyle interventions in the treatment of lean nonalcoholic fatty liver disease patients. Eur J Gastroenterol Hepatol 2020; 32 (10) 1352-1357
    CrossrefPubMedGoogle Scholar
  • 52 Fassio E, Alvarez E, Domínguez N, Landeira G, Longo C. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004; 40 (04) 820-826
    PubMedGoogle Scholar
  • 53 Rafiq N, Bai C, Fang Y. et al. Long-term follow-up of patients with nonalcoholic fatty liver. Clin Gastroenterol Hepatol 2009; 7 (02) 234-238
    CrossrefPubMedGoogle Scholar
  • 54 Kotronen A, Yki-Järvinen H, Männistö S. et al. Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey. BMC Public Health 2010; 10: 237
    CrossrefPubMedGoogle Scholar
  • 55 Suomela E, Oikonen M, Virtanen J. et al. Prevalence and determinants of fatty liver in normal-weight and overweight young adults. The Cardiovascular Risk in Young Finns Study. Ann Med 2015; 47 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 56 Sohrabpour A, Rezvan H, Amini-Kafiabad S, Dayhim M, Merat S, Pourshams A. Prevalence of nonalcoholic steatohepatitis in Iran: a population based study. Middle East J Dig Dis 2010; 2 (01) 14-19
    PubMedGoogle Scholar
  • 57 Alkassabany YM, Farghaly AG, El-Ghitany EM. Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt. Arab J Gastroenterol 2014; 15 (02) 76-81
    CrossrefPubMedGoogle Scholar
  • 58 Dassanayake AS, Kasturiratne A, Rajindrajith S. et al. Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population. J Gastroenterol Hepatol 2009; 24 (07) 1284-1288
    CrossrefPubMedGoogle Scholar
  • 59 Alexander M, Loomis AK, van der Lei J. et al. Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts. BMC Med 2019; 17 (01) 95
    CrossrefPubMedGoogle Scholar
  • 60 Golabi P, Otgonsuren M, de Avila L, Sayiner M, Rafiq N, Younossi ZM. Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD). Medicine (Baltimore) 2018; 97 (13) e0214
    CrossrefPubMedGoogle Scholar
  • 61 Simeone JC, Bae JP, Hoogwerf BJ. et al. Clinical course of nonalcoholic fatty liver disease: an assessment of severity, progression, and outcomes. Clin Epidemiol 2017; 9: 679-688
    CrossrefPubMedGoogle Scholar
  • 62 Younossi ZM, Otgonsuren M, Venkatesan C, Mishra A. In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabolism 2013; 62 (03) 352-360
    CrossrefPubMedGoogle Scholar
  • 63 Alam S, Fahim SM, Chowdhury MAB. et al. Prevalence and risk factors of non-alcoholic fatty liver disease in Bangladesh. JGH Open 2018; 2 (02) 39-46
    CrossrefPubMedGoogle Scholar
  • 64 Eguchi Y, Hyogo H, Ono M. et al; JSG-NAFLD. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol 2012; 47 (05) 586-595
    CrossrefPubMedGoogle Scholar
  • 65 Li J, Zou B, Yeo YH. et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2019; 4 (05) 389-398
    CrossrefPubMedGoogle Scholar
  • 66 Zou B, Yeo YH, Nguyen VH, Cheung R, Ingelsson E, Nguyen MH. Prevalence, characteristics and mortality outcomes of obese, nonobese and lean NAFLD in the United States, 1999-2016. J Intern Med 2020; 288 (01) 139-151
    CrossrefPubMedGoogle Scholar
  • 67 Ye Q, Zou B, Yeo YH. et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5 (08) 739-752
    CrossrefPubMedGoogle Scholar
  • 68 Leitão J, Carvalhana S, Cochicho J. et al. Prevalence and risk factors of fatty liver in Portuguese adults. Eur J Clin Invest 2020; 50 (06) e13235
    CrossrefPubMedGoogle Scholar
  • 69 Nabi O, Lacombe K, Boursier J, Mathurin P, Zins M, Serfaty L. Prevalence and risk factors of nonalcoholic fatty liver disease and advanced fibrosis in general population: the French nationwide NASH-CO study. Gastroenterology 2020; 159 (02) 791-793.e2
    CrossrefPubMedGoogle Scholar
  • 70 Estes C, Chan HLY, Chien RN. et al. Modelling NAFLD disease burden in four Asian regions-2019-2030. Aliment Pharmacol Ther 2020; 51 (08) 801-811
    CrossrefPubMedGoogle Scholar
  • 71 Younossi ZM, Yilmaz Y, Yu ML. et al. ; Global NASH Council. Clinical and patient-reported outcomes from patients with nonalcoholic fatty liver disease across the world: data from the Global Non-Alcoholic Steatohepatitis (NASH)/ Non-Alcoholic Fatty Liver Disease (NAFLD) Registry. Clin Gastroenterol Hepatol 2021; 9 :S1542-3565 (21) 01183-6 DOI: 10.1016/j.cgh.2021.11.004.
    CrossrefPubMedGoogle Scholar
  • 72 Williams R, Aspinall R, Bellis M. et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014;384(9958):1953—1997 [published correction appears in Lancet. 2014 Dec 20;384(9961):2212]
    PubMedGoogle Scholar
  • 73 Mantovani A, Csermely A, Petracca G. et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6 (11) 903-913
    CrossrefPubMedGoogle Scholar
  • 74 Mantovani A, Scorletti E, Mosca A, Alisi A, Byrne CD, Targher G. Complications, morbidity and mortality of nonalcoholic fatty liver disease. Metabolism 2020; 111S: 154170
    CrossrefPubMedGoogle Scholar
  • 75 Targher G, Tilg H, Byrne CD. Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach. Lancet Gastroenterol Hepatol 2021; 6 (07) 578-588
    CrossrefPubMedGoogle Scholar
  • 76 Mikus CR, Rector RS, Arce-Esquivel AA. et al. Daily physical activity enhances reactivity to insulin in skeletal muscle arterioles of hyperphagic Otsuka Long-Evans Tokushima Fatty rats. J Appl Physiol (1985) 2010; 109 (04) 1203-1210
    CrossrefPubMedGoogle Scholar
  • 77 Mantovani A, Petracca G, Beatrice G, Tilg H, Byrne CD, Targher G. Non-alcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501 022 adult individuals. Gut 2021; 70 (05) 962-969
    CrossrefPubMedGoogle Scholar
  • 78 Tao Z, Li Y, Cheng B, Zhou T, Gao Y. Influence of nonalcoholic fatty liver disease on the occurrence and severity of chronic kidney disease. J Clin Transl Hepatol 2022; 10 (01) 164-173
    CrossrefPubMedGoogle Scholar
  • 79 Venniyoor A, Al Farsi AA, Al Bahrani B. The troubling link between non-alcoholic fatty liver disease (NAFLD) and extrahepatic cancers (EHC). Cureus 2021; 13 (08) e17320
    PubMedGoogle Scholar
  • 80 Weinstein AA, Kallman Price J, Stepanova M. et al. Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C. Psychosomatics 2011; 52 (02) 127-132
    CrossrefPubMedGoogle Scholar
  • 81 Younossi ZM, Blissett D, Blissett R. et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology 2016; 64 (05) 1577-1586
    CrossrefPubMedGoogle Scholar
  • 82 Chawla KS, Talwalkar JA, Keach JC, Malinchoc M, Lindor KD, Jorgensen R. Reliability and validity of the Chronic Liver Disease Questionnaire (CLDQ) in adults with non-alcoholic steatohepatitis (NASH). BMJ Open Gastroenterol 2016; 3 (01) e000069
    CrossrefPubMedGoogle Scholar
  • 83 Sumida Y, Yoneda M, Tokushige K. et al; Japan Study Group Of Nafld Jsg-Nafld. FIB-4 first in the diagnostic algorithm of metabolic-dysfunction-associated fatty liver disease in the era of the global metabodemic. Life (Basel) 2021; 11 (02) 143
    PubMedGoogle Scholar
  • 84 Zhou YJ, Wong VW, Zheng MH. Consensus scoring systems for nonalcoholic fatty liver disease: an unmet clinical need. Hepatobiliary Surg Nutr 2021; 10 (03) 388-390
    CrossrefPubMedGoogle Scholar
  • 85 Peleg N, Issachar A, Sneh-Arbib O, Shlomai A. AST to platelet ratio index and fibrosis 4 calculator scores for non-invasive assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease. Dig Liver Dis 2017; 49 (10) 1133-1138
    CrossrefPubMedGoogle Scholar
  • 86 Patel YA, Gifford EJ, Glass LM. et al. Identifying nonalcoholic fatty liver disease advanced fibrosis in the Veterans Health Administration. Dig Dis Sci 2018; 63 (09) 2259-2266
    CrossrefPubMedGoogle Scholar
  • 87 de Carli MA, de Carli LA, Correa MB, Junqueira Jr G, Tovo CV, Coral GP. Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2020; 32 (03) 420-425
    CrossrefPubMedGoogle Scholar
  • 88 Kaya E, Bakir A, Kani HT, Demirtas CO, Keklikkiran C, Yilmaz Y. Simple noninvasive scores are clinically useful to exclude, not predict, advanced fibrosis: a study in turkish patients with biopsy-proven nonalcoholic fatty liver disease. Gut Liver 2020; 14 (04) 486-491
    CrossrefPubMedGoogle Scholar
  • 89 Alkayyali T, Qutranji L, Kaya E, Bakir A, Yilmaz Y. Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease. Acta Diabetol 2020; 57 (05) 613-618
    CrossrefPubMedGoogle Scholar
  • 90 Eren F, Kaya E, Yilmaz Y. Accuracy of Fibrosis-4 index and non-alcoholic fatty liver disease fibrosis scores in metabolic (dysfunction) associated fatty liver disease according to body mass index: failure in the prediction of advanced fibrosis in lean and morbidly obese individuals. Eur J Gastroenterol Hepatol 2022; 34 (01) 98-103
    CrossrefPubMedGoogle Scholar
  • 91 Zhang JZ, Cai JJ, Yu Y, She ZG, Li H. Nonalcoholic fatty liver disease: an update on the diagnosis. Gene Expr 2019; 19 (03) 187-198
    CrossrefPubMedGoogle Scholar
  • 92 European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63 (01) 237-264
    CrossrefPubMedGoogle Scholar
  • 93 Boyd A, Cain O, Chauhan A, Webb GJ. Medical liver biopsy: background, indications, procedure and histopathology. Frontline Gastroenterol 2020; 11 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 94 European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64 (06) 1388-1402
    CrossrefPubMedGoogle Scholar
  • 95 Stanhope KL, Havel PJ. Fructose consumption: considerations for future research on its effects on adipose distribution, lipid metabolism, and insulin sensitivity in humans. J Nutr 2009; 139 (06) 1236S-1241S
    CrossrefPubMedGoogle Scholar
  • 96 Solga S, Alkhuraishe AR, Clark JM. et al. Dietary composition and nonalcoholic fatty liver disease. Dig Dis Sci 2004; 49 (10) 1578-1583
    CrossrefPubMedGoogle Scholar
  • 97 York LW, Puthalapattu S, Wu GY. Nonalcoholic fatty liver disease and low-carbohydrate diets. Annu Rev Nutr 2009; 29: 365-379
    CrossrefPubMedGoogle Scholar
  • 98 Alisi A, Manco M, Pezzullo M, Nobili V. Fructose at the center of necroinflammation and fibrosis in nonalcoholic steatohepatitis. Hepatology 2011; 53 (01) 372-373
    CrossrefPubMedGoogle Scholar
  • 99 Caporaso N, Morisco F, Camera S, Graziani G, Donnarumma L, Ritieni A. Dietary approach in the prevention and treatment of NAFLD. Front Biosci (Landmark Ed) 2012; 17: 2259-2268
    CrossrefPubMedGoogle Scholar
  • 100 Williams CD, Stengel J, Asike MI. et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 2011; 140 (01) 124-131
    CrossrefPubMedGoogle Scholar
  • 101 Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L. et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 2015; 149 (02) 367-78 .e5, quiz e14–e15
    Google Scholar
  • 102 Booth FW, Laye MJ, Lees SJ, Rector RS, Thyfault JP. Reduced physical activity and risk of chronic disease: the biology behind the consequences. Eur J Appl Physiol 2008; 102 (04) 381-390
    CrossrefPubMedGoogle Scholar
  • 103 Johnson NA, George J. Fitness versus fatness: moving beyond weight loss in nonalcoholic fatty liver disease. Hepatology 2010; 52 (01) 370-381
    CrossrefPubMedGoogle Scholar
  • 104 Carroll JF, Franks SF, Smith AB, Phelps DR. Visceral adipose tissue loss and insulin resistance 6 months after laparoscopic gastric banding surgery: a preliminary study. Obes Surg 2009; 19 (01) 47-55
    CrossrefPubMedGoogle Scholar
  • 105 Rector RS, Thyfault JP, Morris RT. et al. Daily exercise increases hepatic fatty acid oxidation and prevents steatosis in Otsuka Long-Evans Tokushima Fatty rats. Am J Physiol Gastrointest Liver Physiol 2008; 294 (03) G619-G626
    CrossrefPubMedGoogle Scholar
  • 106 van der Heijden GJ, Wang ZJ, Chu ZD. et al. A 12-week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity (Silver Spring) 2010; 18 (02) 384-390 [published correction appears in Obesity (Silver Spring). 2010 May;18(5):1062]
    CrossrefPubMedGoogle Scholar
  • 107 Hashida R, Kawaguchi T, Bekki M. et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review. J Hepatol 2017; 66 (01) 142-152
    CrossrefPubMedGoogle Scholar
  • 108 Sung KC, Ryu S, Lee JY, Kim JY, Wild SH, Byrne CD. Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver. J Hepatol 2016; 65 (04) 791-797
    CrossrefPubMedGoogle Scholar
  • 109 Pereko KAK, Setorglo J, Steiner- Asiedu M, Tiweh JBM. Nutrition and lifestyle modifications in the prevention and treatment of non-alcoholic fatty liver disease. In: Valenzuela R, ed. Non-Alcoholic Fatty Liver Disease - Molecular Bases, Prevention and Treatment 2017: 139-142
    PubMed
  • 110 Aller R, De Luis DA, Izaola O. et al. Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. Eur Rev Med Pharmacol Sci 2011; 15 (09) 1090-1095
    PubMedGoogle Scholar
  • 111 Ofosu A, Ramai D, Reddy M. Non-alcoholic fatty liver disease: controlling an emerging epidemic, challenges, and future directions. Ann Gastroenterol 2018; 31 (03) 288-295
    PubMedGoogle Scholar
  • 112 Petroni ML, Brodosi L, Marchignoli F, Musio A, Marchesini G. Moderate alcohol intake in non-alcoholic fatty liver disease: to drink or not to drink?. Nutrients 2019; 11 (12) 3048
    CrossrefPubMedGoogle Scholar
  • 113 Chen VL, Yeh ML, Yang JD. et al. Effects of cirrhosis and diagnosis scenario in metabolic-associated fatty liver disease-related hepatocellular carcinoma. Hepatol Commun 2020; 5 (01) 122-132
    CrossrefPubMedGoogle Scholar
  • 114 Kanwal F, Kramer JR, Li L. et al. Effect of metabolic traits on the risk of cirrhosis and hepatocellular cancer in nonalcoholic fatty liver disease. Hepatology 2020; 71 (03) 808-819
    CrossrefPubMedGoogle Scholar
  • 115 Natarajan Y, Kramer JR, Yu X. et al. Risk of cirrhosis and hepatocellular cancer in patients with NAFLD and normal liver enzymes. Hepatology 2020; 72 (04) 1242-1252
    CrossrefPubMedGoogle Scholar