Author information
1
Center for Disease Analysis (CDA), Lafayette, Colorado, US.
2
Liver Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne, United Kingdom.
3
Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Santander, Spain; Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
4
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
5
Liver Center, Italian Liver Foundation, Trieste, Italy.
6
Hepatology Unit, Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
7
Center for Translational Research in Hepatology, Clinical and Research Center Humanitas, Rozzano, Italy.
8
Department of Gastroenterology, University of Palermo, Palermo, Italy.
9
Gastroenterology and Hepatology Department, Infection, Immunity and Digestive Pathology Group, IDIVAL, Instituto de Investigación Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
10
Division of Hepatology, Department of Medicine II, University of Würzburg, Würzburg, Germany.
11
Center for Global Health, Istituto Superiore di Sanita, Rome, Italy.
12
ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.
13
NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, CA, US; Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, US.
14
Unit of Metabolic Diseases and Clinical Dietetics, DIMEC, "Alma Mater" University, Bologna, Italy.
15
Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospital, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland.
16
Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy.
17
Department of Hepatology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France; University Pierre et Marie Curie, Institut National de la Santé et de la Recherche Médicale UMR 938, Paris, France.
18
Unit for the Clinical Management of Digestive Diseases & CIBERehd, Virgen Macarena - Virgen del Rocio University Hospitals, Seville, Spain.
19
Virginia Commonwealth University Medical Center, Richmond, Virginia, US.
20
Department of Medicine I, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.
21
Department of Medicine III, RWTH University Hospital Aachen, Aachen, Germany.
22
Department of Internal Medicine III, University Hospital RWTH, Aachen, Germany.
23
Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China; Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China.
24
JW Goethe University Hospital, Frankfurt, Germany.
25
Center for Disease Analysis (CDA), Lafayette, Colorado, US. Electronic address: homie.razavi@c4da.com.
Abstract
BACKGROUND:
Nonalcoholic fatty liver disease (NAFLD) with resulting nonalcoholic steatohepatitis (NASH) are increasingly a cause of cirrhosis and hepatocellular carcinoma (HCC) globally. This burden is expected to increase as epidemics of obesity, diabetes and metabolic syndrome continue to grow. The goal of this analysis was to use a Markov model to forecast NAFLD disease burden using currently available data.
METHODS:
A model was used to estimate NAFLD and NASH disease progression in 8 countries based on data for adult prevalence of obesity and type 2 diabetes mellitus (DM). Published estimates and expert consensus were used to build and validate the model projections.
RESULTS:
If obesity and DM level off in the future, we project a modest growth in total NAFLD cases (0-30%), between 2016-2030, with the highest growth in China as result of urbanization and the lowest growth in Japan as result of a shrinking population. However, at the same time, NASH prevalence will increase 15-56%, while liver mortality and advanced liver disease will more than double as result of an aging/increasing population.
CONCLUSIONS:
NAFLD and NASH represent a large and growing public health problem and efforts to understand this epidemic and to mitigate the disease burden are needed. If obesity and DM continue to increase at current and historical rates, both NAFLD and NASH prevalence are expected to increase. Since both are reversible, public health campaigns to increase awareness and diagnosis, and to promote diet and exercise can help manage the growth in future disease burden.
LAY SUMMARY:
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) can lead to advanced liver disease, and are occurring in increasing numbers in tandem with epidemics of obesity and diabetes. A mathematical model was built to understand how the disease burden associated with NAFLD and NASH will change over time. Results suggest increasing numbers of cases of advanced liver disease and liver-related mortality in the coming years.