Global Epidemiology of Nonalcoholic Fatty Liver Disease-Meta-Analytic Assessment of Prevalence, Incidence, and Outcomes
Global Epidemiology of Nonalcoholic Fatty Liver Disease-Meta-Analytic Assessment of Prevalence, Incidence, and Outcomes
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DOI：
10.1002/hep.28431
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发表时间：
2016-07-01
期刊：
影响因子：
13.5
通讯作者：
Wymer, Mark
中科院分区：
文献类型：
--
作者：
Younossi, Zobair M.;Koenig, Aaron B.;Wymer, Mark
非酒精性脂肪性肝病（NAFLD）是全球肝病的主要原因。我们评估了NAFLD和非酒精性脂肪性肝炎（NASH）的全球患病率、发病率、进展和结局。检索了1989年至2015年期间的PubMed/MEDLINE，检索了涉及NAFLD流行病学和进展的术语。排除包括选定的组（仅招募病态肥胖或糖尿病或儿童的研究），并且没有关于饮酒或其他肝脏疾病的数据。确定肝细胞癌（HCC）、肝硬化的发病率、总死亡率和肝脏相关死亡率。NASH需要组织学诊断。所有研究均由三名独立研究人员进行审查。分析按地区、诊断技术、活检指征和研究人群分层。我们使用随机效应模型来提供患病率、发病率、死亡率和发病率比的点估计值（95%置信区间[CI]），并使用亚组分析进行荟萃回归来解释异质性。在729项研究中，纳入了86项研究，样本量为8，515，431，来自22个国家。NAFLD的全球患病率为25.24%（95%CI：22.10-28.65），中东和南美的患病率最高，非洲最低。与NAFLD相关的代谢合并症包括肥胖（51.34%; 95% CI：41.38-61.20），2型糖尿病（22.51%; 95% CI：17.92-27.89），高脂血症（69.16%; 95%CI：49.91-83.46%）、高血压（39.34%; 95%CI：33.15-45.88）和代谢综合征（42.54%; 95%CI：30.06-56.05）。NASH组纤维化进展比例为40.76%（95%CI：34.69-47.13），平均年进展率为0.09（95%CI：0.06-0.12）。NAFLD患者的HCC发病率为0.44/1000人-年（范围：0.29-0.66）。NAFLD和NASH的肝脏特异性死亡率和总死亡率为0.77/1000（范围，0.33-1.77）和11.77/1 000人年（范围，7.10-19.53）和15.44/1，000（范围，11.72-20.34）和25.56/1，000人年（范围，6.29-103.80）。NAFLD的肝脏特异性死亡率和总体死亡率的发病风险比分别为1.94（范围，1.28-2.92）和1.05（范围，0.70-1.56）。结论：随着肥胖症的全球流行加剧了代谢状况，NAFLD的临床和经济负担将变得巨大。
Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. We estimated the global prevalence, incidence, progression, and outcomes of NAFLD and nonalcoholic steatohepatitis (NASH). PubMed/MEDLINE were searched from 1989 to 2015 for terms involving epidemiology and progression of NAFLD. Exclusions included selected groups (studies that exclusively enrolled morbidly obese or diabetics or pediatric) and no data on alcohol consumption or other liver diseases. Incidence of hepatocellular carcinoma (HCC), cirrhosis, overall mortality, and liver-related mortality were determined. NASH required histological diagnosis. All studies were reviewed by three independent investigators. Analysis was stratified by region, diagnostic technique, biopsy indication, and study population. We used random-effects models to provide point estimates (95% confidence interval [CI]) of prevalence, incidence, mortality and incidence rate ratios, and metaregression with subgroup analysis to account for heterogeneity. Of 729 studies, 86 were included with a sample size of 8,515,431 from 22 countries. Global prevalence of NAFLD is 25.24% (95% CI: 22.10-28.65) with highest prevalence in the Middle East and South America and lowest in Africa. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). Fibrosis progression proportion, and mean annual rate of progression in NASH were 40.76% (95% CI: 34.69-47.13) and 0.09 (95% CI: 0.06-0.12). HCC incidence among NAFLD patients was 0.44 per 1,000 person-years (range, 0.29-0.66). Liver-specific mortality and overall mortality among NAFLD and NASH were 0.77 per 1,000 (range, 0.33-1.77) and 11.77 per 1,000 person-years (range, 7.10-19.53) and 15.44 per 1,000 (range, 11.72-20.34) and 25.56 per 1,000 person-years (range, 6.29-103.80). Incidence risk ratios for liver-specific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56). Conclusions: As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous.