NAFLD Is a Growing Problem

Medscape Gastroenterology> Hepatology Highlights

Rowen K. Zetterman, MD

May 18, 2018

A Problem Increasing in Size

Nonalcoholic fatty liver disease (NAFLD) is a condition of hepatic steatosis without significant alcohol intake or another identifiable secondary cause that would result in fat accumulation within hepatocytes. NAFLD is associated with obesity, type 2 diabetes mellitus, and/or hyperlipidemia.[1] Patients with obesity alone in the absence of metabolic syndrome (obesity, type 2 diabetes mellitus, and hyperlipidemia) also have an increased risk of developing NAFLD.[2]NAFLD is a multisystem disease with complications related to obesity and diabetes mellitus, cardiovascular disease, chronic kidney disease, carcinomas (liver, breast, and colon), and polycystic ovary syndrome.[3]

NAFLD is the most common form of liver disease in Western countries.[4] Men are affected more than women.[5] Persons with a “high body mass index in late adolescence” are at risk for advanced liver disease and hepatocellular carcinoma (HCC).[6] The subsequent development of type 2 diabetes mellitus adds even greater risk for development of advanced liver disease.[6]

The current worldwide prevalence of NAFLD is approaching 25%.[7] The prevalence of NAFLD in the United States is increasing, owing to a rising incidence of obesity and type 2 diabetes mellitus.[8,9] Current US projections indicate a 21% increase in NAFLD numbers, leading to a 33.5% overall prevalence by 2030. Coupled with a 63% increase in patients with nonalcoholic steatohepatitis (NASH),[9] there will be a 168% increase in the number of patients with decompensated end-stage liver disease, and a 137% increase in the numbers of patients developing HCC from NAFLD. The growing numbers of NAFLD patients with hepatic fibrosis[8] indicate that end-stage liver disease from NAFLD will probably become the most common reason for liver transplantation in the United States.[10]

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