Burden of non‐alcoholic fatty liver disease in Australia

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease in the Australian population, although precise estimates of prevalence are lacking. NAFLD may progress to liver fibrosis, cirrhosis, decompensated liver disease, and liver cancer and is becoming an increasingly common indication for liver transplantation in Australia and New Zealand. There is an extrahepatic burden of NAFLD extending beyond the liver, which is manifested by an increased risk of developing cardiovascular disease, diabetes, and chronic renal impairment, all of which are common causes of morbidity in the Australian population. Early recognition of those patients at high risk of developing advanced liver disease is essential in order to target those who will benefit from intensive lifestyle modification. In this review, we present data on the epidemiology of NAFLD within Australia, its associated health burden in terms of hepatic and extrahepatic complications, common clinical presentations, and indications for treatment. We also propose a research agenda that highlights knowledge needed to improve diagnosis and management specific to the Australian context.

Prevalence of non‐alcoholic fatty liver and liver fibrosis in patients with moderate–severe psoriasis: A cross‐sectional cohort study

“…The prevalence of NAFLD is increasing rapidly in the Western world, mainly due to obesity and type 2 diabetes, becoming the most prevalent chronic liver disease in the Australian population . Its pathophysiology includes overnutrition, sedentary life, genetic factors and insulin resistance .…”

Screening for non‐alcoholic fatty liver disease in community setting: A cohort study using controlled attenuation parameter‐transient elastography

“…The majority of NAFLD patients are asymptomatic, and a recent international, multicenter, retrospective cohort study of NAFLD patients has demonstrated that the fibrotic stage is independently associated with the overall and liver‐related mortality . Among NAFLD patients, the prevalence of Nonalcoholic steatohepatitis (NASH) and fibrosis stages 3–4 is significant, being found in 15–26% and 3–10% of patients, respectively …”

“…7,8 Among NAFLD patients, the prevalence of Nonalcoholic steatohepatitis (NASH) and fibrosis stages 3-4 is significant, being found in 15-26% and 3-10% of patients, respectively. 9 Controlled attenuation parameter (CAP) and transient elastography (TE) are noninvasive and time-saving diagnostic tools that are used to determine liver steatosis and fibrosis concurrently. A recent study of repeating liver stiffness measurement (LSM) using TE in NAFLD patients showed high sensitivity on TE, with a cut-off value < 7.9 kPa demonstrating a 100% negative predictive value for septal or bridging fibrosis and cirrhosis.…”

Non‐alcoholic fatty liver disease

“…Australia is well placed to conduct collaborative studies such as those needed to test promising biomarker and physical investigations that characterise those patients in need of major interventions. In the meantime, we strongly agree that greater public and professional awareness of fatty liver as a common accompaniment of overweight and metabolic obesity is needed . Given the strong links between NAFLD and risk of type 2 diabetes, cardiovascular disease and common cancers, even those cases in which the liver disease is minor can benefit enormously from lifestyle intervention, irrespective of whether referral to a liver clinic is activated or not.…”

“…While their finding that obesity and glucose intolerance are the usual risk factors for significant liver disease with NAFLD is well supported by the literature, we were surprised that NAFLD formed only 7% of referrals to those clinics. Given that community prevalence of NAFLD in most global communities is at least 30% and estimates for Australia are similar, this low frequency of referrals to Melbourne liver clinics deserves comment.…”