Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System

Abstract

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms “non-alcoholic fatty liver disease” and “non-alcoholic steatohepatitis”, in addition to “prevalence and risk factors for NAFLD”, with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

The Burden and Clinical Care Pathways of Nonalcoholic Steatohepatitis in the Middle East

“…Despite these limitations, the notion that NAFLD is common in Middle East populations is supported by the high prevalence of obesity, T2DM, and the MetS (Fig. ) . Ten countries in the region are placed in the top 15 countries with the highest levels of obesity in the world .…”

“…The prevalence of diabetes (light gray bars), obesity (dark gray bars), and MetS (black bars) in some Middle Eastern countries. Adapted with permission from Gastroenterology Research . Creative Commons License Copyright Canada‐China Clinical Medicine Study Association, 2017.…”

Comparison of variation in frequency for SNPs associated with asthma or liver disease between Estonia, HapMap populations and the 1000 genome project populations

“…Nonalcoholic fatty liver disease (NAFLD) is considered to be the most common form of liver disease. In Africa, the prevalence of NAFLD is estimated to range between 8.7% and 47.6% (Ahmed et al, 2017). In Africa, the prevalence of NAFLD is estimated to range between 8.7% and 47.6% (Ahmed et al, 2017).…”

“…The prevalence of NAFLD in the general population is estimated to range between 12% and 18% in Europe and 27% and 38% in the US (Anstee & Day, 2013). In Africa, the prevalence of NAFLD is estimated to range between 8.7% and 47.6% (Ahmed et al, 2017). In Asia, the prevalence of NAFLD is estimated to range between 15% and 20% (Ashtari, Pourhoseingholi, & Zali, 2015).…”

A gathering storm

“…The problem may be more pronounced in developing countries where there are limited resources available for mass screening and diagnosis of NAFLD [8] . There is a small but growing body of literature examining NAFLD in the setting of HIV, with data from low and middle-income countries (LMIC) particularly lacking.…”