The Growing Burden of Disability Related to Nonalcoholic Fatty Liver Disease: Data From the Global Burden of Disease 2007‐2017

Abstract

Chronic liver disease (CLD) is a growing cause of morbidity and mortality worldwide. The burden of CLD varies according to etiology and geographic location. We assessed the global burden of disability from the most important complications of CLD (cirrhosis and liver cancer [LC]) according to the most common etiologies between 2007 and 2017. We obtained years living with disability (YLD), years of life lost (YLL), and disability‐adjusted life‐years (DALYs) data from the Global Burden of Disease 2017 study. Between 2007 and 2017, LC DALYs decreased by 4.52% and cirrhosis DALYs decreased by 10.58%. Nevertheless, in 2017, CLD caused 62.16 million DALYs (33.4% LC and 66.5% cirrhosis), of which 96.8% came from YLL (34.1% LC and 65.9% cirrhosis) and 3.2% from YLD (11.6% LC and 88.4% cirrhosis). In 2017, Asia accounted for 66% of all DALYs globally. Central Asia, Africa regions, Southeast Asia, and Eastern Europe had the highest liver‐related DALYs (≥1,000 per 100,000), whereas the lowest rates (≤500 per 100,000) were seen in high‐income regions, such as Asia Pacific, North America, Western Europe, and Australasia. In 2007, hepatitis B virus caused the majority (47.5%) of liver‐related DALYs, followed by hepatitis C virus (23.7%), alcoholic liver disease (14.2%), and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) (6.4%). In 2017, these rates shifted to 45.7%, 24.1%, 4.8%, and 7.1%, respectively. Between 2007 and 2017, cirrhosis‐related DALYs due to NAFLD/NASH increased by 23.4%, whereas the increment was 37.5% for LC‐related DALYs due to NAFLD/NASH. Conclusion: DALYs due to viral hepatitis still account for the largest proportion of CLD‐related DALYs. Although DALYs from all other liver diseases have remained stable in the last decade, DALYs related to NAFLD/NASH are growing. National, regional, and global policies are needed to address the disability burden of NAFLD across the world.

Nonalcoholic steatohepatitis: global impact and clinical consequences

“…This study reported that the number of prevalent cases for compensated cirrhosis due to NASH doubled over the study period, while the number for decompensated cirrhosis due to NASH tripled ( 47 ). Another study assessing the burden of NAFLD-/NASH-related burden using the same Global Burden of Disease database revealed that between 2007 and 2017, cirrhosis DALY due to NAFLD/NASH increased by 23.4%, while liver cancer DALY due to NAFLD/NASH increased by 37.5% ( 48 ).…”

“…Global Burden of Disease database revealed that between 2007 and 2017, cirrhosis DALY due to NAFLD/NASH increased by 23.4%, while liver cancer DALY due to NAFLD/NASH increased by 37.5%(49). , and indirect costs, respectively.…”

­A Robust Gene Expression Signature for NASH in Liver Expression Data

“…Approximately 25-40% of the general western world population develop NAFLD throughout their lives, of which approximately 30% progress to NASH(5-7), which is the leading cause for a liver transplant(8, 9) with overall estimated economic burden of $103 billion annually and projected 10-year burden of >$1 trillion in US alone (5, 7,10,11).…”

“…While NAFLD is considered a mild condition, Non-Alcoholic Steatohepatitis (NASH), the severe form of the disease, is de ned by in ammation and cell damage in addition to the fat accumulation. NASH increases the risk of developing liver brosis and may lead to cirrhosis and end-stage liver disease (2-4).Approximately 25-40% of the general western world population develop NAFLD throughout their lives, of which approximately 30% progress to NASH(5-7), which is the leading cause for a liver transplant(8, 9) with overall estimated economic burden of $103 billion annually and projected 10-year burden of >$1 trillion in US alone (5, 7,10,11).Despite truly epidemic proportions, diagnostic options for NASH are very limited (12, 13). Most NAFLD and NASH patients are asymptomatic until relatively late stages of the disease and suspicion of NASH often stems from coincidental ndings(2).…”

Does naringenin supplementation improve lipid profile, severity of hepatic steatosis and probability of liver fibrosis in overweight/obese patients with NAFLD? A randomised, double‐blind, placebo‐controlled, clinical trial

“…5 As a result of high frequency of metabolic comorbidities in patients with NAFLD and also the growing burden of disability related to chronic liver diseases, global policies are required to address the disability burden of NAFLD worldwide. 6 Pathogenesis of NAFLD is complicated and multifactorial. 7According to the "two-hit" theory proposed by Day and Jams, insulin resistance (IR) leads to hepatic accumulation of triglyceride, and then steatosis, making the liver more vulnerable to a "second hit" resulting in oxidative stress, endoplasmic reticulum stress and mitochondrial dysfunction, and ultimately leading to inflammation, fibrosis and cancer.…”