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. 2020 Jun 9;8(2):E429-E436.
doi: 10.9778/cmajo.20190212. Print 2020 Apr-Jun.

Burden of nonalcoholic fatty liver disease in Canada, 2019-2030: a modelling study

Mark G Swain  1 , Alnoor Ramji  1 , Keyur Patel  1 , Giada Sebastiani  1 , Abdel Aziz Shaheen  1 , Edward Tam  1 , Paul Marotta  1 , Magdy Elkhashab  1 , Harpreet S Bajaj  1 , Chris Estes  2 , Homie Razavi  1
Affiliations

Burden of nonalcoholic fatty liver disease in Canada, 2019-2030: a modelling study

Mark G Swain et al. CMAJ Open. .

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a growing proportion of liver disease cases, and there is a need to better understand future disease burden. We used a modelling framework to forecast the burden of disease of NAFLD and NASH for Canada.

Methods: We used a Markov model to forecast fibrosis progression from stage F0 (no fibrosis) to stage F4 (compensated cirrhosis) and subsequent progression to decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death among Canadians with NAFLD from 2019 to 2030. We used historical trends for obesity prevalence among adults to estimate longitudinal changes in the number of incident NAFLD cases.

Results: The model projected that the number of NAFLD cases would increase by 20% between 2019 and 2030, from an estimated 7 757 000 cases to 9 305 000 cases. Increases in advanced fibrosis cases were relatively greater, as the number of model-estimated prevalent stage F3 cases would increase by 65%, to 357 000, and that of prevalent stage F4 cases would increase by 95%, to 195 000. Estimated incident cases of hepatocellular carcinoma and decompensated cirrhosis would increase by up to 95%, and the number of annual NAFLD-related deaths would double, to 5600.

Interpretation: Increasing rates of obesity translate into increasing NAFLD-related cases of cirrhosis and hepatocellular carcinoma and related mortality. Prevention efforts should be aimed at reducing the incidence of NAFLD and slowing fibrosis progression among those already affected.

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Conflict of interest statement

Competing interests: Funding for this project was provided by Gilead Sciences. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Model-estimated prevalent cases of nonalcoholic fatty liver disease (NAFLD) (A), nonalcoholic steatohepatitis (B), stage F0 NAFLD (C), stage F1 NAFLD (D), stage F2 NAFLD (E), stage F3 NAFLD (F), compensated cirrhosis NAFLD (G) and decompensated cirrhosis, hepatocellular carcinoma and liver transplantation related to NAFLD (H) for Canada, 2015–2030. Shaded areas represent 95% uncertainty interval.
Figure 2:
Figure 2:
Model-estimated incident cases of hepatocellular carcinoma (A), decompensated cirrhosis (B) and incident liver-related death (C) related to nonalcoholic fatty liver disease for Canada, 2015–2030. Shaded areas represent 95% uncertainty interval.
See this image and copyright information in PMC

References

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