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Observational Study
. 2021 May 4;11(5):e042843.
doi: 10.1136/bmjopen-2020-042843.

Increasing prevalence of NAFLD/NASH among children, adolescents and young adults from 1990 to 2017: a population-based observational study

Xin Zhang #  1 , Mingshan Wu #  1 , Zhenqiu Liu  2   3   4 , Huangbo Yuan  1 , Xuefu Wu  1 , Tingting Shi  1 , Xingdong Chen  2   3   4 , Tiejun Zhang  5   3
Affiliations
Observational Study

Increasing prevalence of NAFLD/NASH among children, adolescents and young adults from 1990 to 2017: a population-based observational study

Xin Zhang et al. BMJ Open. .

Abstract

Objective: To describe the prevalence and variations of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) among children and adolescents (CADs) and young adults (YADs).

Design: A population-based observational study.

Setting: Annual cases and prevalence of NAFLD/NASH from 1990 to 2017, by sex, region and country were collected from the Global Burden of Disease database.

Main outcome measures: The estimated annual percentage change, which was calculated by a regression line, was used to quantify the temporal trends in NAFLD/NASH burden among young people at the global, regional and national levels.

Results: Globally, NAFLD/NASH incidence increased from 19.34 million in 1990 to 29.49 million in 2017 among CADs, with an annual increase of 1.35%. Additionally, in YADs, the number of cases and NAFLD/NASH prevalence significantly increased during this period, independent of sex and region. The greatest NAFLD/NASH increase was in North Africa and the Middle East. Almost all countries showed an increasing trend from 1990 to 2017, with the most pronounced increase observed in the developed regions.

Conclusions: The epidemiology of NAFLD/NASH in young people has changed considerably over the last three decades. Both the prevalence and number of cases have increased irrespective of sex, age and region. This phenomenon can result in a predictable increase in chronic liver disease burden in the near future. Understanding the prevalence of NAFLD/NASH and its variations is of paramount importance to develop strategies to implement public health policy.

Keywords: epidemiology; hepatobiliary disease; hepatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The temporal trends of the prevalence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) (%) among children and adolescents and young adults from 1990 to 2017 by sex and Socio-Demographic Index (SDI) region.
Figure 2
Figure 2
The prevalence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) (%) among children and adolescents and young adults in 1990 and 2017 at the global burden of disease-region level.
Figure 3
Figure 3
The estimated annual percentage changes (EAPCs) in the prevalence of non-lcoholic fatty liver disease/non-alcoholic steatohepatitis among children and adolescents and young adults at the global burden of disease-regional level between 1990 and 2017. The error bar denotes the 95% CI for EAPC.
Figure 4
Figure 4
The prevalence and estimated annual percentage changes (EAPCs) of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) (%) among children and adolescents (CADs) and young adults (YADs) in 2017 at the national level. (A) The prevalence of NAFLD/NASH among CADs in 2017 at the national level. (B) The prevalence of NAFLD/NASH among YADs in 2017 at the national level. (C) The EAPCs of NAFLD/NASH (%) among CADs in 2017 at the national level. (D) The EAPCs of NAFLD/NASH (%) among YADs in 2017 at the national level.
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