Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jul 20;135(14):1682-1691.
doi: 10.1097/CM9.0000000000002277.

Estimating global prevalence, incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis

Jiaye Liu  1   2   3   4 , Ye Tian  5 , Xia Fu  6 , Chunyang Mu  7 , Menglin Yao  4 , Yinyun Ni  4 , Yong Liu  8 , Zhihui Li  1   2
Affiliations
Meta-Analysis

Estimating global prevalence, incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis

Jiaye Liu et al. Chin Med J (Engl). .

Abstract

Background: The increasing burden of non-alcoholic fatty liver disease (NAFLD) worldwide imposes an emerging public health issue. We perform the current study to estimate the global prevalence, incidence, disease progression, and clinical outcomes of NAFLD.

Methods: A systematic search was conducted in Medline, Embase, Web of Science, Google Scholar, and Cochrane CENTRAL that screened articles in English language published from January 2000 to December 2021. NAFLD prevalence, incidence, rate of disease progression, and outcomes were calculated with the DerSimonian-Laird random effects model with arcsine transformation.

Results: Our search identified 59,156 records, of which 578 studies fulfilled our inclusion criteria. The overall prevalence of NAFLD was 29.38% (95% confidence interval [CI] 28.09-30.69) regardless of the diagnostic techniques. Looking at the group in which the diagnosis was made by ultrasound exclusively, the pooled prevalence was 30.49% (95% CI 29.55-31.43). NAFLD has become more prevalent during the year 2011-2021 (31.63%, 95% CI 30.23-33.04) compared with year 2000-2010 (27.94%, 95% CI 26.23-29.69). The pooled estimation of non-alcoholic steatohepatitis prevalence was 8.26% (95% CI 1.13-21.01), 46.49% (95% CI 35.93-57.20), and 46.72% (95% CI 37.57-55.98) in general population, NAFLD patients, and severe/morbidly obese patients, respectively. Based on a total of 110,142 newly developed NAFLD patients, the pooled incident rate was estimated as 46.24 cases per 1000 person-years (95% CI 43.21-49.30). In patients with NAFLD, the incident rate of hepatocellular carcinoma was 1.46 (95% CI 0.90-2.03) cases per 1000 person-years. The overall pooled estimate of NAFLD related mortality was 23.91 (95% CI 13.55-37.18) death per 1000 person-years.

Conclusions: The prevalence of NAFLD is increasing globally. It is contributing to poor clinical outcomes including hepatocellular carcinoma and death. Rising awareness and urgent actions are warranted to control the NAFLD pandemic across the globe.

Registration: PROSPERO, No. CRD42020171104.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Study selection. ∗13 studies out of 591 studies were overlapped. NAFLD: Non-alcoholic fatty liver disease; NASH: Non-alcoholic steatohepatitis; HBV: Hepatitis B; HCV: Hepatitis C; HIV: Human immunodeficiency virus; T1DM: Type 1 diabetes mellitus; T2DM: Type 1 diabetes mellitus.
Figure 2
Figure 2
Subgroup analysis of prevalence of NAFLD diagnosed by ultrasound. NAFLD: Non-alcoholic fatty liver disease.
See this image and copyright information in PMC

References

    1. Li J, Zou B, Yeo YH, Feng Y, Xie X, Lee DH, et al. . Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2019; 4:389–398. doi: 10.1016/S2468-1253(19)30039-1. - PubMed
    1. Zhou F, Zhou J, Wang W, Zhang XJ, Ji YX, Zhang P, et al. . Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: a systematic review and meta-analysis. Hepatology 2019; 70:1119–1133. doi: 10.1002/hep.30702. - PubMed
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64:73–84. doi: 10.1002/hep.28431. - PubMed
    1. Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. . Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5:739–752. doi: 10.1016/S2468-1253(20)30077-7. - PubMed
    1. Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol 2017; 67:862–873. doi: 10.1016/j.jhep.2017.06.003. - PubMed