Burden of non-alcoholic fatty liver disease in Asia, the Middle East and North Africa: Data from Global Burden of Disease 2009-2019

Abstract

BACKGROUND & AIM Nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease (CLD) worldwide. Our aim was to assess the burden of liver complications (LC, cirrhosis and liver cancer) related to NAFLD (LC-NAFLD) between 2009-2019 in Asia, Middle East and Northern Africa (MENA) regions. METHODS We used Global Burden of Disease data to assess incidence, mortality, and disability-adjusted-life-years (DALYs) for LC-NAFLD from Asia and MENA regions. Annual percentage change in rates were computed by Joinpoint Regression model. Associations of LC-NAFLD with low physical activity, diet and metabolic risks were determined by partial Spearman correlation coefficients (ρ). RESULTS Globally in 2019, there were 170.000 incident cases of LC-NAFLD, accounting for 6.6% of LC incident cases from all chronic liver diseases (CLDs). There were 168,969 deaths related to LC-NAFLD, accounting for 8.6% of LC deaths from all CLDs. Among global incident and death of LC-NAFLD, 48.3% and 46.2% occurred in Asia, 8.9% and 8.6% in MENA. There were 2.08 million DALYs in Asia and 340.000 DALYs in MENA. From 2009 to 2019, regions in Asia and MENA experienced a rise in DALY of LC-NAFLD (compared to LC from other CLDs), ranging from South Asia (APC=+2.12% vs. -0.94%) to high-income Asia Pacific (APC=-0.07%, p=0.646 vs. -0.97%). In Asia, DALY of NAFLD was significantly correlated with dietary risks [(95% CI: 0.280-0.763, p=0.004)], metabolic risks [(0.341-0.790, p<0.001)] and tobacco use [(0.134-0.691, p=0.007)]. In MENA, low physical activity [(0.557-0.918, p<0.001)], metabolic risks [(0.432-0.888, p=0.001)], and dietary risks [(0.315-0.855, p=0.001)] correlated with DALY. CONCLUSIONS NAFLD is posing a substantial burden in Asia and MENA. About half of the global burden of LC-NAFLD is accounted by these regions. LAY SUMMARY Nonalcoholic fatty liver disease (NAFLD) has emerged as one of the most common causes of chronic liver disease worldwide. We used Global Burden of Disease data to assess incidence, mortality, and disability-adjusted-life-years (DALYs) from LC-NAFLD in Asia and MENA regions. NAFLD is poised to be responsible for a substantial liver disease burden in Asia and MENA regions of the world. Regional and global policies are needed to address the increasing burden of complications of NAFLD.