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Global incidence of non-alcoholic fatty liver disease: A systematic review and meta-analysis of 63 studies and 1,201,807 persons
Abstract
Background & aims The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing. We aimed to estimate the pooled global NAFLD incidence.Methods We performed a systematic review and meta-analysis of cohort studies of adults without NAFLD at baseline to evaluate the global incidence of ultrasound-diagnosed NAFLD.Results A total of 63 eligible studies (1,201,807 persons) were analyzed. Studies were from Mainland China/Hong Kong (n = 26), South Korea (n = 22), Japan (n = 14), other (n = 2, Sri Lanka, Israel); 63.8% were clinical center studies; median study year 2000 to 2016; 87% were good quality. Among the 1,201,807 persons at risk, 242,568 persons developed NAFLD, with an incidence rate of 4,612.8 (95% CI 3,931.5-5,294.2) per 100,000 person-years and no statistically significant differences by study sample size (p = 0.90) or study setting (p = 0.055). Males had higher incidence vs. females (5,943.8 vs. 3,671.7, p = 0.0013). Both the obese (vs. non-obese) and the overweight/obese groups (vs. normal weight) were about threefold more likely to develop NAFLD (8,669.6 vs. 2,963.9 and 8,416.6 vs. 3,358.2, respectively) (both p <0.0001). Smokers had higher incidence than non-smokers (8,043.2 vs. 4,689.7, p = 0.046). By meta-regression, adjusting for study year, study setting, and study location, study period of 2010 or after and study setting were associated with increased incidence (p = 0.010 and p = 0.055, respectively). By country, China had a higher NAFLD incidence compared to non-China regions (p = 0.012) and Japan a lower incidence compared to non-Japan regions (p = 0.005).Conclusions NAFLD incidence is increasing with a current estimate of 4,613 new cases per 100,000 person-years. Males and overweight/obese individuals had significantly higher incidence rates compared to females and those of normal weight. Public health interventions for prevention of NAFLD are needed with a special emphasis on males, overweight/obese individuals, and higher risk regions.Impact and implications Non-alcoholic fatty liver disease (NAFLD) affects approximately 30% of people worldwide and appears to be increasing, but data to estimate the incidence rate are limited. In this meta-analytic study of over 1.2 million people, we estimated an incidence rate of NAFLD of 46.13 per 1,000 person-years with significant differences by sex, BMI, geography, and time-period. As treatment options for NAFLD remain limited, prevention of NAFLD should remain the focus of public health strategies. Studies such as these can help policy makers in determining which and whether their interventions are impactful.
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“The estimated global prevalence of MASLD in the general population has risen from 25% in 2016 12 to currently more than 30%, and the incidence is continually increasing. 12 -14”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [14]
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(2014) · Medical Entomology and Zoology · Cited by 17,633
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J., & Bugianesi, E. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.109 · Cited by 5,249
Self-citationGenetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease
Romeo, S., Kozlitina, J., Xing, C., Pertsemlidis, A., Cox, D., Pennacchio, L. A., Boerwinkle, E., Cohen, J. C., & Hobbs, H. H. (2008) · Nature Genetics · doi:10.1038/ng.257 · Cited by 3,416
IntHout, J., Ioannidis, J. P., & Borm, G. F. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-25 · Cited by 2,419
The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis
Riazi, K., Azhari, H., Charette, J. H., Underwood, F. E., King, J. A., Afshar, E. E., Swain, M. G., Congly, S. E., Kaplan, G. G., & Shaheen, A.-A. (2022) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(22)00165-0 · Cited by 2,246
Non-alcoholic fatty liver disease - a global public health perspective
Younossi, Z. M. (2019) · Journal of Hepatology · doi:10.1016/j.jhep.2018.10.033 · Cited by 2,149
Estes, C., Anstee, Q. M., Arias, M., Bantel, H., Bellentani, S., Caballería, J., Colombo, M., Craxì, A., Crespo, J., Day, C. P., et al. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2018.05.036 · Cited by 2,046
Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis
Younossi, Z., Tacke, F., Arrese, M., Chander Sharma, B., Mostafa, I., Bugianesi, E., Wai‐Sun Wong, V., Yilmaz, Y., George, J., Fan, J., et al. (2019) · Hepatology · doi:10.1002/hep.30251 · Cited by 1,858
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Ye, Q., Zou, B., Yeo, Y. H., Li, J., Huang, D. Q., Wu, Y., Yang, H., Liu, C., Kam, L. Y., Tan, X. X. E., et al. (2020) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(20)30077-7 · Cited by 925
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Vali, Y., Wonders, K., LEE, J., Aithal, G. P., Aller, R., Allison, M., Arola, J. T., Bañales, J. M., Bernal-Monterde, V., Berzigotti, A., et al. (2026) · The Lancet · doi:10.1016/s0140-6736(26)01145-1
Ratziu, V., Dufour, J., Ponnaiah, M., Pais, R., Thormann, M., Bugianesi, E., Marra, F., Boyle, M., Hallsworth, K., Aspite, S., et al. (2026) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2026.101893
Metadata
- Authors
- Le, M. H., Le, D. M., Baez, T. C., Wu, Y., Ito, T., Lee, E. Y., Lee, K., Stave, C. D., Henry, L., Barnett, S. D., Cheung, R., & Nguyen, M. H.
- Affiliations
- University of Vermont (US)
- Burrell College of Osteopathic Medicine (US)
- Third Affiliated Hospital of Sun Yat-sen University (CN)
- Nagoya University (JP)
- Stanford Medicine (US)
- Stanford University (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Nguyen, Mindie H.
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 79
- Issue
- 2
- Pages
- 287-295
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W4362719751
- Cited by
- 303
- References
- 51
- Citations by year
- 2026: 71 · 2025: 98 · 2024: 98 · 2023: 35
- FWCI
- 11.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- NAFLD incidence, global prevalence, ultrasonography, obesity, overweight, smoking, sex differences, China, South Korea, Japan, cohort studies, risk factors, study quality bias, study design bias, publication bias
- MeSH terms
- Adult, Female, Humans, Male, Obesity, Cohort Studies, Incidence, Overweight, Non-alcoholic Fatty Liver Disease
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