Image: Bru-nO/Pixabay
Non-alcoholic fatty liver disease affects one in four people in the general population in Europe and just over one in twenty people have advanced liver fibrosis, a meta-analysis of 33 studies from 15 European countries presented at the Digital International Liver Congress shows.
Non-alcoholic fatty liver disease (NAFLD) occurs when fat accumulates in the liver. People with diabetes or metabolic syndrome have a higher risk of developing NAFLD. Fat accumulation can lead to inflammation in the liver and damage (fibrosis). Liver damage due to fat accumulation is called non-alcoholic steatohepatitis (NASH).
NAFLD is a growing public health problem, but the prevalence is unclear. Studies have used differing methods to diagnose NAFLD, employing either blood tests or imaging to diagnose the condition.
The research team identified 19 studies including 42,580 people that diagnosed NAFLD by non-invasive imaging and nine studies including 84,235 people that assessed NAFLD prevalence by blood tests using the Fatty Liver Index. Twelve studies reported on the prevalence of NASH (4696 participants) and five on the prevalence of advanced fibrosis (7270 participants).
A meta-analysis of NAFLD prevalence studies found a pooled prevalence of 27%, with no difference in the result between studies which used imaging or blood tests to assess prevalence.
Studies assessing the prevalence of NASH were inevitably biased due to referral for biopsy based on clinical indication. Biopsy in NAFLD patients is usually recommended if there already is a suspicion of NASH, as examination of the liver tissue helps to differentiate between simple steatosis and steatohepatitis. The 12 studies found that 64% of 4696 NAFLD patients referred for biopsy had NASH.
Meta-analysis of five studies of advanced fibrosis prevalence in the general population found a prevalence of 6%. These studies used blood tests to assess the prevalence of F3 or F4 fibrosis (advanced fibrosis or cirrhosis).
The study authors say this is the largest analysis to date of the burden of NAFLD in Europe and needs to be followed up by an economic analysis of the potential benefits of non-invasive testing for advanced fibrosis in the general population, given the high prevalence detected across studies included in this meta-analysis.
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