How Common Is NAFLD In Asia Pacific And Is There Local Differences

1
How Common Is NAFLD In Asia Pacific And Is There
Local Differences

• Deepak Amarapurkar
• Consultant Gastroenterologist and hepatologist,
  Bombay hospital medical research centre, Mumbai

2
Worldwide Epidemiology of NASH

• NAFLD may be the most common form of chronic
  liver disease in USA, Australia, Asia and Europe
• McCullough AJ, 2002
• Mulhall BP 2002
• Clark JM 2003
• Farrell GC. 2003
• Ruhl 2003

3
Global challenges in Liver Diseases 2006
4
Problems In Studying Epidemiology Of NAFLD And
NASH

• Lack of definitive laboratory test
• Studies dependence on different definitions
• Published series with biopsy confirmation are
  selected cases that have presented to medical
  attention
• Values of alcohol consumption in published series
  ranged from lt 20 gm/week to lt140 gm/week

5
Prevalence of fatty liver

• Estimated prevalence is 5 of population
• 20 to 30 adults in western countries have NAFLD
  of which 2 to 3 are NASH
• (Imaging
  autopsy study)
  
• Steatosis seen in 70 obese 35 lean
  patients
• NASH seen in 18.5 obese 2.7 lean patients
• 
  Hepatology 2003

6
Problems in Assessing NAFLD In Asian Pacific
Region

• Inaccurate evaluation of alcohol abuse
• Infrequent use of liver test in general practice
• Lack of presentation of asymptomatic individual
• Burden of viral hepatitis
• Reluctance to do liver biopsy
• Lack of awareness of the severity
• Pursued slowly progressive nature
• Considered as a disease of affluence
• Chitturi S, Farrell G, George J JGH 2004

7
Prevalence of NAFLD In General Population In
Asian Pacific Region

• Name of the Percentage NAFLD inCountry Adults
• Japan 9 30
• China 5 18
• Korea 18
• India 5 28
• Indonesia 30
• Malaysia 17
• Singapore 5

8
Prevalence of NAFLD In General Population In
Asian Pacific Region

• Name of the Percentage NAFLD
  inCountry Adults
• Australia ) Lack of data, perception
• Taiwan ) amongst the clinician around
• Hongkong ) 10- 30
• Sri Lanka )
• Philippines )

9
Studies on non alcoholic Fatty Liver Disease
And Non-alcoholic steatohepatitis In Asia
10
Prevalence of Risk Factors For NAFLD in Asian
Pacific Region

• Diabetes
• Obesity
• Metabolic Syndrome

11
Prevalence of NAFLD In High Risk Population In
Asian Pacific Region

• Name of the Diabetes Obesity
  Dyslipidemia
• country
• Japan 40-50 50-80 42-58
• China 35 70-80 57
• Korea 35 10-50 26-35
• India 30-90 15-20 NA
• Indonesia 52 47 56

12
1970-1989
A
14
1990-2005
12
10
Prevalence of type 2 diabetes ()
8
6
4
2
0
Prevalence of diabetes between 1979 to 1989
1999 - 2005
B
6
5
4
Multiplication factor for increased Prevalence
of type 2 diabetes
3
2
1
0
India
China
USA
Korea
Taiwan
Indonesia
Singapore
Thailand
13
30-39
A
14
40-49
12
10
8
Prevalence ()
6
4
2
0
Prevalence of diabetes in the age group of 30- 50
years
10
9
8
7
6
5
4
3
2
1
0
14
Comparison of diabetes in Urban And Rural Area
Urban
10
Rural
9
8
7
6
Prevalence ()
5
4
3
2
1
0
Thailand(1986)
India(1992)
Philippines(1992)
Korea(2001)
Cambodia(2004)
15
Prevalence of obesity by International Criteria
70
1970-1989
A
1990-2005
60
50
0
40
Prevalence ()
30
20
10
India
USA
China
Hongkong
Philipines
Singapore
Taiwan
Korea
Thiland
16
Prevalence Of The Metabolic Syndrome In Asians
17
Increasing Incidence of NAFLD

• Has been well documented from studies in Japan
  and China
• Almost all countries in Asian Pacific region have
  reported increased incidence of diabetes,
  obesity, central obesity and insulin resistance

18
NonAlcoholic Fatty Liver Disease

• Histopathologic Spectrum Steatosis
  Steatohepatitis

Cancer
Fibrosis
Cirrhosis
Progression to cirrhosis and cancer have been
documented from few studies in the Asian Pacific
Region but still exact magnitude of the problem
is not known.
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NASH In Asia Pacific Future Shock

• Western Eastern Population Population
• Age at Presentation 4th 8th decade 4th 8th
  decade
• Prevalence 20-30 -10
• Obesity 71 (30-100) 44 (12-89)
• T2DM 28 (2-55) 34 (11-39)
• Hyperlipidemia 38 (15-81) 41 (28-81)
• Natural History Worse with Limited data severe
  firbosis
• Chitturi Et al JGH 2004

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