Nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) are highly prevalent in the United States, where they are a growing cause of cirrhosis and hepatocellular carcinoma (HCC) and increasingly an indicator for liver transplantation. A Markov model was used to forecast NAFLD disease progression. Incidence of NAFLD was based on historical and projected changes in adult prevalence of obesity and type 2 diabetes mellitus (DM). Assumptions were derived from published literature where available and validated using national surveillance data for incidence of NAFLD‐related HCC. Projected changes in NAFLD‐related cirrhosis, advanced liver disease, and liver‐related mortality were quantified through 2030. Prevalent NAFLD cases are forecasted to increase 21%, from 83.1 million (2015) to 100.9 million (2030), while prevalent NASH cases will increase 63% from 16.52 million to 27.00 million cases. Overall NAFLD prevalence among the adult population (aged ≥15 years) is projected at 33.5% in 2030, and the median age of the NAFLD population will increase from 50 to 55 years during 2015‐2030. In 2015, approximately 20% of NAFLD cases were classified as NASH, increasing to 27% by 2030, a reflection of both disease progression and an aging population. Incidence of decompensated cirrhosis will increase 168% to 105,430 cases by 2030, while incidence of HCC will increase by 137% to 12,240 cases. Liver deaths will increase 178% to an estimated 78,300 deaths in 2030. During 2015‐2030, there are projected to be nearly 800,000 excess liver deaths. Conclusion: With continued high rates of adult obesity and DM along with an aging population, NAFLD‐related liver disease and mortality will increase in the United States. Strategies to slow the growth of NAFLD cases and therapeutic options are necessary to mitigate disease burden. (Hepatology 2018;67:123‐133).

中文翻译：

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对非酒精性脂肪性肝病的流行进行建模表明疾病负担呈指数增长

非酒精性脂肪性肝病 (NAFLD) 和由此产生的非酒精性脂肪性肝炎 (NASH) 在美国非常普遍，它们是导致肝硬化和肝细胞癌 (HCC) 的日益严重的原因，并且越来越多地成为肝移植的指标。马尔可夫模型用于预测 NAFLD 疾病进展。NAFLD 的发病率基于成人肥胖和 2 型糖尿病 (DM) 患病率的历史和预测变化。假设来自可用的已发表文献，并使用 NAFLD 相关 HCC 发病率的国家监测数据进行验证。到 2030 年，NAFLD 相关肝硬化、晚期肝病和肝脏相关死亡率的预计变化被量化。 NAFLD 流行病例预计将增加 21%，从 8310 万（2015 年）增加到 1.009 亿（2030 年），而流行的 NASH 病例将从 1652 万例增加到 2700 万例，增加 63%。预计 2030 年成年人群（≥15 岁）NAFLD 的总体患病率为 33.5%，2015-2030 年 NAFLD 人群的中位年龄将从 50 岁增加到 55 岁。2015 年，大约 20% 的 NAFLD 病例被归类为 NASH，到 2030 年增加到 27%，这反映了疾病进展和人口老龄化。到 2030 年，失代偿性肝硬化的发生率将增加 168% 至 105,430 例，而 HCC 的发生率将增加 137% 至 12,240 例。到 2030 年，肝脏死亡人数将增加 178%，达到估计 78,300 人。在 2015-2030 年期间，预计将有近 800,000 人死于肝脏。结论：随着成人肥胖和糖尿病的持续高发病率以及人口老龄化，在美国，与 NAFLD 相关的肝病和死亡率将增加。减缓 NAFLD 病例增长的策略和治疗选择对于减轻疾病负担是必要的。（肝病学 2018 年；67：123-133）。