Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis.,The Lancet Gastroenterology & Hepatology

当前位置： X-MOL 学术 › Gastroenterol. Hepatol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis.
The Lancet Gastroenterology & Hepatology ( IF 35.7 ) Pub Date : 2020-05-12 , DOI: 10.1016/s2468-1253(20)30077-7
Qing Ye ₁ , Biyao Zou ₂ , Yee Hui Yeo ₃ , Jie Li ₄ , Daniel Q Huang ₅ , Yuankai Wu ₆ , Hongli Yang ₄ , Chuanli Liu ₄ , Leslie Y Kam ₂ , Xiang Xuan Eunice Tan ₇ , Nicholas Chien ₂ , Sam Trinh ₂ , Linda Henry ₂ , Christopher Donald Stave ₈ , Tetsuya Hosaka ₉ , Ramsey C Cheung ₁₀ , Mindie H Nguyen ₂

Affiliation

Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; The Third Central Clinical College of Tianjin Medical University, Tianjin, China; Department of Hepatology of The Third Central Hospital of Tianjin, Tianjin, China; Tianjin Key Laboratory of Artificial Cells, Tianjin, China.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Lane Medical Library, Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Hepatology, Toranomon Hospital, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.

Background

Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level.

Methods

For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD.

Findings

We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9–23·0) of people were lean and 40·8% (36·6–45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3–15·6) of people had non-obese NAFLD and 5·1% (3·7–7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4–39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1–56·3) had non-alcoholic steatohepatitis, 29·2% (21·9–37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5–5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5–38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9–7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1–14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0–18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2–31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5–77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity.

Interpretation

Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges.

Funding

None.

中文翻译：

非肥胖或瘦型非酒精性脂肪肝的全球患病率，发病率和结局：系统评价和荟萃分析。

背景

尽管非酒精性脂肪肝疾病（NAFLD）通常与肥胖有关，但越来越多的人在非肥胖个体中发现它。我们的目标是在全球范围内表征非肥胖或瘦型NAFLD的患病率，发病率和长期结果。

方法

为了进行系统的审查和荟萃分析，我们从成立到2019年5月1日搜索PubMed，Embase，Scopus和Cochrane图书馆，以寻找相关的原始研究文章，不受任何语言限制。文献检索和数据提取由两名调查员独立完成。主要结果是NAFLD组中非肥胖或瘦肉型人群的患病率，以及一般，非肥胖和瘦弱人群中非肥胖或瘦肉型NAFLD患病率。非肥胖和瘦人群中NAFLD的发生率；和非肥胖NAFLD患者的长期结果。我们还旨在表征非肥胖型NAFLD患者的人口统计学，临床和组织学特征。

发现

我们确定了来自24个国家或地区的93项研究（n = 10 576 383）：84项研究（n = 10 530 308）用于患病率分析，五项（n = 9121）用于发生率分析，八项（n = 36 954）用于结果分析。在NAFLD人口中，有19·2％（95％CI 15·9-23.0）的人是苗条的，有40·8％（36·6–45·1）的人是不肥胖的。非肥胖NAFLD的患病率在一些国家（例如马来西亚和巴基斯坦）中为25％或更低，而在其他国家（例如奥地利，墨西哥和瑞典）中则高于50％。在一般人群（包括有或没有NAFLD的个体）中，有12.1％（95％CI 9·3-15·6）患有非肥胖NAFLD，有5·1％（3·7-7·0）瘦了NAFLD。非肥胖人群（基线时无NAFLD）中NAFLD的发生率为每1000人年24·6（95％CI 13·4-39·2）。在非肥胖或瘦的NALFD患者中，非酒精性脂肪性肝炎占39·0％（95％CI 24·1-56·3），非酒精性脂肪性肝炎占29·2％（21·9-37·9） ≥2），有3·2％（1·5-5·7）患有肝硬化。在非肥胖或肥胖的NAFLD人群中，每1000人年的全因死亡率为12·1（95％CI 0·5-38·8），与肝有关的死亡率为4·1（每千人年1·9–7·1），与心血管相关的死亡率为每千人年4·0（0·1–14·9），新发糖尿病为12·6（8·0–每千人年18·3），新发心血管疾病每千人年18·7（9·2–31·2），新发高血压为56·1（38·5–77· 0）每1000人年。大多数分析的特点是高度异质性。29·2％（21·9–37·9）有明显的纤维化（≥2期），3·2％（1·5-5·7）有肝硬化。在非肥胖或肥胖的NAFLD人群中，每1000人年的全因死亡率为12·1（95％CI 0·5-38·8），与肝有关的死亡率为4·1（每千人年1·9–7·1），与心血管相关的死亡率为每千人年4·0（0·1–14·9），新发糖尿病为12·6（8·0–每千人年18·3），新发心血管疾病每千人年18·7（9·2–31·2），新发高血压为56·1（38·5–77· 0）每1000人年。大多数分析的特点是高度异质性。29·2％（21·9–37·9）有明显的纤维化（≥2期），3·2％（1·5-5·7）有肝硬化。在非肥胖或肥胖的NAFLD人群中，每1000人年的全因死亡率为12·1（95％CI 0·5-38·8），与肝有关的死亡率为4·1（每千人年1·9–7·1），与心血管相关的死亡率为每千人年4·0（0·1–14·9），新发糖尿病为12·6（8·0–每千人年18·3），新发心血管疾病每千人年18·7（9·2–31·2），新发高血压为56·1（38·5–77· 0）每1000人年。大多数分析的特点是高度异质性。肝相关死亡率为每1000人年4·1（1·9–7·1），心血管相关死亡率为每1000人年4·0（0·1–14·9），糖尿病的发病率为每1000人年12·6（8·0–18·3），心血管疾病的发病率为每1000人年18·7（9·2–31·2），以及高血压每1000人年为56·1（38·5-77·0）。大多数分析的特点是高度异质性。肝相关死亡率为每1000人年4·1（1·9–7·1），心血管相关死亡率为每1000人年4·0（0·1–14·9），糖尿病的发病率为每1000人年12·6（8·0–18·3），心血管疾病的发病率为每1000人年18·7（9·2–31·2），以及高血压每1000人年为56·1（38·5-77·0）。大多数分析的特点是高度异质性。