Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, affecting approximately 25% of the world's population. Recently, because of the sedentary lifestyle and overnutrition resulting from urbanisation, the burden of NAFLD has rapidly increased in many Asian countries. Currently, the prevalence of NAFLD in Asia is approximately 30%, as is the case in many Western countries. In Asia, the prevalence and presentation of NAFLD vary widely across regions because of the substantial diversity in race, socioeconomic status and living environment. Furthermore, the dual aetiology of fatty liver, particularly with viral hepatitis in Asia, makes it complex and challenging to manage. Because Asians are likely to have central adiposity and insulin resistance, approximately 7%-20% of non-obese Asians with body mass indexes of less than 25 kg/m² are estimated to have NAFLD. Accumulating evidence indicates that NAFLD is associated with various extrahepatic comorbidities such as cardiovascular disease, chronic kidney disease, malignancy, in addition to liver-specific complications. Therefore, NAFLD should be managed as a multisystem disease in conjunction with metabolic syndrome. Lifestyle modification remains the basis of NAFLD management, but few patients can achieve adequate weight loss and maintain it long term. While various pharmacological agents are in phase 3 trials for steatohepatitis, Asian patients are underrepresented in most trials. This article reviews the epidemiological trends, clinical features, optimal assessment and current management practices for NAFLD in Asia.

中文翻译：

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改变亚洲 NAFLD 的临床管理

非酒精性脂肪性肝病 (NAFLD) 已成为慢性肝病的主要原因，影响了全球约 25% 的人口。最近，由于城市化导致的久坐生活方式和营养过剩，许多亚洲国家的 NAFLD 负担迅速增加。目前，亚洲 NAFLD 的患病率约为 30%，许多西方国家也是如此。在亚洲，由于种族、社会经济地位和生活环境的巨大差异，NAFLD 的患病率和表现因地区而异。此外，脂肪肝的双重病因，特别是亚洲的病毒性肝炎，使其管理起来复杂且具有挑战性。因为亚洲人很可能患有中枢性肥胖和胰岛素抵抗，估计有^{2人患有 NAFLD。}越来越多的证据表明，除了肝脏特异性并发症外，NAFLD 还与各种肝外合并症有关，例如心血管疾病、慢性肾脏疾病、恶性肿瘤。因此，NAFLD 应作为一种多系统疾病与代谢综合征一起进行管理。生活方式的改变仍然是 NAFLD 管理的基础，但很少有患者能够实现足够的体重减轻并长期保持体重。虽然各种药物正处于脂肪性肝炎的 3 期试验中，但亚洲患者在大多数试验中的代表性不足。本文回顾了亚洲 NAFLD 的流行病学趋势、临床特征、最佳评估和当前管理实践。