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  • Review Article
  • Published:

NAFLD in Asia—as common and important as in the West

Abstract

NAFLD—regarded as a consequence of the modern sedentary, food-abundant lifestyle prevalent in the West—was recorded in Japan nearly 50 years ago and its changing epidemiology during the past three decades is well-documented. NAFLD, and its pathologically more severe form NASH, occur in genetically susceptible people who are over-nourished. Asian people are particularly susceptible, partly owing to body composition differences in fat and muscle. Community prevalence ranges between 20% (China), 27% (Hong Kong), and 15–45% (South Asia, South-East Asia, Korea, Japan and Taiwan). This Review presents emerging data on genetic polymorphisms that predispose Asian people to NAFLD, NASH and cirrhosis, and discusses the clinical and pathological outcomes of these disorders. NAFLD is unlikely to be less severe in Asians than in other populations, but the associated obesity and diabetes pandemics have occurred more recently in Asia than in Europe and the USA, and occur with reduced degrees of adiposity. Cases of cryptogenic cirrhosis and hepatocellular carcinoma have also been attributed to NAFLD. Public health efforts to curb over-nutrition and insulin resistance are needed to prevent and/or reverse NAFLD, as well as its adverse health outcomes of type 2 diabetes, cardiovascular events, cirrhosis and liver cancer.

Key Points

  • NAFLD prevalence in most regions of Asia is similar to that in the USA, Australia and New Zealand, and Europe

  • For equivalent levels of over-nutrition, Asian people are more prone to metabolic syndrome, type 2 diabetes and NAFLD than Europeans because of differences in body composition, particularly adiposity and muscle bulk

  • Lifestyle changes are likely to account for the pandemics of fatty liver, obesity and type 2 diabetes in Asia; more detail is required about the relative importance of physical activity and dietary constituents

  • The genetic predisposition to NAFLD and NASH shows similarities (particularly PNPLA3 polymorphisms) and possible differences (APOC3, PPARA polymorphisms) between Asian and non-Asian people

  • The course of fatty liver disease is unlikely to differ between Asian and other populations, but the obesity epidemic is more recent in Asia than elsewhere in the world

  • NAFLD as a cause of cryptogenic cirrhosis and hepatocellular carcinoma (including a high proportion of cases in noncirrhotic liver) is now readily apparent throughout Asia

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Figure 1: Prevalence of NAFLD in the Hong Kong community increases with age (purple bars).

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All authors contributed to researching data for the article and writing the article. G. C. Farrell also substantially contributed to the discussion of content and reviewed and edited the manuscript before submission.

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Supplementary information

Supplementary Table 1

Studies linking NAFLD to type 2 diabetes mellitus, with insights from Asian studies (DOC 60 kb)

Supplementary Table 2

Genome-wide association studies of predisposition to NAFLD and severity of NASH, with focus on Asian studies (DOC 65 kb)

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Farrell, G., Wong, VS. & Chitturi, S. NAFLD in Asia—as common and important as in the West. Nat Rev Gastroenterol Hepatol 10, 307–318 (2013). https://doi.org/10.1038/nrgastro.2013.34

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