Prevalence and associated factors for non-alcoholic fatty liver disease among adults in the South Asian Region: a meta-analysis

Projected Trends in Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality Through 2040

Importance

Population-based data for metabolic dysfunction-associated steatotic liver disease (MASLD)-related mortality trends and forecasts in the United States are limited.

Objective

To examine MASLD-related mortality trends in the United States from 2006 to 2023 and forecast mortality rates up to 2040 overall and in subgroups by age, sex, race and ethnicity, and urbanization.

Design, Setting, and Participants

This cross-sectional study used data from the National Vital Statistics System dataset. Data on deaths attributed to MASLD were obtained for adults aged 25 years and older from January 1, 2006, to December 31, 2023.

Main Outcomes and Measures

Trends were evaluated by average annual percentage change (AAPC) in age-standardized mortality rates (ASMRs) per 100 000 persons, and mortality rates were forecasted to 2040 using projection models.

Results

A total of 27 961 decedents aged 25 years and older with MASLD (15 251 [54.5%] aged ≥65 years; 15 450 [55.3%] female; 3373 [12.1%] Hispanic, 1480 [5.3%] non-Hispanic Black, and 21 936 [78.5%] non-Hispanic White) were documented from 2006 to 2023. ASMRs rose from 0.25 to 1.27 per 100 000 persons, with AAPCs increasing from 9.27% in 2006 to 2018 to 22.66% in 2018 to 2021, then decreasing to -1.23% from 2021 to 2023, leading to projected ASMRs of 2.24 per 100 000 persons in 2040. There were significant differences in the increases of ASMRs by age, with those aged 65 years or older having the steepest rise (AAPC, 15.34%; 95% CI, 14.40%-16.32%; P < .001; 45-64 years: 8.76%; 95% CI, 7.29%-10.22%; P < .001; 25-44 years: 2.65%; 95% CI, 0.49%-4.86%; P = .02) and a projected increase from 3.69 per 100 000 persons in 2024 to 7.12 per 100 000 persons in 2040. However, there was no significant difference in ASMRs by sex (AAPC among women: 11.24%; 95% CI, 10.09%-12.40%; P < .001; AAPC among men: 11.04%; 95% CI, 9.56%-12.63%; P < .001). ASMRs rose for all major racial ethnic groups, with the highest ASMR increase observed for non-Hispanic White individuals (AAPC, 11.12%; 95% CI, 9.48%-12.83%; P < .001), followed by Hispanic (AAPC, 10.67%; 95% CI, 9.11%-12.26%; P < .001), non-Hispanic Black (AAPC, 9.20%; 95% CI, 7.32%-11.11%; P < .001), and non-Hispanic Asian (AAPC, 7.97%; 95% CI, 4.66%-11.75%; P < .001) individuals, while the projected values for these 4 groups showed similar increasing trends to 2040. There were also significant differences in ASMRs by metropolitan categories overall, with the highest rise in nonmetropolitan areas (AAPC, 13.50%; 95% CI, 10.70%-16.32%; P < .001).

Conclusions and Relevance

In this cross-sectional study, MASLD-related mortality increased rapidly between 2006 and 2023 and was projected to rise over the next 20 years, with the largest disparities among those aged 65 years and older, among non-Hispanic White and Hispanic individuals, and among nonmetropolitan populations.

Management of metabolic dysfunction-associated steatotic liver disease (MASLD)-An expert consensus statement from Indian diabetologists' perspective

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high-risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high-risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non-invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well-planned study design that could enhance the scientific value of these statements.

Revolutionizing the understanding of liver disease: Metabolism, function and future

The intersection between metabolic-associated steatotic liver disease (MASLD) and chronic hepatitis B virus (HBV) infection is an emerging area of research with significant implications for public health and clinical practice. Wang et al's study highlights the complexities of managing patients with concurrent MASLD and HBV. The findings revealed that patients with concurrent MASLD-HBV exhibited more severe liver inflammation and fibrosis, whereas those with HBV alone presented a better lipid profile. The growing recognition of metabolic dysfunction in liver disease, reflected in the shift from nonalcoholic liver disease to MASLD, demands updates to clinical guidelines, particularly for patients with dual etiologies. Understanding the biological interactions between MASLD and HBV could lead to novel therapeutic approaches, emphasizing the need for personalized treatment strategies. The coexistence of MASLD and HBV presents therapeutic challenges, particularly in managing advanced fibrosis and cirrhosis, which are more likely in these patients. The aim of this editorial is to analyze the interaction between MASLD and HBV, highlight the pathophysiological mechanisms that exacerbate liver disease when both conditions coexist, and discuss the clinical implications of the findings of Wang et al.

Diagnostic accuracy of Fatty Liver Index (FLI) for detecting Metabolic Associated Fatty Liver Disease (MAFLD) in adults attending a tertiary care hospital, a cross-sectional study

BACKGROUND

Metabolic-associated fatty liver disease (MAFLD) is a major public health problem worldwide. This study aimed to determine the prevalence of MAFLD and evaluate the diagnostic accuracy of the Fatty Liver Index (FLI) compared to ultrasonography for detecting fatty liver in adults attending a tertiary care hospital in Gujarat, India.

METHODS

This cross-sectional study included 500 adults visiting the outpatient department between January 2023 and December 2023. MAFLD was diagnosed on ultrasound. FLI was calculated using body mass index, waist circumference, triglycerides, and gamma-glutamyl transpeptidase levels. FLI ≥ 60 indicated fatty liver. Logistic regression analysis identified factors associated with fatty liver.

RESULTS

MAFLD prevalence was 32.2% on ultrasound. High FLI (≥ 60) was present in 26.2%. Male sex, higher BMI, waist circumference, night shift work, diabetes, and triglycerides were independent predictors of fatty liver. FLI showed excellent diagnostic accuracy with a sensitivity of 96%, specificity of 92.5%, and AUC of 0.92 for detecting fatty liver on ultrasound.

CONCLUSION

MAFLD prevalence among adults was high in this hospital-based sample. FLI can serve as an accurate non-invasive tool for identifying individuals with a high probability of MAFLD. These findings emphasize the need for larger population-based studies and the implementation of regular MAFLD screening programs in high-risk groups.

Assessment of Non-alcoholic Fatty Liver Disease and Level of Risk of Fibrosis in Diabetic and Non-diabetic Individuals

Background and aim Non-alcoholic fatty liver disease (NAFLD), now known as metabolic dysfunction-associated steatotic liver disease (MASLD), is more common in people with type-2 diabetes mellitus (T2DM) than in people without diabetes mellitus (non-DM). This disease can lead to cirrhosis or hepatic cancer. There is limited data on NAFLD prevalence and the level of risk of fibrosis in Bangladeshi individuals. This study aimed to assess NAFLD prevalence and compare the proportion of NAFLD and the level of risk of fibrosis between T2DM and non-DM Bangladeshi individuals. Methods A cross-sectional analytical study was conducted for six months in 2024 in the outpatient section of the Department of Medicine at Holy Family Red Crescent Medical College, Dhaka, Bangladesh. Among the patients seeking outpatient care, a total of 179 male and non-pregnant female participants aged 18 years and older were selected using a purposive sampling technique. Individuals with a history of alcohol use, diagnosed cases of chronic liver diseases, prior use of hepatotoxic drugs, and primary biliary cholangitis were excluded from the study. Detailed demographic characteristics, comorbidities, family history of diabetes and liver disease, physical measurements, and biochemical tests were done. Ultrasonography (USG) of the hepatobiliary system was employed to ascertain the existence of NAFLD. The presence or absence of T2DM was evaluated through prior medical documents, corroborated by laboratory analyses of random blood glucose (RBS) and glycosylated hemoglobin (HbA1c) levels. The Fibrosis-4 (FIB-4) index score was utilized to evaluate the risk of liver fibrosis. Results The mean age of the participants was 49.11±12.25 years and 107 (59.8%) of participants were female. Almost two-thirds of the participants were suffering from T2DM. About 17 (9.5%) of the study participants were suffering from NAFLD, which was much higher among T2DM (15 (12.5%)) than non-DM individuals (two (3.3%)). T2DM and family history of liver disease were found to significantly increase the risk of suffering from NAFLD by 5.247 times (95% CI: 1.081-25.468) and 4.202 times (95% CI: 1.249-14.135), respectively. About one (6.7%) of T2DM individuals with NAFLD were at high risk for fibrosis. Conclusion Almost one in 10 people had NAFLD, and it was way more common among those with T2DM, who also exhibit a higher risk of hepatic fibrosis. Moreover, T2DM and a family history of liver disease can independently increase the risk of NAFLD.

Incidence of Non-alcoholic Fatty Liver Disease (NAFLD)/Non-alcoholic Steatohepatitis (NASH) in the Female Population of North Karnataka: A Cross-Sectional Study

BACKGROUND

India is currently facing an epidemic of type 2 diabetes mellitus (T2DM) and obesity which are high-risk factors for the development of non-alcoholic fatty liver disease (NAFLD). A non-invasive tool, the vibration-controlled transient elastography (VCTE; FibroScan, Echosens, Paris, France) is used to diagnose NAFLD.

AIM

To identify the prevalence, spectrum, and metabolic determinants of NAFLD in Indian adult women using liver function tests (LFT) and non-invasive FibroScan (liver stiffness measure, i.e., LSM score) of the liver through a cross-sectional population-based study in the city of Belagavi.

METHODS

The subjects were screened for the presence of liver disease with a detailed history, anthropometric measurements, LFTs, blood sugars, and FibroScan of the liver to assess liver steatosis and liver fibrosis.

RESULTS

The study included 2448 women with 860 (35.13%) having NAFLD (controlled attenuation parameter {CAP}≥275 dB/m) as detected by FibroScan. Nearly, 58.8% of the participants with T2DM had NAFLD. Participants with NAFLD had higher BMI and waist circumference. When univariate logistic regression was applied, those with T2DM were 14.5 times (95% CI, 4.55, 6.52) likely to have CAP≥275 dB/m. Similarly, those with higher BMI>23 mg/m2 were 1.34 (95% CI, 1.68, 2.37) times more likely to have CAP ≥275 dB/m. The risk of NAFLD increases by ~1% for every one-year increase in age.

CONCLUSION

NAFLD in women is the most common non‑communicable disease in India; a prevalence of 35.13% was observed in the present study in women. Higher BMI, presence of metabolic risk factors, and incremental age were associated with a high risk of developing NAFLD in women.

Mapping global research trends: Nutrition associations with nonalcoholic fatty liver disease - a Scopus bibliometric analysis

BACKGROUND

Several bibliometric analyses have been carried out to identify research hotspots and trends in nonalcoholic fatty liver disease (NAFLD) research. Nonetheless, there are still significant knowledge gaps that must be filled to advance our understanding of and ability to treat NAFLD.

AIM

To evaluate, through bibliometric and visual analysis, the current status of related research, related research frontiers, and the developmental trends in the field of diet and NAFLD.

METHODS

We retrieved publications about diet and NAFLD published between 1987 and 2022 from Scopus. Next, we used VOSviewer 1.6.20 to perform bibliometric analysis and visualization.

RESULTS

We found a total of 1905 studies, including 1637 (85.93%) original articles and 195 (10.24%) reviews, focused on the examination of NAFLD and its correlation with diet that were published between 1987 and 2022. Among the remaining five types of documents, 38 were letters, notes, editorials, meeting minutes, or brief surveys, representing 1.99% of the total documents. The countries with the most publications on this topic were China (n = 539; 28.29%), followed by the United States (n = 379; 19.90%), Japan (n = 133; 6.98%), and South Korea (n = 127; 6.6%). According to the citation analysis, the retrieved papers were cited an average of 32.3 times and had an h-index of 106, with 61014 total citations. The two main clusters on the map included those related to: (1) Inflammation and oxidative stress; and (2) Dietary interventions for NAFLD.

CONCLUSION

This was the first study to use data taken from Scopus to visualize network mapping in a novel bibliometric analysis of studies focused on diet and NAFLD. After 2017, the two domains that received the most attention were "dietary interventions for NAFL"' and "'inflammation and oxidative stress implicated in NAFLD and its correlation with diet." We believe that this study provides important information for academics, dietitians, and doctors, and that additional research on dietary interventions and NAFLD is warranted.

Comparative study of MAFLD as a predictor of metabolic disease treatment for NAFLD

A novel concept of Metabolic Associated Fatty Liver Disease (MAFLD) was proposed, incorporating metabolic abnormalities such as obesity and diabetes, which are risk factors that affect the prognosis. Non-Alcoholic Fatty Liver Disease (NAFLD), entails fat accumulation in the liver without alcohol consumption and is often linked to obesity, insulin resistance, and metabolic syndrome. However, the broad nature of the disease concept has hindered prognosis accuracy. In this study, we assess the contribution of the impact of diagnostic criteria for MAFLD on metabolic disease progression compared to conventional diagnostic criteria for NAFLD. A total of 7159 patient who were presented to the health screening center in Tokai University Hospital both in 2015 and 2020 were included in the study. Fatty liver was diagnosed using abdominal ultrasonography. The diagnostic criteria for NAFLD were consistent with the global guidelines based on alcohol consumption. The diagnostic criteria for MAFLD were based on the International Consensus Panel. Medications (anti-hypertensive, diabetic, and dyslipidemia medications) were evaluated by self-administration in the submitted medical questionnaire. A total of 2500 (34.9%) participants were diagnosed with fatty liver (FL +), 1811 (72.4%) fit both NAFLD and MAFLD diagnostic criteria (overlap), 230 (9.2%) fit only the NAFLD diagnostic criteria (NAFLD group) and 404 (16.1%) fit the MAFLD diagnostic criteria (MAFLD group) at 2015. Over the next 5 years, medication rates increased in the NAFLD group for anti-hypertensive, + 17 (7.4%); diabetes, + 3 (1.3%); and dyslipidemia, + 32 (13.9%). In contrast, the only-MAFLD group showed a more significant increase with + 49 (12.1%), + 21 (5.2%), and + 49 (12.1%), for the respective medications, indicating a substantial rise in patients starting new medications. Our analysis of repeated health check-ups on participants revealed that the diagnostic criteria for MAFLD are more predictive of future treatment for metabolic disease than conventional diagnostic criteria for NAFLD.

Metabolic syndrome: imaging features and clinical outcomes

Metabolic syndrome, which affects around a quarter of adults worldwide, is a group of metabolic abnormalities characterized mainly by insulin resistance and central adiposity. It is strongly correlated with cardiovascular and all-cause mortality. Early identification of the changes induced by metabolic syndrome in target organs and timely intervention (eg, weight reduction) can decrease morbidity and mortality. Imaging can monitor the main components of metabolic syndrome and identify early the development and progression of its sequelae in various organs. In this review, we discuss the imaging features across different modalities that can be used to evaluate changes due to metabolic syndrome, including fatty deposition in different organs, arterial stiffening, liver fibrosis, and cardiac dysfunction. Radiologists can play a vital role in recognizing and following these target organ injuries, which in turn can motivate lifestyle modification and therapeutic intervention.