Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach

Michael H Le, Yee Hui Yeo, Biyao Zou, Scott Barnet, Linda Henry, Ramsey Cheung, Mindie H Nguyen, Michael H Le, Yee Hui Yeo, Biyao Zou, Scott Barnet, Linda Henry, Ramsey Cheung, Mindie H Nguyen

Abstract

Background/aims: Due to increases in obesity and type 2 diabetes, the prevalence of nonalcoholic fatty liver disease (NAFLD) has also been increasing. Current forecast models may not include non-obese NAFLD. Here, we used the Bayesian approach to forecast the prevalence of NAFLD through the year 2040.

Methods: Prevalence data from 245 articles involving 2,699,627 persons were used with a hierarchical Bayesian approach to forecast the prevalence of NAFLD through 2040. Subgroup analyses were performed for age, gender, presence of metabolic syndrome, region, and smoking status. Sensitivity analysis was conducted for clinical setting and study quality.

Results: The forecasted 2040 prevalence was 55.7%, a three-fold increase since 1990 and a 43.2% increase from the 2020 prevalence of 38.9%. The estimated average yearly increase since 2020 was 2.16%. For those aged <50 years and ≥50 years, the 2040 prevalence were not significantly different (56.7% vs. 61.5%, P=0.52). There was a significant difference in 2040 prevalence by sex (males: 60% vs. 50%) but the trend was steeper for females (annual percentage change: 2.5% vs. 1.5%, P=0.025). There was no difference in trends overtime by region (P=0.48). The increase rate was significantly higher in those without metabolic syndrome (3.8% vs. 0.84%, P=0.003) and smokers (1.4% vs. 1.1%, P=0.011). There was no difference by clinical/community setting (P=0.491) or study quality (P=0.85).

Conclusion: By 2040, over half the adult population is forecasted to have NAFLD. The largest increases are expected to occur in women, smokers, and those without metabolic syndrome. Intensified efforts are needed to raise awareness of NAFLD and to determine long-term solutions addressing the driving factors of the disease.

Keywords: Metabolic syndrome; Smoking; Trends; Women.

Conflict of interest statement

Conflicts of Interest

MHN: Research funding: Pfizer, Enanta, Gilead, CurveBio, Exact Sciences, Helio Health, Glycotest, National Cancer Institute, B.K. Kee Foundation, Vir Biotech; Consulting: Gilead, Intercept, GSK, Exact Science, Novartis, Janssen, Bayer

RC: Research funding: Gilead, Siemens Healthineer

All other authors do not have any conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Overall forecast of global nonalcoholic fatty liver disease prevalence.
Figure 2.
Figure 2.
Forecast of nonalcoholic fatty liver disease prevalence by (A) age and (B) sex. P-values compare the rate of increase between subgroups via linear regression.
Figure 3.
Figure 3.
Forecast of nonalcoholic fatty liver disease (NAFLD) prevalence* for North America, Europe, and Asia. P-values compare the rate of increase between subgroups via linear regression. *Based on past trend of ultrasound diagnosed prevalence of NAFLD. North America subgroup included studies that used FLI to diagnose NAFLD. Data were insufficient to perform forecasting for Africa and South America.
Figure 4.
Figure 4.
Forecast of nonalcoholic fatty liver disease prevalence by the presence of (A) metabolic syndrome or (B) cigarette smoking. P-values compare the rate of increase between subgroups via linear regression.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9597215/bin/cmh-2022-0239f5.jpg

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