Guidelines for the Assessment and Management of Non-alcoholic Fatty Liver Disease in the Asia-Pacific Region: Executive Summary

Geoffrey C Farrell; Professor Geoff Farrell; George KK Lau; José D Sollano; for the Asia–Pacific Working Party on NAFLD

Disclosures

J Gastroenterol Hepatol. 2007;22(6):775-777. 

In This Article

Overview

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in Western industrialized countries,[1,2] affecting 20-30% of the general population, and recent studies indicate that fatty liver is an emerging problem in the Asia-Pacific region.[3] A comprehensive review of available data reveals that the overall prevalence of NAFLD in the Asia-Pacific region is broadly similar to that in North America, affecting between 12% and 24% of community subgroups.[4,5] The prevalence varies by age, gender, ethnicity, and locality (urban versus rural), as well as with criteria used for disease definition.[5] There is strong evidence that the prevalence of NAFLD in this region has increased substantially during the last 15 years in parallel with regional trends in over-nutrition (decreased physical activity with disproportionate food intake), central and overall obesity, type 2 diabetes mellitus (T2DM), and the metabolic syndrome.[6,7,8] Present trends in the obesity and diabetes pandemic indicate that a further increase in NAFLD prevalence is likely in the immediate future.[9,10]

The inextricable relationship between NAFLD and central (visceral) obesity, insulin resistance, and metabolic syndrome is evident in community studies from China,[6] Japan,[8] and Korea,[7] which are the largest reported worldwide. With remarkable reproducibility, the data show changes in the age and gender-specific prevalence of NAFLD in parallel with central obesity, diabetes, and metabolic syndrome.[5] In South-East Asia, early observations indicate that ethnic predisposition to NAFLD is similar to that of metabolic syndrome (Indians > Malays > Chinese).[4,5] The strength of associations between NAFLD and metabolic risk factors is not fully appreciated unless Asian rather than Caucasian anthropometric standards are used for central obesity and body mass index (BMI). Those of the International Diabetes Federation (IDF) published in 2005 are used in the present guidelines.[11,12]

The full range of histological manifestations of NAFLD has been demonstrated in Asian patients, from steatosis through non-alcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma (HCC).[13] The present natural history data are limited, but the course of NAFLD also appears to be similar in Asian as in European populations. Fatty liver attributable to metabolic factors is common in persons affected by other common liver diseases, particularly hepatitis C, hepatitis B, and alcoholic liver disease. This important aspect is touched on only briefly in these guidelines in so much as it impacts on definition and routine clinical assessment. More detailed considerations of the influence of steatosis and metabolic factors on liver pathology, disease outcomes, and treatment efficacy would be worthy subjects for future working parties.

This document summarizes proposals by the Asian-Pacific Working Party for NAFLD (APWP-NAFLD) for the definition of NAFLD, and suggests clinical guidelines for the initial assessment and management of affected patients within the Asia-Pacific region. The accompanying four reviews annotate and summarize the evidence and logic that support these proposals.[4,5,13,14] They canvass suggestions to improve prevention, early recognition, and management of fatty liver disease in clinical practice, as well as early detection and correction of metabolic disorders in the numerous individuals with NAFLD.[14] These perspectives have particular public health relevance to the world's most populous region.

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