NAFLD in India and the world

NAFLD

Increasing obesity, hypertension and type 2 diabetes with have led to parallel increase in prevalence of NAFLD in the world and India alike.

 

Prevalence of NAFLD worldwide

The overall global prevalence of NAFLD is estimated to be around 25.24% according to an analysis made with statistical approach. The highest prevalence is reported from the Middle East with 31.79%, followed by South America with 30.45% and the least prevalent rate is reported from Africa with 13.48%.

Prevalence of NAFLD in association with risk factors of NAFLD

  • Hypertriglyceridemia (high fat levels in blood) is prevalent in 40.74% of NAFLD and 83.33% of NASH patients
  • Hypertension (high blood pressure) is prevalent in 39.34% of NAFLD and 67. 97% of NASH
  • Metabolic Syndrome is prevalent among 42.54% of NAFLD and 70.67% of NASH patients
  • Approximately 41% of the NASH patients had progressed to fibrosis
  • More than 95% of people undergoing bariatric surgery for severe obesity will have NAFLD
  • Around 1/3rd to 2/3rd of the type 2 diabetes patients have NAFLD
  • It is estimated that 50% of people with dyslipidemia (abnormal cholesterol and high fats) have NAFLD
  • The prevalence of NAFLD in men is twice as compared to women

 

Prevalence of NASH

The prevalence of NASH in general population is estimated to be in the range of 1.5% and 6.45%. NASH is estimated to be prevalent in 59.10% of NAFLD population.

Prevalence of NAFLD and NASH in India

It is estimated that 16-32% of general population in India (nearly 120 million) has NAFLD and among them nearly 31% are diagnosed with NASH. Industrialization and change in lifestyle and diet with less physical activity and increased calorie rich food are contributing to the increased prevalence of NAFLD in Indian population.

It is also estimated that 63 million Indians are Type 2 diabetic, and among them 70% are having NAFLD (44 million). And one third of the NAFLD population is estimated to have NASH (13 million). It is also probable that 5% of people with NASH (650,000) may develop liver cancer.

Increased NAFLD prevalence in urban Indian population

In India the prevalence is more in urban areas as compared to rural areas due to presence of risk factors of NAFLD like obesity, hypertension, metabolic syndrome, diabetes, insulin resistance and high fat and cholesterol levels in blood. But it is to be noted that the growing trend of obesity in rural areas is contributing to growing incidence of NAFLD in rural India.

Indian population at increased risk of NAFLD

Studies are pointing out that Indian’s are more prone to NAFLD compared to other races due to presence of higher insulin resistance and higher fat levels (triglycerides) in blood. The major risk factor of NAFLD is insulin resistance and is found in almost 7 -55% of Indian population.

Reference:

  1. Younossi, Z. M., Koenig, A. B., Abdelatif, D. , Fazel, Y. , Henry, L. and Wymer, M. (2016), Global epidemiology of nonalcoholic fatty liver disease—Meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64: 73-84. doi:10.1002/hep.28431

 

  1. Chalasani, N. , Younossi, Z. , Lavine, J. E., Charlton, M. , Cusi, K. , Rinella, M. , Harrison, S. A., Brunt, E. M. and Sanyal, A. J. (2018), The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67: 328-357. doi:10.1002/hep.29367

 

  1. Singh, S., Kuftinec, G.N., & Sarkar, S. (2017). Non-alcoholic Fatty Liver Disease in South Asians: A Review of the Literature. Journal of clinical and translational hepatology,5(1):76-81. doi: 10.14218/JCTH.2016.00045

 

  1. Dusheja A et al. (2015). Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology, 5(1):51-68. doi:  10.1016/j.jceh.2015.02.006