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Background and Aims Chronic hepatitis B virus (HBV), hepatitis C virus (HCV), nonalcoholic fatty liver disease (NAFLD), and alcohol‐associated liver disease (ALD) are main causes of chronic liver disease. We assessed the global incidence, mortality, and disability‐adjusted life‐years (DALYs) related to chronic liver disease (primary liver cancer [LC] and cirrhosis). Approach and Results We obtained data from the 2017 Global Burden of Disease study. In 2017, there were 2.14 million liver‐related deaths (2.06‐2.30 million), representing an 11.4% increase since 2012 (16.0% increase in LC deaths; 8.7% increase in cirrhosis deaths). LC and cirrhosis accounted for 38.3% and 61.7%, respectively, of liver deaths (LC and cirrhosis deaths were related to HBV [39% and 29%], HCV [29% and 26%], ALD [16% and 25%], and NAFLD [8% and 9%]). Between 2012 and 2017, age‐standardized incidence rate, age‐standardized death rate (ASDR), and age‐standardized DALY rate increased for LC from 11.1 to 11.8, 10.1 to 10.2, and 250.4 to 253.6 per 100,000, respectively. Although age‐standardized incidence rate for cirrhosis increased from 66.0 to 66.3, ASDR and age‐standardized DALY rate decreased from 17.1 to 16.5 and 532.9 to 510.7, respectively. The largest increase in ASDR for LC occurred in Eastern Europe (annual percent change [APC] = 2.18% [0.89%‐3.49%]), whereas the largest decrease occurred in high‐income Asia Pacific (APC = −2.88% [−3.58 to −2.18%]). ASDR for LC‐NAFLD and ALD increased annually by 1.42% (1.00%‐1.83%) and 0.53% (0.08‐0.89), respectively, whereas there were no increases for HBV (P = 0.224) and HCV (P = 0.054). ASDR for cirrhosis‐NAFLD increased (APC = 0.29% [0.01%‐0.59%]) but decreased for ALD (APC = −0.44% [−0.78% to −0.40%]), HCV (APC = −0.50% [−0.81% to −0.18%]), and HBV (APC = −1.43% [−1.71% to −0.40%]). Conclusions From 2012 to 2017, the global burden of LC and cirrhosis has increased. Viral hepatitis remains the most common cause of liver deaths, and NAFLD is the most rapidly growing contributor to liver mortality and morbidity.

Background and Aims: NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. Approach and Results: PubMed and Ovid MEDLINE were searched for NAFLD population-based studies from 1990 to 2019 survey year (last published 2022) per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analysis was conducted using randomeffects models. Bias risk assessment was per Joanna Briggs Institute. Of 2585 studies reviewed, 92 studies (N = 9,361,716) met eligibility criteria.Across the study period , meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.

Population‐level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple‐cause mortality data (2007‐2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause‐specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non‐liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD‐10 codes. Trends were evaluated by average annual percentage change (AAPC) in age‐standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non‐Hispanic whites, 32,868 non‐Hispanic blacks, 46,530 Hispanics, 5,025 non‐Hispanic American Indian or Alaska Natives [AIANs], 7,023 non‐Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; P < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; P = 0.003), non‐Hispanic whites (AAPC, 2.48%), non‐Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non‐Hispanic blacks and non‐Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non‐liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD‐related deaths. For cause‐specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non‐liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). Conclusion: NAFLD‐related deaths in U.S. adults are increasing. Cirrhosis is the top cause‐specific death, followed by CVD. Women, non‐Hispanic whites, and non‐Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.

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Background Given the association of NAFLD with metabolic risks, a name change to MAFLD is proposed. We compared the long‐term outcomes of NAFLD and MAFLD. Methods We included patients with fatty liver disease (FLD) from NHANES III and NHANES 2017–2018 (FLD defined as moderate to severe hepatic steatosis by ultrasound for NHANES III and as having a controlled attenuation parameter ≥285 dB/m for NHANES 2017–2018). NAFLD was defined as FLD without other liver diseases and excess alcohol use. Metabolic‐associated fatty liver disease (MAFLD) was defined as FLD and metabolic dysfunction per criteria. All NHANES III participants had linked mortality data through December 31, 2015. Results NHANES III participants (n = 12,878): mean age 43.1 years old; 49.5% male; 20.3% with FLD, 16.5% with NAFLD, and 18.1% with MAFLD. NHANES 2017–2018 participants (n = 4328): mean age 48.0 years old; 49.1% male; 36.8% with FLD, 34.2% with NAFLD, and 36.3% with MAFLD. Excellent concordance was noted between MAFLD and NAFLD diagnosis in both data sets (kappa coefficient = 0.83–0.94). Except for components of each definition (e.g., alcohol use for MAFLD), no other major differences in clinical characteristics were noted. During up to 27 years of follow‐up (median of 22.8 years), no differences in cumulative all‐cause and cause‐specific mortality were noted. In addition to the stage of fibrosis, insulin resistance was a predictor of liver mortality in NAFLD, and alcohol‐associated liver disease (ALD) was a predictor of mortality in MAFLD. Conclusions MAFLD and NAFLD have similar clinical profiles and long‐term outcomes. The increased liver‐related mortality among NAFLD is driven by insulin resistance, and among MAFLD is primarily driven by ALD.

IN BRIEF Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized and common cause of chronic liver disease worldwide. Although most patients with NAFLD are obese, a smaller group of NAFLD patients are lean. This study explored the long-term outcomes of lean patients with NAFLD in the United States. Compared to lean individuals without NAFLD, lean people with NAFLD were significantly more likely to be older and male and had higher comorbidities (i.e., diabetes, hyperlipidemia, hypertension, metabolic syndrome, chronic kidney disease, and cardiovascular disease). The presence of NAFLD in lean individuals was independently associated with increased risk of all-cause and cardiovascular mortality.

Background The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderly have not been well described. Our aim was to assess the prevalence, risk factors and mortality of NAFLD in individuals older than 60 years. Methods The data from the Third National Health and Nutrition Examination Survey with linked mortality files were utilized. NAFLD was defined by United States Fatty Liver Index in the absence of other causes of liver disease. Cox proportional hazards models were used to assess all-cause and cardiovascular (CV) mortality. All analyses were performed using SAS software. Results Three thousand two hundred seventy-one NHANES-III participants were included. The prevalence rates from NAFLD were 40.3% (95% CI: 37.2–43.5%) and 39.2% (95% CI: 34.4–44.0%) among 60–74 and > 74 years old. Among aged 60–74, the risks for 5-year and 10-year all-cause mortality were associated with presence of NAFLD [adjusted hazard ratios: 1.60 (95% CI: 1.24–1.96) for 5-year and 1.22 (95%CI: 1.01–1.49) for 10-year]. CV mortality were higher in this group were (aHR: 2.12 (95% CI: 1.20–3.75) for 5-year and 1.06 (95%CI: 0.73–1.52) for 10-year]. In contrast, in individuals > 74 years old, diagnosis of NAFLD was not associated with all-cause or CVD mortality. Conclusions NAFLD is common among elderly population. Although NAFLD is associated with increased risk of mortality for 60–74-year-old individuals, this risk was not increased in those older than 74 years. Electronic supplementary material The online version of this article (10.1186/s12876-019-0972-6) contains supplementary material, which is available to authorized users.