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The epidemiology of nonalcoholic steatohepatitis

The growing global epidemic of obesity has led the World Health Organization (WHO) to estimate that, in 2016, more than 1.9 billion adults (39% of the adult population) were overweight, and 650 million (13% of adult population) were considered obese. In the United States, the data from the National Health and Nutrition Examination Survey for 2013 to 2014 estimated that an even higher proportion of the adults was overweight (32.5%), obese (37.7%), and extremely obese (7.7%). As these global rates of obesity increase, obesity-related complications are also on the rise. Of these, nonalcoholic fatty liver disease (NAFLD) is becoming one of the most important causes of liver disease throughout the world, with an estimated global prevalence rate of about 24%. In fact, the highest prevalence of NAFLD has been reported from South America and the Middle East, whereas the lowest prevalence has been reported from Africa (Fig. 1). Because the diagnosis of the subtype of NAFLD, or nonalcoholic steatohepatitis (NASH), requires histological confirmation, the prevalence of NASH in the general population can only be estimated from a few biopsy series. This prevalence rate ranges between 1.5% and 6.45%. Although there are reasonably accurate data for the prevalence of NAFLD in the general population, the data about the incidence of NAFLD and NASH from the general population is lacking. In this context, it has been estimated that the incidence of NAFLD varies across the world, ranging from 28.01 per 1000 person-years (95% confidence interval [CI]: 19.34-40.57) to 52.34 per 1000 person-years (95% CI: 28.31-96.77).