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      Nonalcoholic fatty liver disease burden – Saudi Arabia and United Arab Emirates, 2017–2030

      research-article
      1 , 2 , 3 , 1 , 4 , 5 , 6 , 7 , 1 , 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 13
      Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association
      Medknow Publications & Media Pvt Ltd
      Burden of disease, cardiovascular disease, cirrhosis, decompensated cirrhosis, healthcare resource utilization, hepatocellular carcinoma, metabolic syndrome, nonalcoholic fatty liver, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, obesity, type 2 diabetes mellitus

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          Abstract

          Background/Aim:

          Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE).

          Materials and Methods:

          Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections.

          Results:

          In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE.

          Conclusions:

          Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.

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          Most cited references33

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.

            (2016)
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              Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease.

              Some patients with nonalcoholic fatty liver disease (NAFLD) develop liver-related complications and have higher mortality than other patients with NAFLD. We determined the accuracy of simple, noninvasive scoring systems in identification of patients at increased risk for liver-related complications or death. We performed a retrospective, international, multicenter cohort study of 320 patients diagnosed with NAFLD, based on liver biopsy analysis through 2002 and followed through 2011. Patients were assigned to mild-, intermediate-, or high-risk groups based on cutoff values for 2 of the following: NAFLD fibrosis score, aspartate aminotransferase/platelet ratio index, FIB-4 score, and BARD score. Outcomes included liver-related complications and death or liver transplantation. We used multivariate Cox proportional hazard regression analysis to adjust for relevant variables and calculate adjusted hazard ratios (aHRs). During a median follow-up period of 104.8 months (range, 3-317 months), 14% of patients developed liver-related events and 13% died or underwent liver transplantation. The aHRs for liver-related events in the intermediate-risk and high-risk groups, compared with the low-risk group, were 7.7 (95% confidence interval [CI]: 1.4-42.7) and 34.2 (95% CI: 6.5-180.1), respectively, based on NAFLD fibrosis score; 8.8 (95% CI: 1.1-67.3) and 20.9 (95% CI: 2.6-165.3) based on the aspartate aminotransferase/platelet ratio index; and 6.2 (95% CI: 1.4-27.2) and 6.6 (95% CI: 1.4-31.1) based on the BARD score. The aHRs for death or liver transplantation in the intermediate-risk and high-risk groups compared with the low-risk group were 4.2 (95% CI: 1.3-13.8) and 9.8 (95% CI: 2.7-35.3), respectively, based on the NAFLD fibrosis scores. Based on aspartate aminotransferase/platelet ratio index and FIB-4 score, only the high-risk group had a greater risk of death or liver transplantation (aHR = 3.1; 95% CI: 1.1-8.4 and aHR = 6.6; 95% CI: 2.3-20.4, respectively). Simple noninvasive scoring systems help identify patients with NAFLD who are at increased risk for liver-related complications or death. NAFLD fibrosis score appears to be the best indicator of patients at risk, based on HRs. The results of this study require external validation. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Saudi J Gastroenterol
                Saudi J Gastroenterol
                SJG
                Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association
                Medknow Publications & Media Pvt Ltd (India )
                1319-3767
                1998-4049
                Jul-Aug 2018
                : 24
                : 4
                : 211-219
                Affiliations
                [1 ]Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [2 ]Hepatology Division, Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
                [3 ]King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
                [4 ]Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
                [5 ]Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, Division of Organ Transplant Center, King Faisal Specialist Hospital and Research Center-Riyadh, Alfaisal University, Riyadh, Saudi Arabia
                [6 ]Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
                [7 ]Department of Medicine, Gastroenterology Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
                [8 ]Gastroenterology Section, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
                [9 ]Gastroenterology Unit, Rashid Hospital, Dubai, United Arab Emirates
                [10 ]Gastroenterology Division, Mafraq Hospital, Abu Dhabi, United Arab Emirates
                [11 ]Department of Gastroenterology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
                [12 ]Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
                [13 ]Center for Disease Analysis, Lafayette, Colorado, USA
                [14 ]Department of Internal Medicine, Jeddah University, Jeddah, Saudi Arabia
                Author notes
                Address for correspondence: Dr. Homie Razavi, Center for Disease Analysis, 1120 W. South Boulder Rd., Ste. 102, Lafayette, Colorado, USA. E-mail: hrazavi@ 123456cdafound.org
                [*]

                These authors contributed equally as first authors

                Article
                SJG-24-211
                10.4103/sjg.SJG_122_18
                6080149
                29956688
                1b5182f9-9048-411b-93c5-735d87487cff
                Copyright: © 2018 Saudi Journal of Gastroenterology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Original Article

                Gastroenterology & Hepatology
                burden of disease,cardiovascular disease,cirrhosis,decompensated cirrhosis,healthcare resource utilization,hepatocellular carcinoma,metabolic syndrome,nonalcoholic fatty liver,nonalcoholic fatty liver disease,nonalcoholic steatohepatitis,obesity,type 2 diabetes mellitus

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