Prevalence, gender, ethnic variations, and prognosis of NASH
We provide an update review on the prevalence, gender, ethnic variations, and prognosis of nonalcoholic steatohepatitis (NASH). According to annual health checks, 9–30% of Japanese adults have nonalcoholic fatty liver disease (NAFLD) by ultrasonography (US) and prevalence of NASH is estimated to be 1–3%. These conditions are strongly associated with the presence of obesity and lifestyle-related diseases. NAFLD and NASH exhibit age and gender differences in both prevalence and severity. Among younger patients, these conditions are more common in men (2–3 times); however, after 60 years of age, the prevalence of NASH is higher in women. According to a systemic analysis of histological findings for NASH, 37.6% of patients had progressive fibrosis, 20.8% improved, and 41.6% remained stable over a mean duration of follow-up of 5.3 years. Age and presence of inflammation on initial biopsy were independent predictors of progression to advanced fibrosis. The frequencies of development of cirrhosis in NASH are 5–25% during around 7-year follow-up periods. Survival in NASH is lower than the expected survival of the matched general population due to the higher prevalence of cardiovascular and liver-related death. In patients with cirrhotic NASH, hepatocellular carcinoma (HCC) and liver failure are the main causes of morbidity and mortality (5-year cumulative HCC development rate 11.3%, 5-year survival rate 75.2%, respectively). The cumulative rate of recurrence of HCC at 5 years was 72.5%. Regular screening for complications of liver cirrhosis and HCC is extremely important for cirrhotic NASH patients.
KeywordsNASH NAFLD Prevalence Gender variations Prognosis
- 7.Tsuruta G, Tanaka N, Hongo M, Komatsu M, Horiuchi A, Hamamoto K, Iguchi C, Nakayama Y, Umemura T, Ichijo T, Matsumoto A, Yoshizawa K, Aoyama T, Tanaka E. Nonalcoholic fatty liver disease in Japanese junior high school students: its prevalence and relationship to lifestyle habits. J Gastroenterol. 2010;45:666–72.CrossRefPubMedGoogle Scholar
- 17.Kakizaki S, Takizawa D, Yamazaki Y, Nakajima Y, Ichikawa T, Sato K, et al. Nonalcoholic fatty liver disease in Japanese patients with severe obesity who received laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in comparison to non-Japanese patients. J Gastroenterol. 2008;43:86–92.CrossRefPubMedGoogle Scholar
- 42.Tokushige K, Hashimoto E, Yatsuji S, Tobari M, Taniai M, Torii N, et al. Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma by chronic hepatitis C. J Gastroenterology. 2010. doi:10.1007/s00535-010-0237-1