Obesity and non-alcoholic fatty liver disease: Disparate associations among Asian populations

Abstract

Obesity is a global epidemic contributing to an increasing prevalence of obesity-related systemic disorders, including nonalcoholic fatty liver disease. The rising prevalence of nonalcoholic steatohepatitis (NASH) will in the near future lead to end-stage liver disease in a large cohort of patients with NASH-related cirrhosis and NASH is predicted to be a leading indication for liver transplantation in the coming decade. However, the prevalence of obesity and the progression of hepatic histological damage associated with NASH exhibit significant ethnic disparities. Despite a significantly lower body mass index and lower rates of obesity compared to other ethnic groups, Asians continue to demonstrate a significant prevalence of hypertension, diabetes, metabolic syndrome and NASH. Ethnic disparities in central adiposity and visceral fat distribution have been hypothesized to contribute to these ethnic disparities. The current review focuses on the epidemiology of obesity and NASH among Asian populations.

Keywords: Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Obesity; Metabolic syndrome; Asians; Hepatocellular carcinoma

Core tip: Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming a major contributor of chronic liver disease worldwide. The increasing prevalence of NAFLD among Asians reflects both an increasing awareness and diagnosis and the increasing risk of obesity and obesity-related diseases among this population. Ethnic disparities in the impact of weight gain on the development of obesity-related diseases is especially important for Asian populations, who have greater rates of central obesity and visceral deposition of fat and therefore are at greater risk of obesity-related diseases, such as NAFLD, at a lower body mass index.