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Original article

Vol. 149 No. 5152 (2019)

Nonalcoholic fatty liver disease burden – Switzerland 2018–2030

  • Nicolas Goossens
  • Stefano Bellentani
  • Andreas Cerny
  • Jean-Francois Dufour
  • François R. Jornayvaz
  • Joachim Mertens
  • Alberto Moriggia
  • Beat Muellhaupt
  • Francesco Negro
  • Homie Razavi
  • David Semela
  • Chris Estes
DOI
https://doi.org/10.4414/smw.2019.20152
Cite this as:
Swiss Med Wkly. 2019;149:w20152
Published
17.12.2019

Summary

As a result of epidemic levels of obesity and diabetes mellitus, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) will contribute to increases in the liver-related disease burden in Switzerland.

A Markov model was built to quantify fibrosis progression among the NAFLD and NASH populations, and predict disease burden up to 2030. Long-term trending of NAFLD prevalence was based on changes in the prevalence of adult obesity. Published estimates and surveillance data were applied to build and validate the model projections.

The prevalence of NAFLD increased up to 2030 in tandem with projected increases in adult obesity. By 2030, there were an estimated 2,234,000 (1,918,000–2,553,000) NAFLD cases, or 24.3% (20.9–27.8%) of the total Swiss population (all ages). Increases in NASH cases were relatively greater than NAFLD cases. Incident cases of advanced liver disease are projected to increase by approximately 40% by 2030, and incident NAFLD liver deaths to increase from 580 deaths in 2018 to 820 deaths in 2030.

Continued growth in obesity, in combination with an aging population, will result in increasing number of cases of advanced liver disease and mortality related to NAFLD and NASH. Slowing the growth in obesity and metabolic syndrome, along with future potential therapies, are required to reduce liver disease burden.

References

  1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. doi:.https://doi.org/10.1002/hep.28431
  2. Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, et al.; EASL HEPAHEALTH Steering Committee. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69(3):718–35. doi:.https://doi.org/10.1016/j.jhep.2018.05.011
  3. Younossi ZM, Otgonsuren M, Henry L, Venkatesan C, Mishra A, Erario M, et al. Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology. 2015;62(6):1723–30. doi:.https://doi.org/10.1002/hep.28123
  4. Sanyal A, Poklepovic A, Moyneur E, Barghout V. Population-based risk factors and resource utilization for HCC: US perspective. Curr Med Res Opin. 2010;26(9):2183–91. doi:.https://doi.org/10.1185/03007995.2010.506375
  5. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10(11):686–90. doi:.https://doi.org/10.1038/nrgastro.2013.171
  6. Huber CA, Schwenkglenks M, Rapold R, Reich O. Epidemiology and costs of diabetes mellitus in Switzerland: an analysis of health care claims data, 2006 and 2011. BMC Endocr Disord. 2014;14(1):44. doi:.https://doi.org/10.1186/1472-6823-14-44
  7. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387(10026):1377–96. doi:.https://doi.org/10.1016/S0140-6736(16)30054-X
  8. Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al.; NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42. doi:.https://doi.org/10.1016/S0140-6736(17)32129-3
  9. Federal Statistical Office. Diabetes 2014 [Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/gesundheitszustand/krankheiten/diabetes.html.
  10. Williams R, Alexander G, Armstrong I, Baker A, Bhala N, Camps-Walsh G, et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet. 2018;391(10125):1097–107. doi:.https://doi.org/10.1016/S0140-6736(17)32866-0
  11. Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D, et al. Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol. 2014;60(1):110–7. doi:.https://doi.org/10.1016/j.jhep.2013.08.011
  12. United Nations. Department of Economic Social Affairs Population Division. World population prospects: The 2017 revision. New York: United Nations; 2018.
  13. Koehler EM, Plompen EP, Schouten JN, Hansen BE, Darwish Murad S, Taimr P, et al. Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study. Hepatology. 2016;63(1):138–47. doi:.https://doi.org/10.1002/hep.27981
  14. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al.; American Gastroenterological Association; American Association for the Study of Liver Diseases; American College of Gastroenterologyh. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(7):1592–609. doi:.https://doi.org/10.1053/j.gastro.2012.04.001
  15. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia. 2016;59(6):1121–40. doi:.https://doi.org/10.1007/s00125-016-3902-y
  16. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54. doi:.https://doi.org/10.1002/hep.21496
  17. Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13(4):643–54.e9, quiz e39–40. doi:.https://doi.org/10.1016/j.cgh.2014.04.014
  18. Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology. 2017;65(5):1557–65. doi:.https://doi.org/10.1002/hep.29085
  19. McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015;62(5):1148–55. doi:.https://doi.org/10.1016/j.jhep.2014.11.034
  20. White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol. 2012;10(12):1342–1359.e2. doi:.https://doi.org/10.1016/j.cgh.2012.10.001
  21. Piscaglia F, Svegliati-Baroni G, Barchetti A, Pecorelli A, Marinelli S, Tiribelli C, et al.; HCC-NAFLD Italian Study Group. Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. Hepatology. 2016;63(3):827–38. doi:.https://doi.org/10.1002/hep.28368
  22. Younossi ZM, Henry L. Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease. Pharmacoeconomics. 2015;33(12):1245–53. doi:.https://doi.org/10.1007/s40273-015-0316-5
  23. Younossi ZM, Zheng L, Stepanova M, Henry L, Venkatesan C, Mishra A. Trends in outpatient resource utilizations and outcomes for Medicare beneficiaries with nonalcoholic fatty liver disease. J Clin Gastroenterol. 2015;49(3):222–7. doi:.https://doi.org/10.1097/MCG.0000000000000071
  24. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123–33.
  25. Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol. 2018;69(4):896–904. doi:.https://doi.org/10.1016/j.jhep.2018.05.036
  26. Petta S, Di Marco V, Pipitone RM, Grimaudo S, Buscemi C, Craxì A, et al. Prevalence and severity of nonalcoholic fatty liver disease by transient elastography: Genetic and metabolic risk factors in a general population. Liver Int. 2018;38(11):2060–8. doi:.https://doi.org/10.1111/liv.13743
  27. Caballería L, Pera G, Arteaga I, Rodríguez L, Alumà A, Morillas RM, et al. High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study. Clin Gastroenterol Hepatol. 2018;16(7):1138–1145.e5. doi:.https://doi.org/10.1016/j.cgh.2017.12.048
  28. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015;47(3):181–90. doi:.https://doi.org/10.1016/j.dld.2014.09.020
  29. Federal Statistical Office. Permanent and non permanent resident population by canton, sex, residence permit, place of birth and age. (Population and Households Statistics STATPOP) STAT-TAB - interactive tables (FSO) 2016 [Available from: https://www.pxweb.bfs.admin.ch/pxweb/en/px-x-0103010000_102/px-x-0103010000_102/px-x-0103010000_102.px.
  30. Federal Statistical Office. Population change scenarios for Switzerland 2017 [Available from: https://www.media-stat.admin.ch/animated/chart/01pyramid/ga-q-01.03.02-dashboard.html.
  31. Stepanova M, Rafiq N, Makhlouf H, Agrawal R, Kaur I, Younoszai Z, et al. Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD). Dig Dis Sci. 2013;58(10):3017–23. doi:.https://doi.org/10.1007/s10620-013-2743-5
  32. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62(1, Suppl):S47–64. doi:.https://doi.org/10.1016/j.jhep.2014.12.012
  33. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Nonalcoholic Fatty Liver Disease and Risk of Incident Cardiovascular Disease: A Meta-Analysis. J Hepatol. 2016;65(3):589–600. doi:. https://doi.org/10.1016/j.jhep.2016.05.013
  34. Sanyal AJ, Banas C, Sargeant C, Luketic VA, Sterling RK, Stravitz RT, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006;43(4):682–9. doi:.https://doi.org/10.1002/hep.21103
  35. Bernfort L, Sennfält K, Reichard O. Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden. Scand J Infect Dis. 2006;38(6-7):497–505. doi:.https://doi.org/10.1080/00365540500532803
  36. Ries L, Young G, Keel G, Eisner M, Lin Y, Horner M. SEER survival monograph: Cancer survival among adults: U.S. SEER program, 1988-2001, patient and tumor characteristics. Bethesda, MD: National Cancer Institute, SEER Program; 2007.
  37. Federal Statistical Office. Swiss Health Survey 2012 Overview 2013 [Available from: https://www.bfs.admin.ch/bfsstatic/dam/assets/349060/master.
  38. Federal Statistical Office. Health Determinants 2018 [Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/determinanten/uebergewicht.assetdetail.6466132.html
  39. Country Profile - Switzerland [Internet]. 2018. Available from: http://www.ncdrisc.org/downloads/country-pdf/country-profile-Switzerland.pdf.
  40. Lazo M, Hernaez R, Eberhardt MS, Bonekamp S, Kamel I, Guallar E, et al. Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2013;178(1):38–45. doi:.https://doi.org/10.1093/aje/kws448
  41. Caballería L, Pera G, Auladell MA, Torán P, Muñoz L, Miranda D, et al. Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain. Eur J Gastroenterol Hepatol. 2010;22(1):24–32. doi:.https://doi.org/10.1097/MEG.0b013e32832fcdf0
  42. Fan JG, Farrell GC. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol. 2009;50(1):204–10. doi:.https://doi.org/10.1016/j.jhep.2008.10.010
  43. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al.; LIDO Study Group. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128(7):1898–906. doi:.https://doi.org/10.1053/j.gastro.2005.03.084
  44. Swisstransplant. Swisstransplant Preliminary statistics 2017. Available from: https://www.swisstransplant.org/fileadmin/user_upload/Infos_und_Material/Statistiken/Jahreszahlen/Preliminary_statistics_2017.pdf
  45. IRODaT. International Registry on Organ Donation and Transplantation 2017 [cited 2017. Available from: http://www.irodat.org/?p=database.
  46. Organ Procurement and Transplantation Network (OPTN). OPTN data as of October 28. 2016 2016 [updated 2016. Available from: https://optn.transplant.hrsa.gov/data/.
  47. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology. 2014;59(6):2188–95. doi:.https://doi.org/10.1002/hep.26986
  48. Malcolm DG, Roseboom JH, Clark CE, Fazar W. Application of a Technique for Research and Development Program Evaluation. Oper Res. 1959;7(5):646–69. doi:.https://doi.org/10.1287/opre.7.5.646
  49. National Institute for Cancer Epidemiology and Registration. Prevalence of liver cancer in Switzerland. 2014. Cancer data extracted from the Swiss national dataset managed by the Foundation National Institute for Cancer Epidemiology and Registration (NICER). Available from http://www.nicer.org/.
  50. Hong TP, Gow P, Fink M, Dev A, Roberts S, Nicoll A, et al. Novel population-based study finding higher than reported hepatocellular carcinoma incidence suggests an updated approach is needed. Hepatology. 2016;63(4):1205–12. doi:.https://doi.org/10.1002/hep.28267
  51. Altekruse SF, Henley SJ, Cucinelli JE, McGlynn KA. Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol. 2014;109(4):542–53. doi:.https://doi.org/10.1038/ajg.2014.11
  52. Robert Koch Institute and the Association of Population-based Cancer Registries in Germany. Cancer in Germany 2009/2010. Berlin; 2014.
  53. Al Hasani F, Knoepfli M, Gemperli A, Kollar A, Banz V, Kettenbach J, et al. Factors affecting screening for hepatocellular carcinoma. Ann Hepatol. 2014;13(2):204–10. doi:.https://doi.org/10.1016/S1665-2681(19)30883-X
  54. Weinmann A, Alt Y, Koch S, Nelles C, Düber C, Lang H, et al. Treatment and survival of non-alcoholic steatohepatitis associated hepatocellular carcinoma. BMC Cancer. 2015;15(1):210. doi:.https://doi.org/10.1186/s12885-015-1197-x
  55. Wiegand S, Keller KM, Röbl M, L’Allemand D, Reinehr T, Widhalm K, et al.; APV-Study Group and the German Competence Network Adipositas. Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16,390 overweight or obese children and adolescents. Int J Obes. 2010;34(10):1468–74. doi:.https://doi.org/10.1038/ijo.2010.106
  56. Ratziu V, Marchesini G. When the journey from obesity to cirrhosis takes an early start. J Hepatol. 2016;65(2):249–51. doi:.https://doi.org/10.1016/j.jhep.2016.05.021
  57. European Association for Study of LiverAsociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237–64. doi:.https://doi.org/10.1016/j.jhep.2015.04.006
  58. Zhou B, Lu Y, Hajifathalian K, Bentham J, Di Cesare M, Danaei G, et al.; NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513–30. doi:.https://doi.org/10.1016/S0140-6736(16)00618-8
  59. Weinmann A, Koch S, Niederle IM, Schulze-Bergkamen H, König J, Hoppe-Lotichius M, et al. Trends in epidemiology, treatment, and survival of hepatocellular carcinoma patients between 1998 and 2009: an analysis of 1066 cases of a German HCC Registry. J Clin Gastroenterol. 2014;48(3):279–89. doi:.https://doi.org/10.1097/MCG.0b013e3182a8a793
  60. Chong CA, Gulamhussein A, Heathcote EJ, Lilly L, Sherman M, Naglie G, et al. Health-state utilities and quality of life in hepatitis C patients. Am J Gastroenterol. 2003;98(3):630–8. doi:.https://doi.org/10.1111/j.1572-0241.2003.07332.x
  61. Pfeil AM, Reich O, Guerra IM, Cure S, Negro F, Müllhaupt B, et al. Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C. PLoS One. 2015;10(5):e0126984. doi:.https://doi.org/10.1371/journal.pone.0126984
  62. Alberti G, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M ; Consensus Workshop Group. Type 2 diabetes in the young: the evolving epidemic: the international diabetes federation consensus workshop. Diabetes Care. 2004;27(7):1798–811. doi:.https://doi.org/10.2337/diacare.27.7.1798
  63. Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48(3):792–8. doi:.https://doi.org/10.1002/hep.22429
  64. Angulo P, Bugianesi E, Bjornsson ES, Charatcharoenwitthaya P, Mills PR, Barrera F, et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2013;145(4):782–9.e4. doi:.https://doi.org/10.1053/j.gastro.2013.06.057
  65. Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015;149(2):389–97.e10. doi:.https://doi.org/10.1053/j.gastro.2015.04.043
  66. Singh S, Venkatesh SK, Loomba R, Wang Z, Sirlin C, Chen J, et al. Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol. 2016;26(5):1431–40. doi:.https://doi.org/10.1007/s00330-015-3949-z
  67. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: World Health Organization; 2013.

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