Just Read: Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes

Still catching up on the threads of not this recent #LCB18 but the more distant #LowCarbSanDiego, and this paper on the prevalence of the disease the medical profession is just starting to understand, non-alcoholic fatty liver disease, or NAFLD.

NAFLD is important in the context of diabetes reversal and nutrition:

Clinically, NAFLD patients tend to be obese, with insulin resistance and/or type 2 diabetes, dyslipidemia, hypertriglyceridemia, and hypertension, which are all risk factors for cardiovascular diseases (CVDs).(10,11) In fact, prevalence of NAFLD in patients with components of MetS is quite high.(12,13) For instance, NAFLD has been reported in over 76% of type 2 diabetics.(14)

There is no currently known drug treatment for NAFLD. Its causes are related to nutrition, and specifically high-carbohydrate/low-fat nutrition, and recent studies are showing it abates with nutrition approaches:

Just Read: How a low-carbohydrate diet rapidly reverses risk factors in people with high liver fat, in the disease we’ll all be hearing about – NAFLD, NASH, Diabetes Reversal

While the overwhelming number (94%) of people included in this epidemiological study are from North America, the authors reviewed data globally:

  • 25% Prevalence globally
  • 24% in North America
  • Much lower if blood tests are used – 13% in North America vs 24% by ultrasound
  • Associations with other metabolic derangements
    • Hyperlipidemia: 69%
    • Diabetes: 22% (for NAFLD), 44% (for the more progressive NASH)
    • Metabolic Syndrome: 45%
    • Hypertriglyceridemia: 40%

There’s a related editorial which mentions things like mass extinctions (and whose author also consults for Pharma, just noting) (Rinella M, Charlton M. The globalization of nonalcoholic fatty liver disease: Prevalence and impact on world health. Hepatology [Internet]. Wiley-Blackwell; 2016 Jul 1 [cited 2018 Mar 19];64(1):19–22. Available from: http://doi.wiley.com/10.1002/hep.28524) and relates the problem of NAFLD to the obesity epidemic and over-nutrition. However, the recent study published in Cell Metabolism sheds some light on this assertion, since the human subjects in that study reduced their fatty liver burden independent of weight loss.

Where did NAFLD come from? I’ll post on another analysis of the trajectory of the disease next.


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 [Internet]. 2016 Jul 1 [cited 2017 Aug 7];64(1):73–84.

Conflicts of interest

As noted, which would lend a bias toward reporting a greater disease burden

Dr. Younossi consults for Gilead and Intercept. He advises Bristol‐Myers Squibb and AbbVie. The study was partially supported by the Beatty Liver and Obesity Research Fund and Liver Outcomes Research Fund, Inova Health System and Gilead Sciences to the Center for Outcomes Research, Washington DC.


Ted Eytan, MD