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Epidemiology and disease burden of non-alcoholic steatohepatitis in greater China: a systematic review

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Abstract

Background

Non-alcoholic steatohepatitis (NASH) is a progression of non-alcoholic fatty liver disease. The increasing burden of NASH has become a major concern of public health in greater China. This study aimed to characterize the epidemiology, disease burden, and treatment of NASH in greater China to better inform national disease management and delivery of health services.

Methods

We conducted a systematic review searching four English databases (Web of Science, PubMed, Medline, and Cochrane Central) and three Chinese databases (CNKI, Wanfang, and VIP). We identified articles published from database inception to October 10, 2020 which reported NASH epidemiology, disease burden, and/or intervention in Chinese adults.

Results

Of 44,115 articles retrieved, 33 were eligible for inclusion. Overall prevalence of NASH ranged from 2.4 to 6.1% in greater China, with a more substantial burden among males, the aged, and those in Hong Kong and Taiwan. Most NASH patients suffered from several comorbidities, including obesity, diabetes, and cardiovascular conditions. PNPLA3 rs738409 G allele and haptoglobin 2–2 genotype drove the fibrosis progression in NASH. Increasingly prevalent cases of cirrhosis and hepatocellular carcinoma caused a higher NASH-related mortality. Compared with normal population, NASH patients experienced markedly poorer quality of life and heavier costs.

Conclusion

This is the first comprehensive overview of NASH among Chinese population that revealed an overwhelming impact of social and healthcare burden associated with the condition. Further high-quality studies are needed to improve the understanding and management of NASH in greater China.

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Abbreviations

CHB:

Chronic hepatitis B

CVD:

Cardiovascular disease

GD:

Gallbladder disease

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

Hp:

Haptoglobin

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

PROs:

Patient-reported outcomes

QoL:

Quality of life

T2DM:

Type 2 diabetes mellitus

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Author notes

  1. Huimin Zou and Ying Ge jointly first authorship.

Authors and Affiliations

  1. State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, Macao

    Huimin Zou, Ying Ge, Qing Lei, Carolina Oi Lam Ung, Zhen Ruan, Yunfeng Lai, Dongning Yao & Hao Hu

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Contributions

HZ, YG, QL, CU, and HH conceived the research project, coordinated the contributors, and revised drafts of the manuscript. HZ, YG, and QL participated in the study selection and data extraction. YG and QL revised drafts of the manuscript and contributed to data analysis. HZ developed the search strategy, searched the databases, and contributed to the revision of the manuscript. ZR, YL and DY served as scientific advisors.

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Correspondence to Hao Hu.

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Huimin Zou, Ying Ge, Qing Lei, Carolina Oi Lam Ung, Zhen Ruan, Yunfeng Lai, Dongning Yao, Hao Hu declare no competing interests.

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Zou, H., Ge, Y., Lei, Q. et al. Epidemiology and disease burden of non-alcoholic steatohepatitis in greater China: a systematic review. Hepatol Int 16, 27–37 (2022). https://doi.org/10.1007/s12072-021-10286-4

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