Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease

Alexander, M. et al. (2018) Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease. BMC Medicine, 16, 130. (doi: 10.1186/s12916-018-1103-x) (PMID:30099968) (PMCID:PMC6088429)

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Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. We harmonised health records from four major European territories and assessed age- and sex-specific point prevalence and incidence of NAFLD over the past decade.Data were extracted from The Health Improvement Network (UK), Health Search Database (Italy), Information System for Research in Primary Care (Spain) and Integrated Primary Care Information (Netherlands). Each database uses a different coding system. Prevalence and incidence estimates were pooled across databases by random-effects meta-analysis after a log-transformation.Data were available for 17,669,973 adults, of which 176,114 had a recorded diagnosis of NAFLD. Pooled prevalence trebled from 0.60% in 2007 (95% confidence interval: 0.41-0.79) to 1.85% (0.91-2.79) in 2014. Incidence doubled from 1.32 (0.83-1.82) to 2.35 (1.29-3.40) per 1000 person-years. The FIB-4 non-invasive estimate of liver fibrosis could be calculated in 40.6% of patients, of whom 29.6-35.7% had indeterminate or high-risk scores.In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications.

Item Type:Articles
Keywords:Population, epidemiology, NASH, Nafld
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed
Creator Roles:
Sattar, N.Writing – original draft
Authors: Alexander, M., Loomis, A. K., Fairburn-Beech, J., van der Lei, J., Duarte-Salles, T., Prieto-Alhambra, D., Ansell, D., Pasqua, A., Lapi, F., Rijnbeek, P., Mosseveld, M., Avillach, P., Egger, P., Kendrick, S., Waterworth, D. M., Sattar, N., and Alazawi, W.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:BMC Medicine
Publisher:BMC
ISSN:1741-7015
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMC Medicine 16:130
Publisher Policy:Reproduced under a Creative Commons License

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