Fatty liver disease leads to increased liver cancer deaths

LONDON ― Worldwide, alcohol-free foie gras (NAFLD) has led to an increase in liver cancer deaths over the past decade, exceeding alcoholic liver disease, Hepatitis Band Hepatitis Caccording to an analysis of the Global Burden of Disease Study 2019.

A worldwide increase in deaths from liver cancer and chronic liver disease reflects changes in underlying health patterns, said Zobair Younossi, MD, MPH, professor and chair of the Department of Medicine, Inova Fairfax Medical Campus , Falls Church, Virginia, who presented the analysis here at the 2022 International Liver Congress (ILC).

“NAFLD and NASH [nonalcoholic steatohepatitis] quickly become the main causes of cirrhosis and liver cancer around the world,” Younossi said. Medscape Medical News. “We’ve known about the rise in prevalence for some time, but now the mortality outcomes are catching up,” he said.

“The bottom line of this study is that the burden of this disease [NAFLD] is increasing, and it will be the most important disease of the next decade,” he said, adding that “the largest annual percentage increase in death rates from liver cancer or chronic cirrhosis of the liver is related to the NAFLD”.

Specifically, over the decade 2009-2019, the annual percentage change (APC) of +1.33% in the global liver cancer mortality rate was due to the fact that the APC for NAFLD was +2 .47%. In comparison, the APC for alcoholic liver disease was +1.91%; for hepatitis B, the APC was +0.21%; and for hepatitis C, the APC was +1.12%.

Aleksander Krag, MD, PhD, Professor and Senior Consultant in Hepatology and Director of the Odense Liver Research Center at SDU and Odense University Hospital, Denmark, who chaired the session at which this presentation was party, recognized the importance of recognizing the contribution of NAFLD to liver cancer mortality.

Liver disease is on the rise. It is the fastest growing cause of death in the UK, faster than heart disease and other cancers. NAFLD in particular is the fastest growing cause of liver cancer fastest and leading cause in France and the United States,” he remarked.

Krag also pointed to the costs of disease management.

“The management of fatty liver disease in Europe is estimated at €35 billion in direct healthcare, so we need to do something now,” he stressed.

“The global burden of NAFLD is so high that we need both prevention and treatment tools,” Krag said. “Changing lifestyles is a no-brainer and costs governments very little. For the sake of our young people, we have to take this very seriously. At the political level, we can easily implement this, for example by banning junk food .food advertisements, but also educating young people and their families.Good medicine will also help.

NAFLD: The Hepatic Manifestation of Type 2 Diabetes

About 25% to 30% of the world’s population has NAFLD, and 3% to 5% have NASH. Younossi pointed out that the US transplant database shows that NAFLD was the second indication for all liver transplants in the country. NAFLD was also one of the leading causes of liver transplantation in patients with hepatocellular carcinoma.

There are about two billion cases of chronic liver disease worldwide, he said. He noted that over time there has been an increase in all kinds of liver disease, as evidenced by the annual percentage change.

“The global epidemic of obesity and Type 2 diabetes is causing the increase in NAFLD, but even in lean people, the prevalence of NAFLD is around 9%,” Younossi said. “Alongside the ocular and renal complications of diabetes, this is the hepatic manifestation of type 2 diabetes.”

To assess liver disease and deaths around the world, Younossi and his colleagues turned to the Global Burden of Disease Study, which collected data from approximately 7,000 researchers located in 22 different regions of the world, including 156 countries. .

They calculated incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in relation to liver cancer and chronic liver disease, including CPA. They linked the data to changes in four liver diseases: NAFLD, alcoholic liver disease, hepatitis B infection and hepatitis C infection.

The cases of NAFLD reported in the study had been diagnosed by ultrasound or other imaging. Importantly, the prevalence of NAFLD was adjusted for alcohol consumption across different national populations, Younossi explained.

In 2019, they reported that globally, the overall prevalence of liver disease reached 1.69 billion (liver cancer, 0.04%; chronic liver disease, 99.96%), with an incidence of 2.59 million (liver cancer, 20.7%; chronic liver disease, 79.3%). %), mortality of 1.95 million (liver cancer, 24.8%; chronic liver disease, 75.3%) and DALYs of 58.7 million (liver cancer, 21.3%; chronic liver disease, 78 .7%).

Between 2009 and 2019, liver cancer deaths increased by 27.2% and chronic liver disease deaths increased by 10.6%. Liver cancer DALYs increased by 21.9% and chronic liver disease DALYs increased by 5.1%.

In contrast to the increase in liver cancer deaths, deaths from chronic liver disease decreased (APC, -0.18%). The decrease was driven by a decrease in hepatitis B (APC, -1.83%). APCs for hepatitis C (+0.37%), alcoholic liver disease (+0.45%) and NAFLD (+1.33%) increased.

“The burden of hepatitis B mortality has gone down because we’ve been so good at vaccinating people,” Younossi remarked.

NAFLD ‘explodes’ in Middle East, North Africa and East Asia

The increase in NAFLD has been observed in all regions of the world, but a breakdown by region shows that NAFLD is ‘exploding’ mainly with the highest prevalence and mortality in the Middle East (mainly in Egypt, Iran and in Turkey), North Africa and North Africa. East Asia, Younossi said. Additionally, there are strong increases in the West and South America.

“We knew the prevalence was high in the Middle East, but now we know the mortality is also high, so we’re connecting that data,” Younossi said.

Lack of awareness

Younossi insisted that awareness among the general population, primary care providers and policy makers is very low. “From my perspective, NAFLD awareness is the number one priority, and that’s the value of this study.”

He added that more people will become aware as testing becomes more manageable.

“Some non-invasive tests are being developed, so in the future we won’t have to do liver biopsies to diagnose these patients,” he said. “Currently, there are excellent treatments being developed.”

“WHO [World Health Organization] does not list NAFLD as an important non-communicable disease, and that too needs to change,” Younossi added.

International Liver Congress (ILC) 2022: abstract GS008. Presented June 24, 2022.

Younossi has received research grants and/or has been a consultant for Abbott, Allergan, Bristol-Myers Squibb, Echosens, Genfit, Gilead Sciences, Intercept, Madrigal, Merck and Novo Nordisk. Karg did not disclose any relevant financial relationship.

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