Epidemiology and Disease Burden of Non-Alcoholic Steatohepatitis (NASH) in Greater China: A Systematic Review

Background: Non-Alcoholic steatohepatitis (NASH) is a progression of non-alcoholic fatty liver disease, leading to fibrosis, cirrhosis and hepatocellular carcinoma. The increasing burden of NASH has become a major concern of public health in greater China largely contributed by the rapid transition of lifestyle. The study aimed to characterize the epidemiology, disease burden, and treatment of NASH in greater China in order 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 Oct 10, 2020 which reported NASH epidemiology, disease burden, and/or intervention in Chinese adults. The type of studies might include cross-sectional, cohort studies, randomized controlled trials and mathematical models. Exclusion criteria were studies for animal or cellular experiments, about population outside greater China, or with incomplete data. Findings: 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. For non-obese subjects, 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. Clinical trials of medication treatments specific for NASH are still ongoing. Interpretation: 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. Funding: There was no funding source for this study. Declaration of Interests: We declare no competing interests.