From the Guidelines
The most common causes of liver fibrosis globally are non-alcoholic fatty liver disease (NAFLD), chronic hepatitis B and C infections, and alcohol-related liver disease. According to the most recent study 1, NAFLD is estimated to affect over 70% of people with type 2 diabetes, with steatohepatitis (NASH) being a driver for the development of fibrosis. The prevalence of NAFLD is approximately 25% of the global population, as reported in a 2022 study 1. Chronic hepatitis B and C infections are also significant causes of liver fibrosis, with hepatitis B affecting approximately 296 million people worldwide and hepatitis C affecting about 58 million people, as mentioned in a 2018 study 1. Alcohol-related liver disease is prevalent in regions with high alcohol consumption, causing progressive liver damage. Other significant causes include autoimmune hepatitis, certain medications, hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency.
Some key points to consider:
- NAFLD is closely linked to metabolic syndrome, diabetes, and obesity, and is becoming a leading cause of hepatocellular carcinoma (HCC) and liver transplantation 1.
- Chronic hepatitis B and C infections are major risk factors for liver fibrosis, particularly in developing regions 1.
- Alcohol-related liver disease is a significant cause of liver fibrosis, especially in regions with high alcohol consumption 1.
- Early diagnosis and management of the underlying cause are essential to prevent progression to cirrhosis and complications 1.
In terms of geographical distribution, the contribution of different causes of liver fibrosis varies by region, as shown in a 2018 study 1. However, NAFLD is becoming an increasingly common cause of liver fibrosis globally, particularly in developed regions. It is essential to prioritize the management of NAFLD, as well as other causes of liver fibrosis, to reduce the risk of progression to cirrhosis and complications.
From the Research
Causes of Liver Fibrosis
- The most common causes of liver fibrosis globally are non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) 2
- Viral hepatitis, such as Hepatitis B and C, are also significant causes of liver fibrosis, although the burden of liver disease related to viral hepatitis has decreased with successful treatment 2, 3
- Other causes of liver fibrosis include alcohol-associated liver disease and drug-induced liver injury 4
Global Burden of Liver Disease
- Liver disease accounts for two million deaths annually, with approximately two-thirds of all liver-related deaths occurring in men 4
- The most common causes of cirrhosis worldwide are related to viral hepatitis, alcohol, and non-alcoholic fatty liver disease 4
- Hepatotropic viruses are the aetiological factor in most cases of acute hepatitis, but drug-induced liver injury increasingly accounts for a significant proportion of cases 4
Relationship Between NAFLD and Liver Fibrosis
- NAFLD is closely associated with metabolic disorders, including central obesity, dyslipidaemia, hypertension, hyperglycaemia, and persistent abnormalities of liver function tests 5
- Advanced fibrosis is the major predictor of morbidity and liver-related mortality in patients with NAFLD 5
- The presence of NAFLD in subjects with hepatitis C genotype 1 infection is most strongly associated with the presence of the metabolic syndrome and insulin resistance 6