Introduction

Probably secondary to industrialization,

Westernization of lifestyle and change of
diet, the prevalence of non-alcoholic fatty
liver disease (NAFLD) has been rapidly rising
in Asia within recent decades
More and more people will suffer from not
only the liver impairment of NAFLD but also
the associated metabolic diseases e.g. DM
and Hypertension.
Introduction
The incidence of DM, hypertension, coronary heart
diseases (CHD) and stroke will increase together
with the prevalence of NAFLD and the health service
expenditure will rise in coming decades.
However the prevalence of and the metabolic
diseases associated with NAFLD are not well studied
in Southeast Asian populations.
Metabolic risk factors & NAFL

Obesity

NAFL
Type 2
diabetes Hyperlipidemia
mellitus
NAFL & SOCIO ECONOMIC STATUS
(?)
Income

NAFL & SOCIO ECONOMIC STATUS
(?)
Income

Obesity

NAFL & SOCIO ECONOMIC STATUS
(?)
Income

Obesity

NAFL
NAFL & SOCIO ECONOMIC STATUS
Developed Countries Developing Countries
Country Prev Country Prev
Japan 9-30% Sarawak 44.2%
Korea 18% Thailand 35.9&

Amarapurkar DN, et al. J Gastro Hepatol 2007

Rungsinaporn K, et al. J Med Assoc Thai 2008
Cheah WY, et al. Southeast Asian J Trop Med Public Health 2013
 Prevalence and Risk Factors of
NAFL in Indonesia
Irsan Hasan et al. J Gastroenterol Hepatol 2002; 17 (Suppl.): A30

The study was part of non-communicable disease study in

the sub-urban area in collaboration with WHO and
Indonesian Ministry of Health
Multistage random sampling methods were applied to
55,000 people with the targeted sample for age of 25 - 65 y.o
Demographic data were recorded, and BMI was
calculated
Ultrasonography and serum collection were done for each
subject
..
Ultrasound Findings
Total

30% Fatty Liver

Normal

70%
Fatty liver : Gender
Gender

35% Female
Male

65%
Fatty liver : Age distribution
Age

13%
25-40
30%
41-55
56-65

57%
Risk Factors For Fatty Liver
Obesity
Diabetes mellitus
Hyperlipidemia
 CONCLUSION OF THE STUDY
Non alcoholic fatty liver is frequent in Indonesia
as well as people in developed countries
Independent predictors for fatty liver were age,
hypertriglyceridemia, diabetes mellitus and
obesity
The other factors such as sex, dietary intake of
fat, sport and activity were not associated with
fatty liver
Epidemic obesity and type 2 diabetes
in Asia
Kun-Ho Yoon et al. Lancet 2006; 368: 1681-88

The proportions of people with type 2 diabetes and

obesity have increased throughout Asia, and the
rate of increase shows no sign of slowing.
People in Asia tend to develop diabetes with a lesser
degree of obesity at younger ages, suffer longer
with complications of diabetes, and die sooner than
people in other regions.
Childhood obesity has increased substantially and
the prevalence of type 2 diabetes has now reached
epidemic levels in Asia.
A. Prevalence of diabetes
B. Multiplication factor for increased prevalence
 Top 10 Countries in Asia With the Highest Number of Persons With Type 2
Diabetes and Impaired Glucose Tolerance in the Age Group 20 to 79 Years in
2007 & Projected Data in 2025

Juliana JN Chan et al. Diabetes in Asia. JAMA 2009

 Clinical Picture, Insulin Resistance,
and Adipocytokines Profiles of
Nonalcoholic Steatohepatitis (NASH)
Patients in Indonesia
C Rinaldi Lesmana et al. Indones J Intern Med 2009

This was a cross-sectional study comparing patients with

histopathologically confirmed NASH and normal subjects.
All patients underwent ultrasound-guided liver biopsy.
Specimens were graded and staging was done according
to Brunt criteria.
Insulin resistance was measured with homeostasis model
assessment of insulin resistance (HOMA-IR)
 CHARACTERISTIC OF
NASH AND NORMAL SUBJECTS
Insulin Resistance & Cytokine profiles
 Conclusion of the study
Most of the metabolic syndrome features
were found in patients with NASH.
HOMA- IR and TNF-alpha levels in
subjects with NASH are higher than
controls, while adiponectin levels in
subjects with NASH are lower than controls
 NAFL in
(Southeast) Asian Population

Clinical and metabolic profiles of Asian are

similar to Western population with NAFL
BMI of Asian with NAFL is lower than in
Western populations
Race / genetic influences in NAFL in the Asian
population ?
Prevalence and Risk Factors of NAFLD in a
Multiracial Suburban Asian Population in
Malaysia
Seok-Chin Goh et al. Hepatol Int 2013; 7: 548-554

Population from a health checkup at a suburban

area
Subjects recruited were healthy individuals
The diagnosis of fatty liver was based on the
presence of bright liver, vascular blurring, and deep
attenuation of ultrasound signal
Demographic data were recorded, and BMI was
calculated
Results
Basic demographic data (n=1,621)

Mean age + SD 46.0 + 15.3

Male : female ratio 547 : 1,074
Ethnic distribution (%)
Malay 197 (12.1)
Chinese 1,269 (78.3)
Indian 155 (9.6)
 Prevalence of NAFLD in Malaysia
Total Malay Chinese Indian

33% 34%

23%
20%

Total Malay Chinese Indian

Prevalence of NAFLD
80%

70%

60%

50%
Malay
40% 40%
Chinese
30%
30% Indian
25%
Total
20%

10% 8%

0%
Male < 45 years Female < 45 Male 45 years Female 45
years years
Goh SC. Hepatol Int. 2013;7:54854
The reasons for racial
predilection ?

Genetic
susceptibility Environmental
factors
Indian diet
Malay diet
...................
.......
Chinese diet
 CONCLUSION
In Southeast Asia region recognition of fatty liver
disorders as a distinct and common entity has been
slow in coming
The profile of Southeast Asian patients with NAFLD
is similar to cases reported in contemporary
publications outside the region
However the prevalence of and the metabolic
diseases associated with NAFLD are not well studied
in Southeast Asian populations.
THANK YOU !