Over the past two decades, rapid urbanization in many Asian countries has brought in trends of sedentary lifestyle and overnutrition, predisposing to the epidemic of obesity.

An article published in the Journal of Hepatology reviewed the epidemiological prevalence of obesity in Asia with a special emphasis on the emerging condition of NAFLD. The authors reported that the population prevalence of NAFLD in Asia is around 25%. Although hepatocellular carcinoma and end-stage liver disease secondary to NAFLD remain uncommon, a rising predilection has emerged. However, nearly 8-19% of Asians with BMIs below 25kg/m² are also found to have NAFLD—a condition often described as "lean" or "non-obese" NAFLD. Despite this condition being generally less severe than that in more obese patients, steatohepatitis and fibrotic disease are well recognized.

Central adiposity, insulin resistance and weight gain are major risk factors for NAFLD. Meanwhile, genetic predisposition, such as the PNPLA3 polymorphism appears to be more important in the development of NAFLD in the non-obese population. This article reinstated that lifestyle modification remains the cornerstone of management for obesity and NAFLD. However, only a few patients manage to achieve adequate weight reduction and even fewer can maintain a healthy body weight in the long run.

It was inferred that pharmacological agents have entered phase III development for steatohepatitis. However, Asian patients are under-represented in most drug trials. Thus, future studies should define the optimal management of obesity and NAFLD in Asia.

Source:  Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. Journal of Hepatology. 2017;67(4):862-73.