Opinion Review
Copyright ©The Author(s) 2020.
World J Gastroenterol. Jul 7, 2020; 26(25): 3528-3541
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3528
Table 1 Prevalence and Estimation Studies of Risk Factors of nonalcoholic fatty liver disease in United Arab Emirates, Kingdom of Saudi Arabia, and Kuwait
Place of studyStudyMain findingsRef.
Dubai, UAECross-sectional study to access prevalence of MetS and its associated risk factors among children and adolescents (596 students)Prevalence of MetS was 3.7%; was more common among boys than girls (12 boys versus 10 girls); 18.6% were overweight; 21.2% were obese; MetS was more commonly found in obese (16%) compared to overweight students (2%)Haroun et al[81], 2018
Abu Dhabi, UAEMulticenter cohort study to determine cardiovascular risk factor prevalence rates (50138 participants)35% were obese, 32% were overweight, 55% had central obesity, 18% were diabetic, 27% were prediabetic; Age-standardized diabetes and prediabetes rates were 25% and 30%, respectively; Age-standardized obesity and overweight rates were 41% and 34%, respectivelyHajat et al[12], 2012
UAESystematic review and qualitative synthesis of prevalence, incidence rates, trends, and Economic Burden of Obesity and cardiometabolic disorder (36 studies)All studies reported high prevalence rates for obesity, diabetes, hypertension, and MetS; Obesity and related cardiometabolic disorders seem highly prevalent in the UAE but estimating an accurate occurrence is challenging due to methodological heterogeneity of the epidemiological studies addressing them; Frequency of overweight and obesity was reported to increase by 2-3-fold between 1989 and 2017Radwan et al[13], 2018
Saudi ArabiaSurvey to determine obesity prevalence and associated factors (n = 10293)28.7% of the population evaluated were obese; Obesity prevalence was higher among women (33.5%) than men (24.1%)Memish et al[14], 2014
Saudi ArabiaSecondary analysis to estimate the trends in the prevalence of adult obesity over the period 1992–2022 (5 studies)Obesity trend from 1992-2005: In men, the prevalence increased from (1) 10.1% to 27.1% in age-group 25-34 yr; and (2) 12.9% to 31.0% in age group 55-64 yr. In women, obesity prevalence was higher; increased from (1) 16.1% to 39.5% in age group 25-34 yr; and (2) 22.8% to 53.2% in age group 55-64 yr. Obesity projection from 1992-2022: The future obesity prevalence was estimated to increase from (1) 12% to 41% in men; and (2) 21% to 78% in womenAl-Quwaidhi et al[15], 2014
Saudi ArabiaCross sectional study to evaluate the prevalence of MetSThe prevalence of MetS in Saudi Arabia was found to be 39.8% (34.4% in men and 29.2% in women) as per the NCEP ATP III and 31.6% (45.0% in men and 35.4% in women) as per IDF criteriaAl-Rubeaan et al[26], 2018
KuwaitObservational study (multicenter) to examine the prevalence of MetS and its components (992 adults ≥ 20 yr)Obesity percentage was significantly greater in females (54.7%) compared to males (32.3%); Abdominal obesity was the most predominant MetS abnormality; Prevalence of MetS increased with age and was higher in females than malesAl Zenki et al[82], 2012
KuwaitCross-sectional survey to estimate prevalence of overweight, obesity, and various types of adiposity (3589 adults, 18-69 yr)Overall obesity prevalence was 40.3% (men, 36.5%; women, 44.0%); The prevalence of Class I, Class II, and Class III obesity was 24.9%, 9.9%, and 5.5%, respectivelyWeiderpass et al[83], 2019
KuwaitDescriptive, cross-sectional survey (multicenter) to understand the prevalence of MetS, and estimation of the 10-year risk for developing T2DM and CHD (n = 1610)4% subjects were found to have screen detected T2DM. A history of high blood glucose levels was reported by 18.0% subjects; 35.5% of the participants were obese; MetS was present in about 32% of the participants; Almost 30% of participants were found to be at moderate/high/very high risk of developing T2DM within the next 10 yr; 8.45% were found to be at moderate/high/very high risk of developing both T2DM/CHD within the next 10 yrAwad et al[84], 2014
Table 2 Key diagnostic modalities for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[11,35,85,86]
Diagnostic TestsAdvantagesLimitations
Liver enzymes and other blood tests for fibrosis
Platelet count; APRI; AST; ALT; AST/ALT ratio; Hyaluronic acid; ELF; Hepascore; FibroSpect; FibroTest/FibroSureSimple and easy; AST/ALT of > 1 is predictive of fibrosis; ELF can predict stage of fibrosis and outcomesAST and ALT can be normal in some patients with NAFLD; ELF is not widely available; Some tests initially developed for HCV; Limited published data on external validation
UltrasonographyEasily available; Safe; Overall scanning of abdominal organsCannot detect mild degree of steatosis (< 30% of hepatocytes); Does not distinguish between steatosis and NASH; Operator dependent
MRIMore sensitive than ultrasonographyCost and availability; Does not distinguish between steatosis and NASH
Transient; ElastographyCan detect fibrosisCost and availability
MRECan detect fibrosis and MRI-PDFF can quantify steatosisCost and availability
Fibrosis scoring systems
NAFLD fibrosis score (NFS), Fibro Meter Fibrosis-4 (FIB-4)Allow a more targeted use of liver biopsy by reliably excluding advanced fibrosis in a high proportion of NAFLD patients; Potentially predict liver-related and cardiovascular complications and deathSignificant number with indeterminate scores; Limited external validation in NASH
Liver biopsyGold standard for diagnosis of NAFLD and NASH; Allows staging of the diseaseInvasive; Associated with complications – pain, intraperitoneal bleeding; Cost