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  • Review Article
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The changing epidemiology of liver diseases in the Asia–Pacific region

Nature Reviews Gastroenterology & Hepatology volume 16, pages 57–73 (2019)Cite this article

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Abstract

This Review presents current epidemiological trends of the most common liver diseases in Asia–Pacific countries. Hepatitis B virus (HBV) remains the primary cause of cirrhosis; despite declining prevalence in most Asian nations, this virus still poses a severe threat in some territories and regions. Mortality resulting from HBV infection is declining as a result of preventive measures and antiviral treatments. The epidemiological transition of hepatitis C virus (HCV) infection has varied in the region in the past few decades, but the medical burden of infection and the prevalence of its related cancers are increasing. The lack of licensed HCV vaccines highlights the need for novel treatment strategies. The prevalence of nonalcoholic fatty liver disease (NAFLD) has risen in the past decade, mostly owing to increasingly urbanized lifestyles and dietary changes. Alternative herbal medicine and dietary supplements are major causes of drug-induced liver injury (DILI) in some countries. Complications arising from these chronic liver diseases, including cirrhosis and liver cancer, are therefore emerging threats in the Asia–Pacific region. Key strategies to control these liver diseases include monitoring of at-risk populations, implementation of national guidelines and increasing public and physician awareness, in concert with improving access to health care.

Key points

  • In the Asia–Pacific region, HBV, HCV, excessive alcohol consumption, the metabolic syndrome and concomitant liver diseases are the major factors resulting in chronic liver injury and end-stage liver pathology.

  • The expanding implementation of HBV vaccination has been effective in reducing the incidence of liver cancer, especially in countries like China.

  • Further effort is required to tackle the rising prevalence of HCV infection, for which a vaccine is not available.

  • Nonalcoholic fatty liver disease (NAFLD) prevalence is increasing owing to increasingly urbanized lifestyles and dietary changes; as a result, the rising trend of NAFLD is becoming comparable to that of Western countries.

  • As NAFLD is associated with the development of cardiovascular and kidney diseases, patients with this disease should receive tailor-made advice and continuous support for lifestyle modification.

  • Liver cancer is prevalent, particularly in China, Vietnam, North Korea and Thailand.

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Fig. 1: HBV prevalence in the Asia–Pacific region.
Fig. 2: HCV prevalence in the Asia–Pacific region.
Fig. 3: Prevalence of nonalcoholic fatty liver disease in the Asia–Pacific region.

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Acknowledgements

The authors acknowledge the editorial contribution of P. Arnold.

Review criteria

Government statistics and literature published since 2000 were searched. Data regarding these diseases were comprehensively reviewed. The authors also retrieved data from international studies such as Global Burden of Disease 2015 and GLOBOCAN 2012. This Review does not cover the Asia–Pacific or Western–Pacific regions as defined by the WHO or by any other body. It covers only those countries specifically mentioned in the text and the tables.

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Authors and Affiliations

  1. Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Martin C. S. Wong, Henry L. Y. Chan & Siew C. Ng

  2. State Key Laboratory for Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Martin C. S. Wong, Henry L. Y. Chan & Siew C. Ng

  3. J.C. School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Martin C. S. Wong, Jason L. W. Huang, Junjie Huang & Colette Leung

  4. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Martin C. S. Wong, Henry L. Y. Chan & Siew C. Ng

  5. Storr Liver Centre, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia

    Jacob George & Mohammed Eslam

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Contributions

C.L., J.H. and J.L.W.H. researched data for the article. H.L.Y.C., J.G., M.C.S.W., M.E. and S.C.N. discussed content for the article. C.L., J.H. and J.L.W.H. wrote the manuscript. H.L.Y.C., J.G., M.C.S.W., M.E. and S.C.N. reviewed and/or edited the manuscript before submission.

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Correspondence to Siew C. Ng.

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Related links

Global Burden of Disease: http://ghdx.healthdata.org/gbd-results-tool

GLOBOCAN 2012: http://globocan.iarc.fr

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Wong, M.C.S., Huang, J.L.W., George, J. et al. The changing epidemiology of liver diseases in the Asia–Pacific region. Nat Rev Gastroenterol Hepatol 16, 57–73 (2019). https://doi.org/10.1038/s41575-018-0055-0

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