PT  - JOURNAL ARTICLE
AU  - Swain, Mark G.
AU  - Ramji, Alnoor
AU  - Patel, Keyur
AU  - Sebastiani, Giada
AU  - Shaheen, Abdel Aziz
AU  - Tam, Edward
AU  - Marotta, Paul
AU  - Elkhashab, Magdy
AU  - Bajaj, Harpreet S.
AU  - Estes, Chris
AU  - Razavi, Homie
TI  - Burden of nonalcoholic fatty liver disease in Canada, 2019–2030: a modelling study
AID  - 10.9778/cmajo.20190212
DP  - 2020 Apr 01
TA  - CMAJ Open
PG  - E429--E436
VI  - 8
IP  - 2
4099  - http://www.cmajopen.ca/content/8/2/E429.short
4100  - http://www.cmajopen.ca/content/8/2/E429.full
SO  - CMAJ2020 Apr 01; 8
AB  - Background: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a growing proportion of liver disease cases, and there is a need to better understand future disease burden. We used a modelling framework to forecast the burden of disease of NAFLD and NASH for Canada.Methods: We used a Markov model to forecast fibrosis progression from stage F0 (no fibrosis) to stage F4 (compensated cirrhosis) and subsequent progression to decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death among Canadians with NAFLD from 2019 to 2030. We used historical trends for obesity prevalence among adults to estimate longitudinal changes in the number of incident NAFLD cases.Results: The model projected that the number of NAFLD cases would increase by 20% between 2019 and 2030, from an estimated 7 757 000 cases to 9 305 000 cases. Increases in advanced fibrosis cases were relatively greater, as the number of model-estimated prevalent stage F3 cases would increase by 65%, to 357 000, and that of prevalent stage F4 cases would increase by 95%, to 195 000. Estimated incident cases of hepatocellular carcinoma and decompensated cirrhosis would increase by up to 95%, and the number of annual NAFLD-related deaths would double, to 5600.Interpretation: Increasing rates of obesity translate into increasing NAFLD-related cases of cirrhosis and hepatocellular carcinoma and related mortality. Prevention efforts should be aimed at reducing the incidence of NAFLD and slowing fibrosis progression among those already affected.