Australia’s future burden of disease from non-alcoholic fatty liver disease (NAFLD) and its sequelae looks bleak, clinicians say.

Even if obesity rates stabilise, ageing of the population will continue to increase the risk of NAFLD-related morbidity and mortality over the next decade, according to an analysis by eight leading gastroenterologists and hepatologists.

Their modelling study incorporating trends in adult BMI has predicted that NAFLD will increase by 25% between 2019 and 2030 – from about 5.5 million to over 7 million cases.

Similarly, NAFLD fibrosis stage F0-1 will increase by 25% from about 5.1 million to 6.3 million.

But more severe disease, despite being less common, will increase disproportionately.

F2 cases are expected to increase by 50% (228,000 to 347,000) and F3 cases by 70% (133,000 to 223,000).

Compensated cirrhotic cases were forecasted to increase 85% from 62,900 to 115,000 cases.

“Prevalent cases of decompensated cirrhosis, primary liver cancer and liver transplants are expected to increase concurrently from a combined 8,500 (5,600-14,500) to 16,000 (11,000-25,700) cases, an increase of 85% during 2019-2030,” the study said.

The age group with the highest NAFLD prevalence will also increase from 55-59 years to 60-64 years.

Published in the Journal of Gastroenterology and Hepatology, the study, co-authored by leading clinicians including GESA president prof Simone Strasser, also found that annual liver-related deaths in the NAFLD population will increase by a staggering 90% from 1,700 to 3,200 in 2030.

“The results of NAFLD modelling suggest that NAFLD presents an expanding burden such that the Australian population is expected to experience substantial increases in NAFLD-related disease burden in the coming decades,” they wrote.

“In the coming decade, NASH may become a leading indication for liver transplantation in Australia, in tandem with a reduced burden of viral hepatitis.”

The study highlighted some of the risk factors for NAFLD-related liver disease.

“Even if obesity prevalence in Australia stabilises, NAFLD-related morbidity and mortality is projected to rise. The Australian population aged ≥65 years is projected to increase by over 1.4 million persons between 2019 and 2030. With increasing average age, the population will experience greater risk for advanced liver disease.”

An expected increase in diabetes will put further upward pressure on NAFLD-related liver disease as will the likely longer duration of obesity and earlier onset of NAFLD.

“Our results further confirm the continued growth in NAFLD-related liver cancer in Australia and the pressing need to better identify NAFLD cases, especially persons with significant fibrosis.”

“Both lifestyle modifications and other therapeutic options must be considered to avert the coming epidemic of NAFLD-related liver disease.”