@article {1489915,
	title = {Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease},
	journal = {BMC Med},
	volume = {16},
	number = {1},
	year = {2018},
	month = {2018 08 13},
	pages = {130},
	abstract = {BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20\% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. We harmonised health records from four major European territories and assessed age- and sex-specific point prevalence and incidence of NAFLD over the past decade.

METHODS: Data were extracted from The Health Improvement Network (UK), Health Search Database (Italy), Information System for Research in Primary Care (Spain) and Integrated Primary Care Information (Netherlands). Each database uses a different coding system. Prevalence and incidence estimates were pooled across databases by random-effects meta-analysis after a log-transformation.

RESULTS: Data were available for 17,669,973 adults, of which 176,114 had a recorded diagnosis of NAFLD. Pooled prevalence trebled from 0.60\% in 2007 (95\% confidence interval: 0.41-0.79) to 1.85\% (0.91-2.79) in 2014. Incidence doubled from 1.32 (0.83-1.82) to 2.35 (1.29-3.40) per 1000 person-years. The FIB-4 non-invasive estimate of liver fibrosis could be calculated in 40.6\% of patients, of whom 29.6-35.7\% had indeterminate or high-risk scores.

CONCLUSIONS: In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications.},
	keywords = {Databases, Factual, Disease Progression, Female, Humans, Incidence, Male, Middle Aged, Non-alcoholic Fatty Liver Disease, Prevalence, Risk Factors},
	issn = {1741-7015},
	doi = {10.1186/s12916-018-1103-x},
	author = {Alexander, Myriam and Loomis, A Katrina and Fairburn-Beech, Jolyon and van der Lei, Johan and Duarte-Salles, Talita and Prieto-Alhambra, Daniel and Ansell, David and Pasqua, Alessandro and Lapi, Francesco and Rijnbeek, Peter and Mosseveld, Mees and Avillach, Paul and Egger, Peter and Kendrick, Stuart and Waterworth, Dawn M and Sattar, Naveed and Alazawi, William}
}
