Systematic Reviews Open Access
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 8, 2015; 7(13): 1788-1796
Published online Jul 8, 2015. doi: 10.4254/wjh.v7.i13.1788
Non-alcohol fatty liver disease in Asia: Prevention and planning
Sara Ashtari, Mohamad Amin Pourhoseingholi, Mohamad Reza Zali, Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran 1985717413, Iran
Author contributions: Pourhoseingholi MA and Zali MR designed the research; Ashtari S performed the research and writes the paper.
Supported by Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science.
Conflict-of-interest statement: The authors have not declared any conflicts-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara Ashtari, MSc, Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tabnak St, Yaman Ave, Velenjak, Tehran 1985717413, Iran. sara_ashtari@yahoo.com
Telephone: +98-21-22432515 Fax: +98-21-22432517
Received: October 11, 2014
Peer-review started: October 13, 2014
First decision: October 28, 2014
Revised: December 3, 2014
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 8, 2015

Abstract

AIM: To review all of epidemiological aspects of non-alcoholic fatty liver disease (NAFLD) and also prevent this disease is examined.

METHODS: We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.

RESULTS: NAFLD is the most common liver disorder in worldwide, with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide. The prevalence of NAFLD in Asia, depending on location (urban vs rural), gender, ethnicity, and age is variable between 15%-20%. According to the many studies in the world, the relationship between NAFLD, obesity, diabetes mellitus, and metabolic syndrome (MS) is quiet obvious. Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but, it has increased recently due to the rise of obesity, type 2 diabetes and MS in this region. One of the main reasons for the increase in obesity, diabetes and MS in Asia is a lifestyle change and industrialization. Today, NAFLD is recognized as a major chronic liver disease in Asia. Therefore, prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, type 2 diabetes and MS.

CONCLUSION: Prevention of NAFLD is very important in Asian countries particularly in Arab countries because of high prevalence of obesity, diabetes and MS.

Key Words: Non-alcoholic fatty liver disease, Metabolic risk factors, Asian countries, Prevention

Core tip: Today non-alcoholic fatty liver disease (NAFLD) is one of the main concerns of the medical world. NAFLD is identified as a main risk factor for chronic liver disease across the world. NAFLD is clearly linked with obesity, type 2 diabetes and metabolic syndrome (MS). The prevalence of NAFLD is lower in Asian countries than Western countries but, it has increased dramatically in recent years because of increasing rate of obesity, type 2 diabetes and MS in this region. The high prevalence of obesity with diabetes, and MS would increase the risk of NAFLD in recent years. So, prevention of these factors is the key strategy to reduce the incidence of NAFLD.



INTRODUCTION

Nowadays, non-alcoholic fatty liver disease (NAFLD) is a major health concern worldwide which is characterized by abnormal fat accumulation in liver cells[1,2]. The development process of NAFLD can be started from simple steatosis (NAFLD) to non-alcoholic steatohepatitis (NASH) and finally leads to cirrhosis and hepatocellular carcinoma in absence excessive alcohol intake[3,4]. NAFLD is one of the main cause of chronic liver disease in industrializes countries[5,6]. According to the American Association for the Study of Liver Disease Guidelines[7], liver biopsy is the gold standard for the diagnosis of NAFLD, nevertheless ultrasonography is more commonly used particularly in developing countries, because of increased health risks and high expenditures associated with liver biopsies[2]. So, the prevalence of NAFLD varies according to the method used to diagnosis and study population[7-9]. In generally, the prevalence of NAFLD ranges is from 6.3% to 33% worldwide, and prevalence of NASH is from 3% to 5% in general population[7,10]. Despite the low prevalence of NAFLD in Asian countries (12%-24%)[11], than in Western countries (> 20%)[12], it is identified as a main risk factor for chronic liver disorder in all over world[13]. In Asian countries, the prevalence of NAFLD varies in different countries, and is related to the age, gender, locality and ethnicity[11]. NAFLD prevalence increases with age[6], and also men (40-49 years) tend to get NAFLD earlier than women (over 50 years)[11,14]. According to the other studies especially in South-East region of Asia[15-18], more men than women had NAFLD. For diagnosis of NASH, liver biopsy is required and it’s costly especially in low-income countries so the establish the prevalence of NASH is difficult. More than 30% of obese patients may have NASH and 12%-25% have fibrosis[2,19,20]. In predictors and diagnosis of NASH and fibrosis, diabetes and insulin resistance are the two main factors than body mass index (BMI)[21,22].

MATERIALS AND METHODS

We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed. We extracted data on epidemiology of NAFLD, Burden and prevalence of NAFLD, risk factors characteristics association NAFLD, and prevention of NAFLD. We analyzed the data and reported the results in the tables and text.

RESULTS

Based on systematic reviews, defines NAFLD as a compound disorder delineated by a set of metabolic syndrome (MS) risk factors, usually related to obesity, diabetes, hypertension and dyslipidemia[3,11,23,24]. Insulin resistance is the main factor in NAFLD pathogenesis, because of association between NAFLD and MS[11]. The presence of obesity and type 2 diabetes mellitus (T2DM) significantly increases the risk of NAFLD[11]. Available data from previous studies indicate that the prevalence of NAFLD likely increases 65%-70%[2,25-27] in T2DM populations and greater than 75% and 90% in obese people[28,29] and morbidly obese patients[30,31], respectively. In addition, NAFLD can be increase the risk of cardiovascular events in obese and diabetic people[2,32].

Obesity

Obesity has doubled worldwide since 1980. In Asia also, based on several national health surveys[33-36] prevalence of overweight and obese subjects has increased in the past few decades, but it varies between countries[37] [Table 1: Provides the 2010 World Health Organization (WHO); Global status report on non-communicable disease statistics for overweigh and obesity prevalence in Asian countries, Data adjusted for 2008 for comparability]. The prevalence of obesity in eastern Asia (e.g., China, Japan, South Korea and Taiwan), Southern Asia (e.g., Bangladesh, India, Pakistan and Sri Lanka), and South-Eastern Asia (e.g., Malaysia, Philippines, Singapore, Thailand and Vietnam) is quite low compared with developed countries such as the United States[38-40]. The highest rate of obesity in these regions of Asia are in Malaysia and Thailand, where 14% and 8.8% of adults are reported to be obese, respectively[41]. The lowest obesity rates in these regions are in the less developed parts of Asia: 1.1% in Bangladesh, 1.7% in Vietnam and 1.9% in India[36,41]. In contrast to these regions of Asia, in West Asian countries (Middle East countries; e.g., Iran, Iraq, Bahrain, Egypt, Kuwait, Saudi Arabia, Oman and Qatar) prevalence of obesity is very high and almost is equal with the Western developed countries. So that in countries such as Kuwait (42%), Saudi Arabia (33.3%), Qatar (33.2%) and Egypt (33.1%), the prevalence of obesity is higher than United States (33%)[41]. Except in Japan, Rates of obesity among women are twice that of men in all Asian countries.

Table 1 Prevalence of overweight and obesity in Asian countries, estimates for 2008 (%).
CountryOverweight1
Obesity2
MalesFemalesTotalMalesFemalesTotal
Kuwait78.479.578.837.549.842.0
Saudi Arabia69.168.869.028.639.133.3
Qatar73.170.272.331.338.133.2
Egypt60.475.367.921.444.533.1
Bahrain70.970.370.629.538.032.9
UAE71.371.271.330.039.032.7
Turkey59.764.161.921.734.027.8
Lebanon66.157.961.825.829.027.4
Iraq59.565.162.320.633.427.0
Oman56.954.255.818.923.820.9
Iran46.056.851.412.426.519.4
Malaysia42.146.344.210.417.614.0
Thailand26.537.432.25.012.28.8
South Korea34.329.231.87.28.37.7
Singapore33.926.430.27.07.17.1
Philippines24.628.426.54.68.06.3
China25.525.425.44.76.75.7
Pakistan19.127.123.03.37.85.5
Japan30.119.224.45.84.45.0
India9.912.211.01.32.41.9
Vietnam9.510.910.21.22.11.7
Bangladesh7.47.87.60.91.31.1

NAFLD prevalence is much higher estimates in obese people[42]. Population-based survey from Iran reported that obesity and MS are the most predictive factors of NAFLD[43]. In addition, in the other Population-based study conducted China, the relationship between NAFLD and obesity have been reported so that, among 661 patients with fatty liver, 611 (92%) patients were obese[44]. The high prevalence of obesity in the West of Asia also increases the risk of NAFLD[11].

Diabetes mellitus

Diabetes mellitus is present as one of the biggest public health problems of the recent century[45]. The International diabetes federation (IDF)[46] estimated the global burden diabetes was 382 million (comparative prevalence: 8.3%) in 2013 and it would be likely more than double to 592 million (comparative prevalence: 8.8%) by 2035. Approximately 175 million people worldwide living with diabetes are unaware of their disease[46]. According to the 6th edition of the Diabetes Atlas in 2013[46], Saudi Arabia (24%), Kuwait (23.1%) and Qatar (2.9%) are among the world’s top ten countries with the highest prevalence of diabetes in 20-79 years population are in the Middle-East countries. And also from the ten countries with the highest number of diabetic people (20-79 years), five countries are located in Asia that which includes; China, India, Indonesia, Egypt and Japan. T2DM consist 85% to 95% in high-income countries and even higher percentage in low and middle income countries[47]. It is one of the major health problems in the world, and also is known as an important risk factor for NAFLD[48,49]. T2DM prevalence is increasing in the world[50] and also in Asian countries the prevalence rate of it has increased during the past three decades[51]. Increasing the T2DM in Asian countries for the following reasons is different from the countries because of the short time spread, and that can be seen in a younger age group and people with much lower BMI[37]. Many ethnic studies on Asian population pointed out, that they have more abdominal obesity and visceral fat (3%-5%) than other ethnic groups[52-54]. Improper accumulation of fat in abdominal and visceral adiposity can cause to increase hepatic insulin resistance and T2DM, which can cause an abnormal accumulation of fat in the liver[55,56]. This rapidly-growing prevalence of T2DM among the Asian countries is related to the rapid economic developments, aging, urbanization, changes in nutrition, and increases in sedentary lifestyles, and also increases with increasing prevalence of obesity and MS[57,58].

Middle East region, particularly Arab speaking countries have some of the highest rate of diabetes in the world[59]. The prevalence of T2DM has increased dramatically in this region over the last three decades because of industrial development. Most of countries in the Middle East such as Kuwait, Saudi Arabia, Qatar, Bahrain and the United Arab Emirates are the world’s leaders in term of T2DM prevalence[60]. In both developed and developing countries diabetes is the main cause of NAFLD, and also the prevalence of NAFLD is higher in people with diabetes than in non-diabetic[61] (Table 2: Provides the 2013 IDF statistics for diabetes prevalence in Asian countries).

Table 2 Prevalence of diabetes in Asian countries, estimates for 2013.
CountryAdult population(20-79) in 1000sDiabetes cases(20-79) in 1000sDiabetes nationalprevalence (%)1Diabetes comparativeprevalence (%)Diabetes relateddeaths (20-79)
Saudi Arabia18056.843650.8920.2223.8722113
Kuwait2293.74407.5317.7723.091122
Qatar1796.42282.5315.7322.87651
Bahrain974.96168.6617.3021.84706
UAE7443.81745.9410.0218.981385
Egypt48276.397510.6015.5616.8086478
Lebanon3295.49478.9614.5314.996637
Oman2493.25199.788.0114.241214
Malaysia18919.441913.2410.1110.8524049
Singapore4058.27498.1912.2810.424134
Iran52145.454395.938.439.9438002
Iraq16473.211226.227.449.5017643
India760429.7365076.368.569.091065053
China1023050.4298407.389.629.021271003
Yemen11568.55708.126.128.459892
Taiwan17605.381721.069.788.30-
Afghanistan12619.61794.706.308.2718864
Pakistan99369.826712.706.767.9087354
South Korea37365.673323.908.907.4830836
Philippines54210.533256.216.016.8654535
Bangladesh92271.615089.045.526.31102139
Vietnam61387.553299.115.375.8154953
Thailand49049.753150.676.425.6766943
Japan95304.387203.787.565.1264680
MS

MS is known as a collection of interrelated abnormalities that increase the risk of T2DM and NAFLD[62]. According to the available data, experimental and epidemiological studies describe the NAFLD as the hepatic manifestation of MS[63,64]. Today prevalence of MS is increasing and the main risk factors associated with MS are abdominal obesity, hypertension, dyslipdemia, insulin resistance and glycemia intolerance[24]. Different criteria have been introduced in recent years to detect MS. The first criteria definition of MS was published in 1998 by WHO, according to this definition impaired glucose tolerance, and impaired fasting glucose, T2DM or insulin resistance are known as essential components of the MS, along with at least two of the following parameters: hypertension (> 140/90 mmHg), obesity (BMI = 30 kg/m2), hypertriglyceridemia (≥ 150 mg/dL) or high density lipoprotein cholesterol (HDL-C) values (< 35 in males and < 40 in females) and microalbuminuria (≥ 20 μg/min)[65-67]. On the other hand, in 2001, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) published a new set of criteria of MS that included waist circumference as define obesity (≥ 102 cm in males and ≥ 88 cm in females), arterial hypertension (≥ 130/85 mmHg), fasting glucose(≥ 110 mg/dL) and blood lipids as HDL-C values (< 40 mg/dL in males and < 50 mg/dL in females) and hypertriglyceridemia (≥ 150 mg/dL)[68]. The NCEP-ATP III definitions differed from WHO and European Group for the study of Insulin Resistance definitions in that insulin resistance is not necessary for diagnostic. In 2005, the IDF published other criteria to define the MS which proposed abdominal obesity as the essential components of the diagnosis of MS, abdominal obesity (Europe men: ≥ 94 cm, Europe women ≥ 80 cm and for Asian men: ≥ 90 cm, Asian women ≥ 80 cm), arterial hypertension (≥ 130/85 mmHg), fasting glycaemia (≥ 100 mg/dL), HDL-C values (< 40 mg/dL in males and < 50 mg/dL in females) and hypertriglyceridemia (≥ 150 mg/dL)[69-72]. The American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) published a new set of criteria of MS that abdominal obesity is not required as a risk factor. The definition provided by the AHA/NHLBI of abdominal obesity with IDF guidelines was quite different[70,73]. So, in recent years AHA/NHLBI and IDF offered a new definition of criteria that two side agreed that abdominal obesity is 1 of 5 criteria for identifying but is not essential for diagnosis[74] (Table 3: Provides the criteria for clinical diagnosis of the MS).

Table 3 American Heart Association/National Heart, Lung and Blood Institute metabolic syndrome diagnostic criteria.
MeasureCategorical cut points
Elevated waist circumference1Population and country specific definition
Elevated triglycerides≥ 150 mg/dL (1.7 mmol/L) or drug treatment for high triglycerides (i.e., fibrates or nicotinic acid)
Low HDL-C2< 40 mg/dL (1.0 mmol/L) in males
< 50 mg/dL (1.3 mmol/L) in females
Or drug treatment for low HDL-C (i.e., fibrates or nicotinic acid)
Elevated blood pressureSystolic ≥ 130 mmHg
Diastolic ≥ 85 mmHg
Or drug treatment for hypertension
Elevated fasting glucose≥ 100 mg/dL
Or drug treatment for elevated glucose

Prevalence of MS varies and depends on the criteria used in different definitions[75,76]. And it is increasing in different region like Asia[77] and developing countries[78], it has been reported 12.8% to 41.1% in different part of the world[79]. Prevalence of MS depends on criteria used is different for example the IDF guidelines with a lower abdominal obesity cut-off (90 cm for men, 80 cm for women) identify a greater prevalence of MS than the NCEP-ATP III[80-83]. In 2007, the prevalence of MS in the Iran was reported by IDF and ATPIII criteria 32.1% and 33.2% respectively[84]. According to 2005 version of IDF criteria, China[67], Taiwan[85,86], Hong Kong[87], and Thailand[88] had prevalence rates ranging between 10%-15% (in 2008). On the other hand, rates for Koreans[89], approximately one quarter, were higher than the Chinese and Thais. India[90] had significantly high prevalence rates compared to the rest of Asia. Unfortunately, no many studies have been done in the field of MS in Arab countries[81]. Because of increasing prevalence of obesity and diabetes in Middle-East countries particularly in Arab countries, increased risk of MS is high[91,92].

The major reason for the higher rate using in the new definition is because of focus on abdominal obesity, which is the most common component in Arab countries[81]. The increased prevalence of MS was shown in both genders, whereas the increased prevalence is higher in women in Arab populations[91,93]. And also the other components of the MS, diabetes is more common among the Arab population than other regions of the world and is estimated to have increased rapidly in the region[81,91]. Approximately 50% of patients with T2DM also suffer from MS, whereas the risk of NAFLD in these patients is higher more than the other persons[94].

DISCUSSION

Due to the increasing rate of NAFLD, prevention of this is one of the most important issues of the world. Prevention methods of NAFLD that is limited to the prevention of risk factors, because the pathogenesis of this disease is unknown. So prevention of the risk factors of NAFLD such as obesity, insulin resistance, T2DM and MS is the key strategy to reduce the incidence rate of NAFLD in the world[95]. Today, due to drastic changes in lifestyle and desire to in sedentary lifestyle, because of rapid economic and social changes in many countries, including Asian countries, prevalence of obesity, T2DM and MS are on the rise, which are important risk factors for NAFLD.

Hence, the key management of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, T2DM and MS. Many studies indicate that lifestyle modification, including a reduction in intake of saturated fat and refined carbohydrates and sweetened beverages, may reduce aminotransferases and improve hepatic steatosis[96-99]. Earlier studies suggested that reduction of body weight by 10% can normalize liver test, but recent studies have shown that loss of at least 3%-5% of body weight can achieve improvement in hepatic steatosis[100,101]. Control and reduce the incidence of insulin resistance and MS is another important aspect of prevention and management of NAFLD[7,14]. Early detection, appropriate treatment, and also care programs with essential training can be an effective step in control and reduce the incidence of MS, insulin resistance and also cardiovascular disease and diabetes. Not only Lifestyle changes, weight loss and regular physical activity are essential first steps for the prevention and treated patients with NAFLD, but also the prevention of metabolic risk factors, such as diabetes, dyslipidemia, hypertension is also very important[4]. However, in addition to lifestyle changes for the treatment of patients with NAFLD, are there specific pharmacologic therapies such as insulin sensitizers (metformin and thiazolidinediones)[102-105], weight loss drugs (orlistat and sibutramine)[106], antioxidants (vitamin E)[107], and have also considered bariatric surgery for morbidly obese patients[4,108].

ACKNOWLEDGMENTS

This project was completely supported and funded by Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences.

COMMENTS
Background

Non-alcoholic fatty liver disease (NAFLD) is a major health concern worldwide which is characterized by abnormal fat accumulation in liver cells. Today, NAFLD is identified as a main cause of chronic liver disease in Asia. Due to the increasing rate of NAFLD, prevention of this is one of the most important issues of the world. Prevention methods of NAFLD that is limited to the prevention of risk factors, because the pathogenesis of this disease is unknown.

Research frontiers

The objective of this study was to review systematically all of aspects of NAFLD in Asia, provides updated epidemiological data on NAFLD and its etiology and also this study has examined the current and future possibilities of prevention of this disease in Asian countries.

Innovations and breakthroughs

Based on systematic reviews, NAFLD is tightly linked with obesity, type 2 diabetes mellitus (T2DM) and the presence of metabolic syndrome (MS). Because of increasing prevalence of obesity, T2DM and MS in Asian countries particularly in Arab countries, increased risk of NAFLD is high in this region. So, by increasing the prevalence and incidence of NAFLD in this region prevention of this disease is very important.

Applications

Prevention of NAFLD should be considered in the Asian countries, because it is increasingly recognized as a major chronic liver disease in these regions.

Terminology

NAFLD is characterized by abnormal fat accumulation in liver cells. The development process of NAFLD can be started from simple steatosis (NAFLD) to non-alcoholic steatohepatitis and finally leads to cirrhosis and hepatocellular carcinoma, in absence excessive alcohol intake.

Peer-review

This is a well-written and comprehensive review of the epidemiology of nonalcoholic fatty liver disease in Asia.

Footnotes

P- Reviewer: Rajeshwari K, Tziomalos K S- Editor: Tian YL L- Editor: A E- Editor: Liu SQ

References
1.  Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28:155-161.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 607]  [Cited by in F6Publishing: 636]  [Article Influence: 48.9]  [Reference Citation Analysis (0)]
2.  Conlon BA, Beasley JM, Aebersold K, Jhangiani SS, Wylie-Rosett J. Nutritional management of insulin resistance in nonalcoholic fatty liver disease (NAFLD). Nutrients. 2013;5:4093-4114.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 48]  [Article Influence: 4.8]  [Reference Citation Analysis (1)]
3.  Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99-S112.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1756]  [Cited by in F6Publishing: 1868]  [Article Influence: 109.9]  [Reference Citation Analysis (0)]
4.  Fruci B, Giuliano S, Mazza A, Malaguarnera R, Belfiore A. Nonalcoholic Fatty liver: a possible new target for type 2 diabetes prevention and treatment. Int J Mol Sci. 2013;14:22933-22966.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 69]  [Cited by in F6Publishing: 75]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
5.  Suzuki A, Angulo P, Lymp J, St Sauver J, Muto A, Okada T, Lindor K. Chronological development of elevated aminotransferases in a nonalcoholic population. Hepatology. 2005;41:64-71.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 143]  [Cited by in F6Publishing: 149]  [Article Influence: 8.3]  [Reference Citation Analysis (0)]
6.  Hassan K, Bhalla V, El Regal ME, A-Kader HH. Nonalcoholic fatty liver disease: a comprehensive review of a growing epidemic. World J Gastroenterol. 2014;20:12082-12101.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 129]  [Cited by in F6Publishing: 126]  [Article Influence: 14.0]  [Reference Citation Analysis (2)]
7.  Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005-2023.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2413]  [Cited by in F6Publishing: 2512]  [Article Influence: 228.4]  [Reference Citation Analysis (0)]
8.  Lee JY, Kim KM, Lee SG, Yu E, Lim YS, Lee HC, Chung YH, Lee YS, Suh DJ. Prevalence and risk factors of non-alcoholic fatty liver disease in potential living liver donors in Korea: a review of 589 consecutive liver biopsies in a single center. J Hepatol. 2007;47:239-244.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 190]  [Cited by in F6Publishing: 203]  [Article Influence: 12.7]  [Reference Citation Analysis (0)]
9.  Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, Landt CL, Harrison SA. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124-131.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1522]  [Cited by in F6Publishing: 1596]  [Article Influence: 133.0]  [Reference Citation Analysis (0)]
10.  Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274-285.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2065]  [Cited by in F6Publishing: 1958]  [Article Influence: 163.2]  [Reference Citation Analysis (0)]
11.  Fan JG, Saibara T, Chitturi S, Kim BI, Sung JJ, Chutaputti A. What are the risk factors and settings for non-alcoholic fatty liver disease in Asia-Pacific? J Gastroenterol Hepatol. 2007;22:794-800.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 182]  [Cited by in F6Publishing: 181]  [Article Influence: 11.3]  [Reference Citation Analysis (0)]
12.  Kneeman JM, Misdraji J, Corey KE. Secondary causes of nonalcoholic fatty liver disease. Therap Adv Gastroenterol. 2012;5:199-207.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 151]  [Cited by in F6Publishing: 161]  [Article Influence: 14.6]  [Reference Citation Analysis (0)]
13.  Wong VW. Nonalcoholic fatty liver disease in Asia: a story of growth. J Gastroenterol Hepatol. 2013;28:18-23.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 50]  [Cited by in F6Publishing: 53]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
14.  Chitturi S, Farrell GC, Hashimoto E, Saibara T, Lau GK, Sollano JD. Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. J Gastroenterol Hepatol. 2007;22:778-787.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 221]  [Cited by in F6Publishing: 204]  [Article Influence: 12.8]  [Reference Citation Analysis (0)]
15.  Park SH, Jeon WK, Kim SH, Kim HJ, Park DI, Cho YK, Sung IK, Sohn CI, Keum DK, Kim BI. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. J Gastroenterol Hepatol. 2006;21:138-143.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 299]  [Cited by in F6Publishing: 293]  [Article Influence: 17.2]  [Reference Citation Analysis (0)]
16.  Shen L, Fan JG, Shao Y, Zeng MD, Wang JR, Luo GH, Li JQ, Chen SY. Prevalence of nonalcoholic fatty liver among administrative officers in Shanghai: an epidemiological survey. World J Gastroenterol. 2003;9:1106-1110.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Chen QK, Chen HY, Huang KH, Zhong YQ, Han JA, Zhu ZH, Zhou XD. Clinical features and risk factors of patients with fatty liver in Guangzhou area. World J Gastroenterol. 2004;10:899-902.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Chen CH, Huang MH, Yang JC, Nien CK, Yang CC, Yeh YH, Yueh SK. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol. 2006;40:745-752.  [PubMed]  [DOI]  [Cited in This Article: ]
19.  Wong VW, Wong GL, Choi PC, Chan AW, Li MK, Chan HY, Chim AM, Yu J, Sung JJ, Chan HL. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010;59:969-974.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 459]  [Cited by in F6Publishing: 471]  [Article Influence: 36.2]  [Reference Citation Analysis (0)]
20.  Sylvester JE, Greenberg P, Selch MT, Thomas BJ, Amstutz H. The use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement. Int J Radiat Oncol Biol Phys. 1988;14:471-476.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 281]  [Cited by in F6Publishing: 285]  [Article Influence: 25.9]  [Reference Citation Analysis (0)]
21.  Huang HL, Lin WY, Lee LT, Wang HH, Lee WJ, Huang KC. Metabolic syndrome is related to nonalcoholic steatohepatitis in severely obese subjects. Obes Surg. 2007;17:1457-1463.  [PubMed]  [DOI]  [Cited in This Article: ]
22.  Kang H, Greenson JK, Omo JT, Chao C, Peterman D, Anderson L, Foess-Wood L, Sherbondy MA, Conjeevaram HS. Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD. Am J Gastroenterol. 2006;101:2247-2253.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 139]  [Cited by in F6Publishing: 141]  [Article Influence: 8.3]  [Reference Citation Analysis (0)]
23.  Williams R. Global challenges in liver disease. Hepatology. 2006;44:521-526.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 526]  [Cited by in F6Publishing: 572]  [Article Influence: 33.6]  [Reference Citation Analysis (0)]
24.  Souza MR, Diniz Mde F, Medeiros-Filho JE, Araújo MS. Metabolic syndrome and risk factors for non-alcoholic fatty liver disease. Arq Gastroenterol. 2012;49:89-96.  [PubMed]  [DOI]  [Cited in This Article: ]
25.  Targher G, Byrne CD. Clinical Review: Nonalcoholic fatty liver disease: a novel cardiometabolic risk factor for type 2 diabetes and its complications. J Clin Endocrinol Metab. 2013;98:483-495.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 213]  [Cited by in F6Publishing: 218]  [Article Influence: 21.8]  [Reference Citation Analysis (0)]
26.  Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, Day C, Arcaro G. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007;30:1212-1218.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 702]  [Cited by in F6Publishing: 719]  [Article Influence: 44.9]  [Reference Citation Analysis (1)]
27.  Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int. 2009;29:113-119.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 350]  [Cited by in F6Publishing: 376]  [Article Influence: 26.9]  [Reference Citation Analysis (0)]
28.  Bellentani S, Saccoccio G, Masutti F, Crocè LS, Brandi G, Sasso F, Cristanini G, Tiribelli C. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000;132:112-117.  [PubMed]  [DOI]  [Cited in This Article: ]
29.  Luyckx FH, Desaive C, Thiry A, Dewé W, Scheen AJ, Gielen JE, Lefèbvre PJ. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22:222-226.  [PubMed]  [DOI]  [Cited in This Article: ]
30.  Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121:91-100.  [PubMed]  [DOI]  [Cited in This Article: ]
31.  García-Monzón C, Martín-Pérez E, Iacono OL, Fernández-Bermejo M, Majano PL, Apolinario A, Larrañaga E, Moreno-Otero R. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol. 2000;33:716-724.  [PubMed]  [DOI]  [Cited in This Article: ]
32.  Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010;363:1341-1350.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1326]  [Cited by in F6Publishing: 1356]  [Article Influence: 104.3]  [Reference Citation Analysis (0)]
33.  Hajian-Tilaki KO, Heidari B. Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years, in the north of Iran: a population-based study and regression approach. Obes Rev. 2007;8:3-10.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 141]  [Cited by in F6Publishing: 159]  [Article Influence: 9.9]  [Reference Citation Analysis (0)]
34.  Haddad J, Juif JG, Speeg-Schatz C, Messer J. [Unilateral cerebellar atrophy in 2 newborn infants. Value of MRI]. Arch Fr Pediatr. 1992;49:47-49.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 302]  [Cited by in F6Publishing: 314]  [Article Influence: 18.5]  [Reference Citation Analysis (0)]
35.  Sidik SM, Rampal L. The prevalence and factors associated with obesity among adult women in Selangor, Malaysia. Asia Pac Fam Med. 2009;8:2.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 34]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
36.  Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35:93-99.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 663]  [Cited by in F6Publishing: 714]  [Article Influence: 39.7]  [Reference Citation Analysis (0)]
37.  Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006;368:1681-1688.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1114]  [Cited by in F6Publishing: 1160]  [Article Influence: 68.2]  [Reference Citation Analysis (0)]
38.  Deurenberg-Yap M, Chew SK, Lin VF, Tan BY, van Staveren WA, Deurenberg P. Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore. Int J Obes Relat Metab Disord. 2001;25:1554-1562.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 124]  [Cited by in F6Publishing: 129]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
39.  Kim DM, Ahn CW, Nam SY. Prevalence of obesity in Korea. Obes Rev. 2005;6:117-121.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 151]  [Cited by in F6Publishing: 154]  [Article Influence: 8.6]  [Reference Citation Analysis (0)]
40.  Aekplakorn W, Chaiyapong Y, Neal B, Chariyalertsak S, Kunanusont C, Phoolcharoen W, Suriyawongpaisal P. Prevalence and determinants of overweight and obesity in Thai adults: results of the Second National Health Examination Survey. J Med Assoc Thai. 2004;87:685-693.  [PubMed]  [DOI]  [Cited in This Article: ]
41.  World Health Organization Noncommunicable diseases report, chapter 1: mortality, morbidity and risk factors. 2011.  Available from: http://www.who.int/nmh/publications/ncd_report_full_en.pdf.  [PubMed]  [DOI]  [Cited in This Article: ]
42.  Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: Disparate associations among Asian populations. World J Hepatol. 2014;6:263-273.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 81]  [Article Influence: 9.0]  [Reference Citation Analysis (1)]
43.  Sohrabpour A, Rezvan H, Amini-Kafiabad S, Dayhim M, Merat S, Pourshams A. Prevalence of Nonalcoholic Steatohepatitis in Iran: A Population based Study. Middle East J Dig Dis. 2010;2:14-19.  [PubMed]  [DOI]  [Cited in This Article: ]
44.  Fan JG, Zhu J, Li XJ, Chen L, Li L, Dai F, Li F, Chen SY. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005;43:508-514.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 283]  [Cited by in F6Publishing: 300]  [Article Influence: 16.7]  [Reference Citation Analysis (0)]
45.  Gadsby R. Epidemiology of diabetes. Adv Drug Deliv Rev. 2002;54:1165-1172.  [PubMed]  [DOI]  [Cited in This Article: ]
46.  Bruce DG, Davis WA, Davis TM. Glycemic control in older subjects with type 2 diabetes mellitus in the Fremantle Diabetes Study. J Am Geriatr Soc. 2000;48:1449-1453.  [PubMed]  [DOI]  [Cited in This Article: ]
47.  International Diabetes Federation IDF Diabetes Atlas. 4th ed. Brussels Belgium: International Diabetes Federation 2009; .  [PubMed]  [DOI]  [Cited in This Article: ]
48.  Passa P. Diabetes trends in Europe. Diabetes Metab Res Rev. 2002;18 Suppl 3:S3-S8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 85]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
49.  Hussain A, Vaaler S, Sayeed MA, Mahtab H, Ali SM, Khan AK. Type 2 diabetes and impaired fasting blood glucose in rural Bangladesh: a population-based study. Eur J Public Health. 2007;17:291-296.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 38]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
50.  Lusignan S, Sismanidis C, Carey IM, DeWilde S, Richards N, Cook DG. Trends in the prevalence and management of diagnosed type 2 diabetes 1994-2001 in England and Wales. BMC Fam Pract. 2005;6:13.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 55]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
51.  Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care. 2006;29:226-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 134]  [Cited by in F6Publishing: 137]  [Article Influence: 8.1]  [Reference Citation Analysis (0)]
52.  Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281:64-91.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 483]  [Cited by in F6Publishing: 505]  [Article Influence: 50.5]  [Reference Citation Analysis (0)]
53.  Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86:353-359.  [PubMed]  [DOI]  [Cited in This Article: ]
54.  Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3:141-146.  [PubMed]  [DOI]  [Cited in This Article: ]
55.  Wong VW. Gestational diabetes mellitus in five ethnic groups: a comparison of their clinical characteristics. Diabet Med. 2012;29:366-371.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 41]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
56.  Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008;51:1781-1789.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 209]  [Cited by in F6Publishing: 149]  [Article Influence: 9.9]  [Reference Citation Analysis (0)]
57.  Al-Moosa S, Allin S, Jemiai N, Al-Lawati J, Mossialos E. Diabetes and urbanization in the Omani population: an analysis of national survey data. Popul Health Metr. 2006;4:5.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 69]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
58.  Shetty P, Schmidhuber J. Introductory lecture the epidemiology and determinants of obesity in developed and developing countries. Int J Vitam Nutr Res. 2006;76:157-162.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 21]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
59.  Alhyas L, McKay A, Balasanthiran A, Majeed A. Prevalences of overweight, obesity, hyperglycaemia, hypertension and dyslipidaemia in the Gulf: systematic review. JRSM Short Rep. 2011;2:55.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 69]  [Cited by in F6Publishing: 87]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
60.  Badran M, Laher I. Type II Diabetes Mellitus in Arabic-Speaking Countries. Int J Endocrinol. 2012;2012:902873.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 111]  [Article Influence: 10.1]  [Reference Citation Analysis (0)]
61.  Vikram NK, Tandon N, Misra A, Srivastava MC, Pandey RM, Mithal A, Sharma S, Ajmani A, Madhu SV, Batra CM. Correlates of Type 2 diabetes mellitus in children, adolescents and young adults in north India: a multisite collaborative case-control study. Diabet Med. 2006;23:293-298.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 40]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
62.  Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 755]  [Cited by in F6Publishing: 752]  [Article Influence: 62.7]  [Reference Citation Analysis (0)]
63.  Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, McCullough AJ, Natale S, Forlani G, Melchionda N. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844-1850.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1725]  [Cited by in F6Publishing: 1797]  [Article Influence: 81.7]  [Reference Citation Analysis (0)]
64.  Marchesini G, Marzocchi R, Agostini F, Bugianesi E. Nonalcoholic fatty liver disease and the metabolic syndrome. Curr Opin Lipidol. 2005;16:421-427.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 244]  [Cited by in F6Publishing: 256]  [Article Influence: 14.2]  [Reference Citation Analysis (0)]
65.  Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539-553.  [PubMed]  [DOI]  [Cited in This Article: ]
66.  Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999;16:442-443.  [PubMed]  [DOI]  [Cited in This Article: ]
67.  Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK, He J. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365:1398-1405.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 666]  [Cited by in F6Publishing: 616]  [Article Influence: 34.2]  [Reference Citation Analysis (0)]
68.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20476]  [Cited by in F6Publishing: 21432]  [Article Influence: 974.2]  [Reference Citation Analysis (0)]
69.  Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7515]  [Cited by in F6Publishing: 7955]  [Article Influence: 441.9]  [Reference Citation Analysis (0)]
70.  Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23:469-480.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3852]  [Cited by in F6Publishing: 3977]  [Article Influence: 233.9]  [Reference Citation Analysis (0)]
71.  Khunti K, Taub N, Webb D, Srinivasan B, Stockman J, Griffin SJ, Simmons RK, Davies MJ. Validity of self-assessed waist circumference in a multi-ethnic UK population. Diabet Med. 2012;29:404-409.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 15]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
72.  Hernández Mijares A, Riera Fortuny C, Martínez Triguero ML, Morillas Ariño C, Cubells Cascales P, Morales Suárez-Varela M. [Metabolic syndrome in patients with coronary heart disease. Results of using different diagnostic criteria]. Rev Esp Cardiol. 2004;57:889-893.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
73.  Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998;6 Suppl 2:51S-209S.  [PubMed]  [DOI]  [Cited in This Article: ]
74.  Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-1645.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8720]  [Cited by in F6Publishing: 9309]  [Article Influence: 664.9]  [Reference Citation Analysis (0)]
75.  Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, Van Pelt RE, Wang H, Eckel RH. The metabolic syndrome. Endocr Rev. 2008;29:777-822.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1164]  [Cited by in F6Publishing: 1194]  [Article Influence: 79.6]  [Reference Citation Analysis (0)]
76.  Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, Pineo A, Busardo’ A, Paolisso G. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Mol Aspects Med. 2003;24:39-52.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 273]  [Cited by in F6Publishing: 287]  [Article Influence: 14.4]  [Reference Citation Analysis (0)]
77.  Pan WH, Yeh WT, Weng LC. Epidemiology of metabolic syndrome in Asia. Asia Pac J Clin Nutr. 2008;17 Suppl 1:37-42.  [PubMed]  [DOI]  [Cited in This Article: ]
78.  Lameira D, Lejeune S, Mourad JJ. [Metabolic syndrome: epidemiology and its risks]. Ann Dermatol Venereol. 2008;135 Suppl 4:S249-S253.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 13]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
79.  Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults--a population study using modified ATP III criteria. Diabetes Res Clin Pract. 2003;60:199-204.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 195]  [Cited by in F6Publishing: 223]  [Article Influence: 11.2]  [Reference Citation Analysis (0)]
80.  Athyros VG, Ganotakis ES, Tziomalos K, Papageorgiou AA, Anagnostis P, Griva T, Kargiotis K, Mitsiou EK, Karagiannis A, Mikhailidis DP. Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population. Curr Med Res Opin. 2010;26:713-719.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 75]  [Cited by in F6Publishing: 77]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
81.  Harzallah F, Alberti H, Ben Khalifa F. The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria. Diabet Med. 2006;23:441-444.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 54]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
82.  Sharifi F, Mousavinasab SN, Saeini M, Dinmohammadi M. Prevalence of metabolic syndrome in an adult urban population of the west of Iran. Exp Diabetes Res. 2009;2009:136501.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 36]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
83.  Ma WY, Li HY, Hung CS, Lin MS, Chiu FC, Lin CH, Shih SR, Chuang LM, Wei JN. Metabolic syndrome defined by IDF and AHA/NHLBI correlates better to carotid intima-media thickness than that defined by NCEP ATP III and WHO. Diabetes Res Clin Pract. 2009;85:335-341.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 17]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
84.  Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract. 2007;77:251-257.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 100]  [Cited by in F6Publishing: 105]  [Article Influence: 6.6]  [Reference Citation Analysis (0)]
85.  Chen HJ, Pan WH. Probable blind spot in the International Diabetes Federation definition of metabolic syndrome. Obesity (Silver Spring). 2007;15:1096-1100.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 18]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
86.  Chuang SY, Chen CH, Chou P. Prevalence of metabolic syndrome in a large health check-up population in Taiwan. J Chin Med Assoc. 2004;67:611-620.  [PubMed]  [DOI]  [Cited in This Article: ]
87.  Ko GT, Cockram CS, Chow CC, Yeung V, Chan WB, So WY, Chan NN, Chan JC. High prevalence of metabolic syndrome in Hong Kong Chinese--comparison of three diagnostic criteria. Diabetes Res Clin Pract. 2005;69:160-168.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 72]  [Cited by in F6Publishing: 73]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
88.  Lohsoonthorn V, Dhanamun B, Williams MA. Prevalence of metabolic syndrome and its relationship to white blood cell count in a population of Thai men and women receiving routine health examinations. Am J Hypertens. 2006;19:339-345.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 35]  [Cited by in F6Publishing: 41]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
89.  Kim HM, Kim DJ, Jung IH, Park C, Park J. Prevalence of the metabolic syndrome among Korean adults using the new International Diabetes Federation definition and the new abdominal obesity criteria for the Korean people. Diabetes Res Clin Pract. 2007;77:99-106.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 41]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
90.  Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population. Int J Cardiol. 2004;97:257-261.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 146]  [Cited by in F6Publishing: 128]  [Article Influence: 7.1]  [Reference Citation Analysis (0)]
91.  Al-Lawati JA, Mohammed AJ, Al-Hinai HQ, Jousilahti P. Prevalence of the metabolic syndrome among Omani adults. Diabetes Care. 2003;26:1781-1785.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 142]  [Cited by in F6Publishing: 162]  [Article Influence: 8.1]  [Reference Citation Analysis (0)]
92.  Abdul-Rahim HF, Husseini A, Bjertness E, Giacaman R, Gordon NH, Jervell J. The metabolic syndrome in the West Bank population: an urban-rural comparison. Diabetes Care. 2001;24:275-279.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 98]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
93.  Jaber LA, Brown MB, Hammad A, Zhu Q, Herman WH. The prevalence of the metabolic syndrome among arab americans. Diabetes Care. 2004;27:234-238.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 97]  [Article Influence: 5.1]  [Reference Citation Analysis (0)]
94.  Ghamar Chehreh ME, Vahedi M, Pourhoseingholi MA, Ashtari S, Khedmat H, Amin M, Zali MR, Alavian SM. Estimation of diagnosis and treatment costs of non-alcoholic Fatty liver disease: a two-year observation. Hepat Mon. 2013;13:e7382.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 16]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
95.  Zelber-Sagi S, Lotan R, Shlomai A, Webb M, Harrari G, Buch A, Nitzan Kaluski D, Halpern Z, Oren R. Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up. J Hepatol. 2012;56:1145-1151.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 182]  [Cited by in F6Publishing: 188]  [Article Influence: 17.1]  [Reference Citation Analysis (0)]
96.  Sreenivasa Baba C, Alexander G, Kalyani B, Pandey R, Rastogi S, Pandey A, Choudhuri G. Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J Gastroenterol Hepatol. 2006;21:191-198.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 144]  [Cited by in F6Publishing: 139]  [Article Influence: 8.2]  [Reference Citation Analysis (0)]
97.  Larson-Meyer DE, Heilbronn LK, Redman LM, Newcomer BR, Frisard MI, Anton S, Smith SR, Alfonso A, Ravussin E. Effect of calorie restriction with or without exercise on insulin sensitivity, beta-cell function, fat cell size, and ectopic lipid in overweight subjects. Diabetes Care. 2006;29:1337-1344.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 374]  [Cited by in F6Publishing: 382]  [Article Influence: 22.5]  [Reference Citation Analysis (0)]
98.  Kantartzis K, Thamer C, Peter A, Machann J, Schick F, Schraml C, Königsrainer A, Königsrainer I, Kröber S, Niess A. High cardiorespiratory fitness is an independent predictor of the reduction in liver fat during a lifestyle intervention in non-alcoholic fatty liver disease. Gut. 2009;58:1281-1288.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 196]  [Cited by in F6Publishing: 205]  [Article Influence: 14.6]  [Reference Citation Analysis (0)]
99.  Kirk E, Reeds DN, Finck BN, Mayurranjan SM, Patterson BW, Klein S. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology. 2009;136:1552-1560.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 306]  [Cited by in F6Publishing: 316]  [Article Influence: 22.6]  [Reference Citation Analysis (0)]
100.  Petersen KF, Dufour S, Befroy D, Lehrke M, Hendler RE, Shulman GI. Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes. 2005;54:603-608.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 655]  [Cited by in F6Publishing: 677]  [Article Influence: 37.6]  [Reference Citation Analysis (0)]
101.  Clark JM. Weight loss as a treatment for nonalcoholic fatty liver disease. J Clin Gastroenterol. 2006;40 Suppl 1:S39-S43.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 32]  [Reference Citation Analysis (0)]
102.  Uygun A, Kadayifci A, Isik AT, Ozgurtas T, Deveci S, Tuzun A, Yesilova Z, Gulsen M, Dagalp K. Metformin in the treatment of patients with non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2004;19:537-544.  [PubMed]  [DOI]  [Cited in This Article: ]
103.  Nair S, Diehl AM, Wiseman M, Farr GH, Perrillo RP. Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial. Aliment Pharmacol Ther. 2004;20:23-28.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 263]  [Cited by in F6Publishing: 239]  [Article Influence: 12.6]  [Reference Citation Analysis (0)]
104.  Ratziu V, Giral P, Jacqueminet S, Charlotte F, Hartemann-Heurtier A, Serfaty L, Podevin P, Lacorte JM, Bernhardt C, Bruckert E. Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial. Gastroenterology. 2008;135:100-110.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 458]  [Cited by in F6Publishing: 473]  [Article Influence: 31.5]  [Reference Citation Analysis (0)]
105.  Omer Z, Cetinkalp S, Akyildiz M, Yilmaz F, Batur Y, Yilmaz C, Akarca U. Efficacy of insulin-sensitizing agents in nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2010;22:18-23.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 85]  [Cited by in F6Publishing: 88]  [Article Influence: 6.8]  [Reference Citation Analysis (0)]
106.  Zelber-Sagi S, Kessler A, Brazowsky E, Webb M, Lurie Y, Santo M, Leshno M, Blendis L, Halpern Z, Oren R. A double-blind randomized placebo-controlled trial of orlistat for the treatment of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2006;4:639-644.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 237]  [Cited by in F6Publishing: 243]  [Article Influence: 14.3]  [Reference Citation Analysis (0)]
107.  Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, Neuschwander-Tetri BA, Lavine JE, Tonascia J, Unalp A. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362:1675-1685.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2215]  [Cited by in F6Publishing: 2227]  [Article Influence: 171.3]  [Reference Citation Analysis (1)]
108.  Mathurin P, Hollebecque A, Arnalsteen L, Buob D, Leteurtre E, Caiazzo R, Pigeyre M, Verkindt H, Dharancy S, Louvet A. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532-540.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 364]  [Cited by in F6Publishing: 373]  [Article Influence: 26.6]  [Reference Citation Analysis (0)]