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Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions

Nature Reviews Gastroenterology & Hepatology (2024)Cite this article

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Abstract

Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions.

Key points

  • Over 50% of global deaths related to chronic liver disease, cirrhosis, and liver cancer occur in the Asia-Pacific region.

  • The majority of people living with chronic hepatitis B (CHB) infection are undiagnosed or untreated, rendering CHB the key cause of liver-related deaths in the Asia-Pacific region.

  • Differences in genetic makeup, lifestyle and cultures contribute to unique phenotypes of metabolic dysfunction-associated steatotic liver disease in the Asia-Pacific region.

  • Many challenges in tackling chronic liver diseases in the Asia-Pacific region stem from resource limitations, leading to poor accessibility to investigations and treatments.

  • Regulation of alcohol use, enforcement of national strategies for viral hepatitis elimination, and the establishment of pharmacovigilance programmes and disease awareness campaigns might reduce the burden of chronic liver disease in Asia.

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Fig. 1: Age-standardized death rates per 100,000 population of cirrhosis and chronic liver disease in 2019 by country in the Asia-Pacific region.
Fig. 2: Contribution of the various aetiologies of liver disease to age-standardized death rates from primary liver cancer and cirrhosis in Southeast Asia and the Western Pacific, in comparison to global data for the year 2019.
Fig. 3: MASLD prevalence stratified by GDP per capita in the Asia-Pacific region.
Fig. 4: Age-standardized death rates per 100,000 population for liver cancer in 2019 by country in the Asia-Pacific region.

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Data availability

Structural databases referred to in Figures and Table 1 can be accessed and downloaded from https://gbd2019.healthdata.org/gbd-results/ (Global Burden of Disease 2019 study), https://data.worldbank.org/indicator/NY.GDP.PCAP.CD and https://population.un.org/wpp/ (gross domestic product per capita). Where data of disease burden for certain countries or regions were not available, the Global Burden of Disease 2019 study results depended on modelling and past trends.

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Acknowledgements

The authors are members of the Asian Pacific Association of Gastroenterology (APAGE) Emerging Leaders Committee, and thank APAGE for supporting the formation of this committee.

Author information

Authors and Affiliations

  1. The University of Hong Kong, Hong Kong, China

    Lung-Yi Mak

  2. The University of Sydney, Sydney, Australia

    Ken Liu

  3. Phramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, Thailand

    Sakkarin Chirapongsathorn

  4. Tan Tock Seng Hospital, Singapore, Singapore

    Kuo Chao Yew

  5. Musashino Red Cross Hospital, Tokyo, Japan

    Nobuharu Tamaki

  6. Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia

    Ruveena Bhavani Rajaram

  7. National Kidney and Transplant Institute, Quezon City, Philippines

    Mara Teresa Panlilio

  8. The Chinese University of Hong Kong, Hong Kong, China

    Rashid Lui & Jimmy Che-To Lai

  9. Yonsei University College of Medicine, Seoul, Korea

    Hye Won Lee

  10. Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India

    Anand V. Kulkarni

  11. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Madhumita Premkumar

  12. Medical Faculty Universitas Indonesia, Jakarta, Indonesia

    Cosmas Rinaldi Adithya Lesmana

  13. Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan

    Yao Chun Hsu

  14. School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan

    Yao Chun Hsu

  15. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Daniel Q. Huang

  16. Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore

    Daniel Q. Huang

Authors
  1. Lung-Yi Mak
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  2. Ken Liu
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  3. Sakkarin Chirapongsathorn
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  4. Kuo Chao Yew
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  5. Nobuharu Tamaki
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  6. Ruveena Bhavani Rajaram
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  7. Mara Teresa Panlilio
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  8. Rashid Lui
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  9. Hye Won Lee
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  10. Jimmy Che-To Lai
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  11. Anand V. Kulkarni
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  12. Madhumita Premkumar
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  13. Cosmas Rinaldi Adithya Lesmana
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  14. Yao Chun Hsu
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  15. Daniel Q. Huang
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Contributions

The authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Daniel Q. Huang.

Ethics declarations

Competing interests

L.-Y.M. served on the advisory board for Gilead Sciences and Roche Diagnostics. K.C.Y. was a speaker for Gilead and AbbVie, and received a grant supported by the Educate, Test, Treat! Programme, which was funded in part by Gilead Sciences Inc. R.L. has served as an advisory board member for Gilead Sciences, speaker for GenieBiome, and owns equity in Pfizer. J.C.-T.L. served as a speaker for Gilead Sciences, and served on an advisory board committee for Gilead Sciences and Boehringer Ingelheim. Y.C.H. has received research grants from Gilead Sciences, served on advisory committees for Gilead Sciences and Sysmex, and received lecture fees from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme and Novartis. D.Q.H. has served on the advisory board for Gilead Sciences and Roche Diagnostics. The other authors have no competing interests to declare.

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Nature Reviews Gastroenterology & Hepatology thanks Vincent Chen and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Mak, LY., Liu, K., Chirapongsathorn, S. et al. Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions. Nat Rev Gastroenterol Hepatol (2024). https://doi.org/10.1038/s41575-024-00967-4

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