LAUSR

I have read the research article entitled ‘Etiologies and outcomes of cirrhosis in a large contemporary cohort’ by Hagstr€ om et al. [1]. I want to congratulate the authors for this successful research article, and make some contributions. In the original article, non-alcoholic fatty liver disease (NAFLD) has been reported as an increasing cause of liver cirrhosis in the Stockholm region (population 2.3 million), accounting for 9.6% of all cirrhosis between 2004 and 2017 [1]. These results confirm previous observations from the Swedish southern region of Halland (population 336,000), in which NAFLD was responsible for 5.7% of all cirrhosis between 2011 and 2018 [2]. Another study from the southern region of Scania (population 1.39 million) reported nonalcoholic steatohepatitis (NASH) in 4% of all cirrhosis between 2001 and 2010 [3]. Given the novel findings recently reported and in order to allow a more precise comparison between the studies, we have re-defined NAFLD in our cohort by using the same definition described by Hagstr€ om and colleagues [1]. Ad hoc analyses show that upon this re-definition, NAFLD was responsible for 10.2% of all cirrhosis in the region of Halland (Figure 1). Unfortunately, further comparison with the study from Scania is not possible since no data regarding body mass index are available [3]. Although there are noticeable regional differences regarding the epidemiology of cirrhosis in Sweden [1–3], available data supports prior prognosis of NAFLD becoming a major cause of cirrhosis in coming years. According to the Public Health Agency of Sweden, around 50% of adults in Sweden are overweight or obese. Additionally, the prevalence of obesity has increased between 2004 and 2016, and 15% of the adult population is obese. This alarming increment of overweight and obesity in Sweden during the last decades has become a major health concern, now also reflected by the increased occurrence of NAFLD associated end-stage liver disease.