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We thank your correspondents for their interest in our work and for their interesting comments. In analyzing a large cohort from outpatient medical practices/primary care in Germany and observed that over a follow-up period of 10 years, patients with non-alcoholic fatty liver disease (NAFLD) have a higher risk of developing cancer (1) than people of comparable sex, age, and Charlson comorbidity index (CCI). We share our correspondents’ concerns about the rising prevalence of overweight and obesity—especially in children and adolescents—as one of the underlying risk factors. In addition to further rises in fatty liver disease—which currently is certainly an underrecognized condition—type 2 diabetes and a further increase in tumor disease are to be anticipated. We believe that in addition to the academic discussion and the urgently needed scientific studies on NAFLD (3), enormous social and political efforts are required and preventive measures need to be strengthened. To this end, initiatives outside the healthcare sector with strengthened access to educational resources for younger people of all social strata are urgently required, as is information on foods. The effect of physical activity on physical and mental health and quality of life (4) is part and parcel. Ultimately, economic stimuli—in the shape of taxes or tax benefits—could be useful to support a health promoting lifestyle. In our opinion, such measures are the only way to affect positively the future challenges in the healthcare system that arise from metabolic disorders—including NAFLD. This, however, requires readiness of the society and the political will to support initiatives to promote metabolic health.

DOI: 10.3238/arztebl.m2021.0109

On behalf of the authors
Prof. Dr. med. Jörn M. Schattenberg
PD Dr. med. Yvonne Huber
Schwerpunkt Metabolische Lebererkrankungen
I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
joern.schattenberg@unimedizin-mainz.de

Prof. Dr. rer. med. Karel Kostev
Epidemiologie, IQVIA, Frankfurt

Conflict of interest statement

Prof. Schattenberg has received consultancy payments from BMS, Echosens, Genfit, Gilead Sciences, Intercept Pharmaceuticals, Madrigal, Novartis, Pfizer, and Roche, as well as reimbursement of congress attendance fees and travel and accommodation costs from Gilead Sciences.

Prof. Kostev is employed by IQVIA.

Dr Huber declares that no conflict of interest exists.

1.
Huber Y, Labenz C, Michel M, et al.: Tumor incidence in patients with non-alcoholic fatty liver disease. Dtsch Arztebl Int 2020; 117: 719–24 VOLLTEXT
2.
Lazarus JV, Colombo M, Cortez-Pinto H, et al.: NAFLD—sounding the alarm on a silent epidemic. Nat Rev Gastroenterol Hepatol 2020; 17: 377–9 CrossRef MEDLINE
3.
Labenz C, Huber Y, Michel M, et al.: Impact of NAFLD on the incidence of cardiovascular diseases in a primary care population in Germany. Dig Dis Sci 2020; 65: 2112–9 CrossRef MEDLINE
4.
Huber Y, Pfirrmann D, Gebhardt I, et al.: Improvement of non-invasive markers of NAFLD from an individualised, web-based exercise program. Aliment Pharmacol Ther 2019; 50: 930–9 CrossRef MEDLINE
1.Huber Y, Labenz C, Michel M, et al.: Tumor incidence in patients with non-alcoholic fatty liver disease. Dtsch Arztebl Int 2020; 117: 719–24 VOLLTEXT
2.Lazarus JV, Colombo M, Cortez-Pinto H, et al.: NAFLD—sounding the alarm on a silent epidemic. Nat Rev Gastroenterol Hepatol 2020; 17: 377–9 CrossRef MEDLINE
3.Labenz C, Huber Y, Michel M, et al.: Impact of NAFLD on the incidence of cardiovascular diseases in a primary care population in Germany. Dig Dis Sci 2020; 65: 2112–9 CrossRef MEDLINE
4.Huber Y, Pfirrmann D, Gebhardt I, et al.: Improvement of non-invasive markers of NAFLD from an individualised, web-based exercise program. Aliment Pharmacol Ther 2019; 50: 930–9 CrossRef MEDLINE

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