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Abstract Details
Prevalence of Liver Steatosis and Fibrosis in the General Population and Various High-Risk Populations: A Nationwide Study With 5.7 Million Adults in China
Gastroenterology. 2023 Oct;165(4):1025-1040. doi: 10.1053/j.gastro.2023.05.053.Epub 2023 Jun 26.
1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Meinian Institute of Health, Beijing, China; Peking University Health Science Center Meinian Public Health Institute, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
2Meinian Institute of Health, Beijing, China; Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
3Meinian Institute of Health, Beijing, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
4Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
5Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
6Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Health Science Center Meinian Public Health Institute, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
7Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: liuhui@pumc.edu.cn.
8Meinian Institute of Health, Beijing, China; Peking University Health Science Center Meinian Public Health Institute, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China. Electronic address: paul@meinianresearch.com.
9Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Health Science Center Meinian Public Health Institute, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China. Electronic address: lmlee@bjmu.edu.cn.
Abstract
Background & aims: This study aimed to estimate the prevalence of liver steatosis and fibrosis in the general population and populations with potential risk factors in China, so as to inform policies for the screening and management of fatty liver disease and liver fibrosis in general and high-risk populations.
Methods: This cross-sectional, population-based, nationwide study was based on the database of the largest health check-up chain in China. Adults from 30 provinces who underwent a check-up between 2017 and 2022 were included. Steatosis and fibrosis were assessed and graded by transient elastography. Overall and stratified prevalence was estimated among the general population and various subpopulations with demographic, cardiovascular, and chronic liver disease risk factors. A mixed effect regression model was used to examine predictors independently associated with steatosis and fibrosis.
Results: In 5,757,335 participants, the prevalence of steatosis, severe steatosis, advanced fibrosis, and cirrhosis was 44.39%, 10.57%, 2.85%, and 0.87%, respectively. Participants who were male, with obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, or elevated alanine aminotransferase or aspartate aminotransferase had a significantly higher prevalence of all grades of steatosis and fibrosis, and those with fatty liver, decreased albumin or platelet count, and hepatitis B virus infection also had a significantly higher prevalence of fibrosis than their healthy counterparts. Most cardiovascular and chronic liver disease risk factors were independent predictors for steatosis and fibrosis, except for dyslipidemia for fibrosis.
Conclusions: A substantial burden of liver steatosis and fibrosis was found in China. Our study provides evidence for shaping future pathways for screening and risk stratification of liver steatosis and fibrosis in the general population. The findings of this study highlight that fatty liver and liver fibrosis should be included in disease management programs as targets for screening and regular monitoring in high-risk populations, especially in those with diabetes.