Original Article / Liver
Prevalence and risk factors of fatty liver
disease in Chengdu, Southwest China
Hong Li, You-Ju...
Hepatobiliary & Pancreatic Diseases International
study was to investigate the prevalence and risk factors  a...
Prevalence and risk factors of fatty liver disease
years,  with  no  significant  difference  between  males  ...
Hepatobiliary & Pancreatic Diseases International
were defined as NAFLD, 235 (20.6%) as AFLD, and 330  d...
Prevalence and risk factors of fatty liver disease
several reports showing that the development of FLD is  ...
Hepatobiliary & Pancreatic Diseases International
overweight  Japanese  adults:  incidence  and  clinical  ...
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Prevalence and risk factors of fatty liver

Published on: Mar 4, 2016
Published in: Health & Medicine      
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Transcripts - Prevalence and risk factors of fatty liver

  • 1. Original Article / Liver Prevalence and risk factors of fatty liver disease in Chengdu, Southwest China Hong Li, You-Juan Wang, Ke Tan, Li Zeng, Li Liu, Feng-Jun Liu, Tao-You Zhou, En-Qiang Chen and Hong Tang Chengdu, China BACKGROUND: Fatty liver disease (FLD) is increasingly CONCLUSIONS: The prevalence of FLD among a health- recognized as one of the most common chronic liver checkup population in Chengdu, Southwest China was diseases in China. This study aimed to investigate the lower than the published for other areas of China. FLD in prevalence and risk factors of FLD in Chengdu, Southwest Chengdu adults was found to be closely associated with sex, China, and to provide a relevant basis for the prevention age, BMI, and other metabolic syndrome features. and intervention of FLD. (Hepatobiliary Pancreat Dis Int 2009; 8: 377-382) METHODS: Altogether 9094 subjects (4721 men and 4373 women) of over 18 years old who had received a medical KEY WORDS: fatty liver; checkup in the West China Hospital of Sichuan University prevalence; between January and December 2007 were evaluated for risk factors; FLD. FLD was diagnosed by ultrasonography. Body mass obesity; index (BMI), height, body weight, blood pressure, fasting alcohols plasma glucose (FPG), triglycerides (TG), total cholesterol (TCh), alanine aminotransferase (ALT), hepatitis B surface antigen (HBsAg), high-density lipoprotein cholesterol Introduction F (HDL-C), and low-density lipoprotein cholesterol (LDL-C) atty  liver  disease  (FLD)  is  a  worldwide  disease  were measured using routine laboratory methods. that  has  consistently  increased  in  prevalence  RESULTS: The overall prevalence of FLD was 12.5%, which with  changes  of  life-style  in  recent  years.  The  was more than 3-fold higher in males than in females mean  prevalence  in  Western  countries  as  measured  (18.9% vs. 5.7%, χ2 =359.624, P<0.001). The prevalence by ultrasonography ranges from 20% to 60%.[1] Many  increased with age in females and males of less than 50 years. The prevalence of alcoholic, suspected alcoholic, and potential  risk  factors  for  non-alcoholic  fatty  liver  non-alcoholic FLD was 2.6%, 3.6%, and 6.3%, respectively. disease  (NAFLD)  have  been  identified,  including  Multiple logistic regression analyses showed that 10 factors obesity,  insulin  resistance,  hyperlipidemia,  and  (male sex, age, BMI, FPG, hypertension, TG, TCh, HDL-C, diabetes.[2-4] LDL-C, and ALT abnormalities) were closely related to FLD. FLD  can  be  either  alcoholic  or  non-alcoholic,  and  In heavy drinkers, obesity increased the risk of FLD by both conditions may progress to end-stage liver disease,  23.78-fold (95% CI, 10.22-55.33), but heavy drinking was characterized  by  fibrosis,  cirrhosis,  and  the  eventual  only associated with a 2-fold (95% CI, 1.50-2.66) increased risk in obese subjects. development  of  hepatocellular  carcinoma.[5-7]  Due  to  the seriousness of this disease, epidemiological studies  of  FLD  have  drawn  wide  attention  from  the  medical  community. Two reports from Shanghai and Shenzhen  Author Affiliations: Center of Infectious Diseases; Division of Molecular  Biology of Infectious Diseases, National Key Laboratory of Biotherapy  showed  that  the  prevalence  of  FLD  was  20.8%  in  (Li  H,  Liu  L,  Liu  FJ,  Zhou  TY,  Chen  EQ  and  Tang  H),  Physical  Eastern  China  and  20.7%  in  Southern  China.[8, 9]  Examination  Center  (Wang  YJ  and  Zeng  L),  West  China  Hospital;  Another  report  from  Wuhan[10]  showed  that  the  Department  of  Health  Statistics, West  China  College  of  Public  Health  (Tan K), Sichuan University, Chengdu 610041, China  prevalence of FLD in Central China was 12.5% in 1995,  but  that  it  rose  gradually  to  24.5%  by  2004.  However,  Corresponding Author: Hong  Tang,  Professor,  Division  of  Molecular  Biology  of  Infectious  Diseases,  National  Key  Laboratory  of  Biotherapy,  the incidence and prevalence of FLD in other areas of  West China Hospital, Sichuan University, Chengdu 610041, China (Tel:  China  have  not  been  determined.  The  prevalence  and  86-28-85422650; Fax: 86-28-85423052; Email: htang6198@hotmail.com) associated  risk  factors  of  this  disease  may  vary  widely  © 2009, Hepatobiliary Pancreat Dis Int. All rights reserved. in different geographical regions. The objective of this  Hepatobiliary Pancreat Dis Int,Vol 8,No 4 • August 15,2009 • www.hbpdint.com • 377
  • 2. Hepatobiliary & Pancreatic Diseases International study was to investigate the prevalence and risk factors  alcohol  consumption  more  than  40  g  (male)  or  20  g  of FLD in Chengdu, Southwest China, and to provide a  (female)  of  alcohol  per  day  for  over  5  years;  NAFLD,  relevant basis for the management of FLD in China. non-drinkers  or  alcohol  consumption  less  than  20  g (male) or 10 g (female) of alcohol per day for more  than  1  year;  and  suspected  AFLD,  intermediate  Methods alcohol consumption and duration which fell between  Subjects the other two subtypes. Gallstones  were  diagnosed  on  the  basis  of  their  In  all,  11  045  subjects  of  over  18  years  old  who  were  distinct  ultrasonographic  features,  including  echo  working  in  Chengdu  and  had  a  medical  checkup  at  density,  acoustic  shadowing,  and  gravitational  the  Physical  Examination  Center  of  the  West  China  dependence.[13] Body mass index (BMI) was calculated  Hospital  of  Sichuan  University  between  January  and  as  a  subject's  weight  in  kg  divided  by  the  square  December  2007  were  investigated.  Subjects  without  of  their  height  in  meters.  Obesity  was  defined  as  a  complete  laboratory  data  were  excluded  from  this  BMI ≥25 kg/m2 in both male and female, according  investigation.  At  last,  a  total  of  9094  subjects  were  to  the  redefined  WHO  criteria  in  the  Asia  Pacific  included  for  the  final  analysis.  This  study  was  Region.[14]  Hypertension  was  diagnosed  as  a  systolic  approved by the Ethics Committee of the West China  blood  pressure  ≥140  mmHg  or  a  diastolic  blood  Hospital of Sichuan University (Chengdu, China). pressure ≥90 mmHg, according to the WHO criteria.  Hyperlipidemia was defined as a total cholesterol level  Methods of examination ≥5.2  mmol/L  or  a  triglyceride  level  ≥1.7  mmol/L.  For each subject, a comprehensive medical history  Fasting  hyperglycemia  was  defined  as  fasting  plasma  was  obtained  by  experienced  medical  staff  members  glucose  ≥6.1  mmol/L.  ALT  abnormalities  were  from  the  Physical  Examination  Center.  The  history  defined as ALT ≥55 IU/L for males and ≥38 IU/L for  included  alcohol  consumption,  smoking,  and  a  females. Diagnoses of diabetes mellitus were based on  detailed  history  of  viral  hepatitis,  gallstone  disease,  the WHO 1999 criteria.[15] Participants who reported  previous  diagnosis  of  diabetes,  and  hypertension.  current  use  of  anti-hypertension  or  anti-diabetes  Body  weight,  height,  and  blood  pressure  were  medications were regarded as having hypertension or  measured  during  the  examination.  Liver,  gallbladder,  diabetes, respectively. and  spleen  were  examined  by  ultrasonography  using  a  Philips  HD11XE  (Philips  Medical  Systems,  Bothell,  Statistical analysis USA)  with  a  2-5  MHz  probe.  After  overnight  fasting,  Statistical analyses were made using SPSS version  fasting plasma glucose (FPG), triglycerides (TG), total  13.0  software.  The  descriptive  results  of  continuous  cholesterol  (TCh),  alanine  aminotransferase  (ALT),  variables  were  expressed  as  the  mean±standard  high-density  lipoprotein  cholesterol  (HDL-C),  and  deviation  (SD).  Differences  in  numerical  data  low-density  lipoprotein  cholesterol  (LDL-C)  were  were  assessed  using  Student's  t  test  and  Wilcoxon's  measured  using  a  Hitachi  Modular  analysis  system  rank-sum  test.  Differences  in  categorical  data  were  (Roche  Modular  DPP,  Hitachi  Ltd.,  Tokyo,  Japan).  assessed  using  the  Chi-square  test.  In  the  analysis  The  presence  of  hepatitis  B  surface  antigen  (HBsAg)  was  tested  using  a  diagnostic  kit  for  HBsAg  (Intec  of  continuous  variables,  data  were  categorized  Products Inc., Xiamen, China). according  to  cut-off  values  and  analyzed  using  the  Chi-square  test  or  Fisher's  exact  test.  Logistic  regression analysis was used to identify risk factors for  Diagnostic criteria FLD. Odds ratios (OR) and 95% confidence intervals  Diagnosis  of  FLD  was  based  on  the  presence  of  (CI)  were  estimated  when  appropriate.  All  statistical  an  ultrasonographic  pattern  which  met  the  criteria  comparisons  were  two-tailed.  P  values  less  0.05  were  for  FLD  as  established  by  the  Chinese  Society  for  considered statistically significant. Liver Disease.[11,  12] The determination  of the etiology  of  FLD  was  based  on  the  guidelines  for  diagnosis  and  treatment  of  non-alcoholic  and  alcoholic  FLD  issued by the FLD and Alcoholic Liver Disease Study  Results Group  of  the  Chinese  Society  for  Liver  Disease.[11,  12]  Prevalence of FLD and gender differences According  to  these  guidelines,  FLD  was  divided  into  A total of 4721 males and 4373 females were included  three  subtypes:  alcoholic  fatty  liver  disease  (AFLD),  in  this  study.  The  overall  mean  age  was  43.93±13.47  378 • Hepatobiliary Pancreat Dis Int,Vol 8,No 4 • August 15,2009 • www.hbpdint.com
  • 3. Prevalence and risk factors of fatty liver disease years,  with  no  significant  difference  between  males  For analysis of FLD risk factors, the 9094 subjects  and  females.  Of  the  9094  subjects,  1140  (12.5%)  were  divided  into  a  FLD  group  (n=1140)  and  a  non- were  diagnosed  as  having  FLD,  with  a  3-fold  higher  FLD group (n=7954). Univariate analysis showed that  prevalence in males than in females (18.9% vs. 5.7%,  age, BMI, FPG, blood pressure, TG, TCh, LDL-C, and  χ2=359.624, P<0.001). ALT  were  all  significantly  higher  in  the  FLD  group  The  prevalence  of  FLD  was  9.4%  in  males  aged  than  in  the  non-FLD  group,  whereas  HDL-C  was  less  than  30  years  and  increased  gradually  to  24.4%  lower  in  the  FLD  group  (Table  1).  Differences  in  the  in  males  aged  40-49  years,  but  then  decreased  in  prevalence of the features of metabolic syndrome and  progression  after  50  years  of  age.  In  females,  the  of  several  other  characteristics  between  the  FLD  and  prevalence  of  FLD  increased  gradually  from  0.4%  in  non-FLD groups were significant (P<0.001) (Table 2). those  aged  less  than  30  years  to  18.6%  in  those  aged  In  order  to  identify  FLD  risk  factors,  stepwise  more  than  70  years  (Fig.).  The  prevalence  of  FLD  in  logistic  regression  analysis  was  performed  using  a  males  of  less  than  60  years  old  was  higher  than  that  probability for entry of 0.05 and for removal of 0.1. The  in females of similar age (19.8% vs. 3.9%, χ2=459.233,  results  revealed  that  FLD  was  significantly  associated  P<0.001), but the prevalence was similar in males and  with male sex, age, BMI, FPG, hypertension, TG, TCh,  females aged 60-69 years (13.8% vs. 15.0%, χ2=0.212,  HDL-C, LDL-C, and ALT abnormalities (Table 3). P=0.645). However, in subjects of more than 70 years  old, the prevalence of FLD in females was higher than  Etiological constituent ratios of FLD and their in males (18.6% vs. 11.9%, χ2=4.155, P<0.05). mutual influences Analysis of risk factors for FLD Among  the  1140  subjects  with  FLD,  575  (50.4%)  Table 2.  Prevalence of features of metabolic syndrome and other  characteristics of subjects in the FLD and non-FLD groups  FLD group non-FLD P value Characteristics χ2   (%)   group (%)   (<) Obesity 784 (68.8) 1539 (19.3) 1280.574 0.001 Fasting hyperglycemia 182 (16.0)   241 (3.0)   376.156 0.001 Diabetes mellitus   84 (7.4)   190 (2.4)   84.612 0.001 Hypertension 431 (37.8) 1323 (16.6) 220.417 0.001 Hyperlipidemia 852 (74.7) 2839 (35.7) 630.344 0.001 Gallstone 148 (13.0)   640 (8.0)   30.698 0.001 HBsAg (-)   56 (4.9)   651 (8.2)   14.894 0.001 ALT abnormalities 366 (32.1)   600 (7.5) 633.590 0.001 Fig. Prevalence of FLD in 9094 Chinese adults by age. Alcohol-drinking 565 (49.6) 2540 (31.9) 137.792 0.001 Smoking 455 (39.9) 1959 (24.6) 119.442 0.001 Table 1.  Characteristics of subjects in the FLD and non-FLD  groups  Table 3. Multiple logistic regression of factors associated with FLD  Non-FLD FLD group testing variables   group P value Characteristics   (n=1140, t/Z B SE Wald P OR 95% CI   (n=7954,   (<)   mean±SD)   mean±SD) Male     0.262 0.98     7.097   0.008 1.299 (1.072-1.576) Age (years)     46.81±16.62   29.25±14.40   -7.742 0.001 Age     0.011 0.004   10.392   0.001 1.011 (1.004-1.018) 2 BMI (kg/m )     26.63±2.90   22.48±2.99 -43.570 0.001 BMI     0.324 0.015 459.222 <0.001 1.386 (1.343-1.425) FPG (mg/dl)       5.41±1.68     4.74±0.95 -19.795 0.001 FPG     0.206 0.028   56.012 <0.001 1.229 (1.164-1.297) SBP (mmHg)   126.83±34.51 116.30±16.87 -16.134 0.001 Hypertension     0.343 0.092   13.940 <0.001 1.409 (1.177-1.687) DBP (mmHg)      8359±10.46   76.53±10.08 -21.325 0.001 TG     0.469 0.054   76.476 <0.001 1.598 (1.439-1.775) TG (mmol/L)       2.74±1.73     1.44±1.03 -35.589 0.001 TCh   -0.650 0.155   17.699 <0.001 0.522 (0.386-0.707) TCh (mmol/L)       4.85±0.87     4.51±0.87 -12.216 0.001 HDL-C   -1.074 0.197   29.550 <0.001 0.342 (0.232-0.503) ALT (IU/L)     45.68±25.89   25.54±17.54 -30.926 0.001 LDL-C     0.925 0.162   32.490 <0.001 2.521 (1.835-3.465) HDL-C (mmol/L)       1.21±0.29     1.56±0.40   28.589 0.001 ALT      1.041 0.098 112.161 <0.001 2.833 (2.336-3.435) LDL-C (mmol/L)       3.03±0.75     2.75±0.75 -11.802 0.001   abnormalities SBP: systolic blood pressure; DBP: diastolic blood pressure. Constant -11.074 0.520 452.980 <0.001 0.000 Hepatobiliary Pancreat Dis Int,Vol 8,No 4 • August 15,2009 • www.hbpdint.com • 379
  • 4. Hepatobiliary & Pancreatic Diseases International were defined as NAFLD, 235 (20.6%) as AFLD, and 330  different  from  these  in  other  areas  of  China,  all  of  (29.0%)  as  suspected  AFLD.  The  overall  prevalence  of  which may be related to the development of FLD.[8] AFLD, suspected AFLD, and NAFLD in the entire study  In this study, the prevalence of FLD was higher in  population was 2.6%, 3.6%, and 6.3%, respectively. males  than  in  females  of  less  than  60  years  old,  was  Based  on  BMI  and  alcohol  consumption,  1630  of  similar in males and females aged 60-69 years, and was  the  9094  enrolled  subject,  were  in  the  control  group  higher  in  females  after  the  age  of  70  years.  A  similar  (BMI <23 kg/m2, non-drinkers or alcohol consumption  phenomenon  has  been  noted  in  several  previous  of less than 20 g (male) or 10 g (female) alcohol per day  studies.[8, 10, 18] These age-related gender differences may  for  more  than  1  year),  197  in  the  excessive  drinking  be  related  to  reduced  androsterone  in  males  and  low  group  (BMI  <23  kg/m2  and  alcohol  consumption  of  estrogen  levels  and  relatively  increased  androsterone  more than 40 g (male) or 20 g (female) alcohol per day  after  menopause  in  females  of  more  than  60  years  for  over  5  years),  680  in  the  obese  group  (BMI  ≥25  old.[17, 19] This possibility implies that female hormones  kg/m2, non-drinkers or alcohol consumption less than  might have favorable effects on lipid metabolism in the  20  g  (male)  or  10  g  (female)  alcohol  per  day  for  more  liver, while androsterone may have the opposite effect. than  1  year),  and  297  in  the  obese  excessive  drinking  The  prevalence  of  AFLD  was  2.6%  in  our  study  group  (BMI  ≥25  kg/m2  and  alcohol  consumption  population,  which  was  much  higher  than  the  0.79%  more  than  40  g  (male)  or  20  g  (female)  alcohol  per  and 0.94% reported in Shanghai and Zhejiang province,  day  for  over  5  years).  The  prevalence  rates  of  FLD  respectively.[8,  20]  However,  this  finding  was  consistent  in  the  control,  excessive  drinking,  obese,  and  obese  with  the  high  alcohol  consumption  rate  (34.14%)  in  excessive drinking groups were 1.35%, 3.05%, 27.21%,  the  subjects  evaluated  in  the  present  study.  Similarly,  and  42.76%,  respectively.  Compared  with  the  control  compared  with  Shanghai  and  Zhejiang  province,  group,  the  odds  ratios  (95%  CI)  for  FLD  in  the  other  AFLD  in  Chengdu  comprised  a  larger  constituent  groups  were  2.30  (0.92-5.73),  27.32  (17.36-42.99),  and  ratio  of  FLD  (20.6%).  However,  the  etiological  54.60  (33.81-88.20),  respectively.  Among  the  excessive  constituent  ratio  of  FLD  needs  to  be  further  studied  drinkers,  obesity  increased  the  risk  for  FLD  by  in North China, where more heavy drinkers have been  23.78-fold  (10.22-55.33).  However,  excessive  drinking  reported.[21] Compared with the controls, the risk for  was associated with only a 2-fold (1.50-2.66) increased  FLD was 2.30-fold higher in heavy drinkers, 27.32-fold  risk in subjects with obesity, whereas the risk of FLD in  higher in subjects with obesity, and 54.60-fold higher  subjects  with  obesity  without  excessive  drinking  was  in  obese  heavy  drinkers.  In  heavy  drinkers,  obesity  11.90-fold  (5.19-27.30)  higher  than  that  of  excessive  increased  the  risk  for  FLD  by  23.78-fold,  whereas  drinkers without obesity. heavy  drinking  was  associated  with  only  a  2.00-fold  increased risk in obese subjects, indicating that FLD is  more strongly associated with obesity than with heavy  Discussion drinking, and that the prevalence of FLD dramatically  FLD  is  a  common  chronic  liver  disease  with  genetic,  increased when both conditions were present. environmental,  metabolic,  and  stress-related  com- Our  data  demonstrated  that  FLD  was  mainly  ponents.  The  natural  history  of  FLD  ranges  from  associated  with  obesity,  hyperglycemia,  dyslipidemia,  asymptomatic  indolent  to  the  end  stages  of  liver  and  hypertension,  which  comprise  the  main  features  disease.  The  mean  prevalence  of  FLD  in  western  of  metabolic  syndrome.[22]  People  with  metabolic  countries,  as  measured  by  ultrasonography,  ranges  syndrome are at increased risk for developing diabetes  from 20% to 60%,[1] with 21.8% in Japan and 24.3%  mellitus  and  cardiovascular  disease.[23,  24]  FLD  is  in  Korea.[16,  17]  Our  study  showed  that  approximately  believed  to  be  an  additional  feature  of  metabolic  12.5%  of  Chengdu  adults  had  FLD,  which  was  much  syndrome  and  is  regarded  as  a  common  "burden  of  lower than the 20.8% prevalence reported in Eastern  disease" in the Chinese population.[10] China, 20.7% in Southern China, or 24.5% in Central  China is an endemic area for HBV infection, with  China.[8-10]  This  discrepancy  with  previous  studies  a nationwide survey conducted in 2006 showing that  may  be  the  result  of  differences  in  the  methods  of  the  prevalence  of  HBsAg  carriers  was  approximately  subject  selection  and  possible  regional  differences.  7.18%  in  the  nationwide  population  between  the  Our study included apparently healthy Chinese people  ages of 1 and 59 years.[25] In our study, the prevalence  who underwent a routine health checkup at a hospital  of  HBsAg  carriers  was  7.8%,  which  may  indicate  the  in  Chengdu.  Also,  the  relative  economic  conditions,  prevalence  of  HBsAg  in  Chengdu  is  somewhat  higher  age  stratification,  and  dietary  habits  in  Chengdu  are  than  the  mean  prevalence  in  China.  Consistent  with  380 • Hepatobiliary Pancreat Dis Int,Vol 8,No 4 • August 15,2009 • www.hbpdint.com
  • 5. Prevalence and risk factors of fatty liver disease several reports showing that the development of FLD is  and interpretation of the study and to further drafts. TH is the  not  associated  with  HBV  infection,[26-28]  monovariant  guarantor. Competing interest: No benefits in any form have been received  regression  analysis  in  our  study  showed  a  negative  or will be received from a commercial party related directly or  correlation  between  positive  HBsAg  and  FLD.  This  indirectly to the subject of this article. result  suggests  that  chronic  hepatitis  B  infection  does  not contribute to the development of FLD. Concern  about  FLD  is  growing,  not  only  because  References it is a common liver disorder, but also because it is one  1       ellentani  S,  Bedogni  G,  Miglioli  L,  Tiribelli  C.  The  B of  the  leading  causes  of  abnormal  liver  function.[29, 30]  epidemiology  of  fatty  liver.  Eur  J  Gastroenterol  Hepatol  Unexplained ALT abnormalities are strongly associated  2004;16:1087-1093. with  adiposity  and  thus  may  represent  NFLD.[31]  Our  2       ngelico  F,  Del  Ben  M,  Conti  R,  Francioso  S,  Feole  K,  A study showed that the prevalence of ALT abnormalities  Maccioni  D,  et  al.  Non-alcoholic  fatty  liver  syndrome:  a  hepatic  consequence  of  common  metabolic  diseases.  J  was  13.0%,  of  whom  37.9%  had  FLD.  The  percentage  Gastroenterol Hepatol 2003;18:588-594.  of  ALT  abnormalities  was  much  higher  in  the  FLD  3       ark SH, Kim BI, Yun JW, Kim JW, Park DI, Cho YK, et al.  P group  than  in  the  non-FLD  group  (32.1%  vs.  7.5%,  Insulin  resistance  and  C-reactive  protein  as  independent  χ2=633.590, P<0.001), which suggests that the increase  risk  factors  for  non-alcoholic  fatty  liver  disease  in  non- of ALT may be a consequence of FLD and can thus be  obese Asian men. J Gastroenterol Hepatol 2004;19:694-698. regarded as a predicative indicator for FLD. 4       ngulo  P.  Nonalcoholic  fatty  liver  disease.  N  Engl  J  Med  A 2002;346:1221-1231. Since the present study was conducted in apparently  5       eddy  JK,  Rao  MS.  Lipid  metabolism  and  liver  R healthy  adults  in  Chengdu  who  underwent  health  inflammation. II. Fatty liver disease and fatty acid oxidation.  checkups  at  a  hospital,  results  of  the  study  cannot  be  Am J Physiol Gastrointest Liver Physiol 2006;290:G852-858. generalized  to  other  groups  and  contexts  in  Chengdu.  6     Clark  JM.  The  epidemiology  of  nonalcoholic  fatty  liver    In future studies, it would be of interest to investigate  disease in adults. J Clin Gastroenterol 2006;40:S5-10. 7     Björnsson  E.  The  clinical  aspects  of  non-alcoholic  fatty    the  possible  relationship  of  FLD  to  additional  factors,  liver disease. Minerva Gastroenterol Dietol 2008;54:7-18. such  as  the  use  of  various  drugs,  physical  exercise,  8       an JG, Zhu J, Li XJ, Chen L, Li L, Dai F, et al. Prevalence  F educational level, and HCV. Our diagnoses of FLD were  of and risk factors for fatty liver in a general population of  based on ultrasonography instead of liver biopsy, since  Shanghai, China. J Hepatol 2005;43:508-514. liver biopsy is an invasive examination with increased  9       hao  GX,  Zhang  XG,  Huang  ZP,  Zhu  QY,  Tang  H.  S Discussion on body mass index and fatty liver distribution  risk and high cost. Ultrasonography is widely used for  from  28,384  patients  in  Shenzhen  area.  Zhonghua  Gan  the detection of FLD with high sensitivity (up to 89%)  Zang Bing Za Zhi 2003;11:372-373. and specificity (up to 93%).[32] Thus, we considered this  10    ang Z, Xia B, Ma C, Hu Z, Chen X, Cao P. Prevalence and  W technique to be suitable for use in the diagnosis of FLD  risk factors of fatty liver disease in the Shuiguohu district of  in the present study. Wuhan city, central China. Postgrad Med J 2007;83:192-195. 11    atty  Liver  and  Alcoholic  Liver  Disease  Study  Group  of  F In conclusion, this study demonstrated that FLD is  the  Chinese  Liver  Disease  Association.  Guidelines  for  closely  associated  with  male  sex,  old  age,  obesity,  and  diagnosis and treatment of nonalcoholic fatty liver diseases.  other  features  of  metabolic  syndrome.  Although  the  Zhonghua Gan Zang Bing Za Zhi 2006;14:161-163. prevalence of FLD in Chengdu adults was 12.5%, this  12    atty  Liver  and  Alcoholic  Liver  Disease  Study  Group  F disease must be regarded as potentially serious because  of  the  Chinese  Liver  Disease  Association.  Guidelines  of  its  possible  evolution  to  end-stage  liver  disease.  In  for  diagnosis  and  treatment  of  alcoholic  liver  diseases.  Zhonghua Gan Zang Bing Za Zhi 2006;14:164-166. particular,  subjects  with  obesity  and  unexplained  13    an JG, Zhu J, Li XJ, Chen L, Lu YS, Li L, et al. Fatty liver  F abnormal  liver  function  tests  should  be  screened  with  and  the  metabolic  syndrome  among  Shanghai  adults.  J  abdominal  ultrasonography.  Specific  strategies  for  the  Gastroenterol Hepatol 2005;20:1825-1832. prevention of FLD in Southwestern China also need to  14    nuurad  E,  Shiwaku  K,  Nogi  A,  Kitajima  K,  Enkhmaa  B,  A be pursued. Shimono  K,  et  al.  The  new  BMI  criteria  for  asians  by  the  regional office for the western pacific region of WHO are  suitable  for  screening  of  overweight  to  prevent  metabolic  Funding:  The study was supported by a grant from the National  syndrome in elder Japanese workers. J Occup Health 2003;  Natural Science Foundation of China (No. 30571640). 45:335-343. Ethical approval:  This  study  was  approved  by  the  Ethics  15    haw  JE,  de  Courten  M,  Boyko  EJ,  Zimmet  PZ.  Impact  S Committee of the West China Hospital of Sichuan University  of  new  diagnostic  criteria  for  diabetes  on  different  (Chengdu, China). populations. Diabetes Care 1999;22:762-766. Contributors:  TH proposed the study. LH wrote the first draft.  16    magari  K,  Kadokawa  Y,  Masuda  J,  Egawa  I,  Sawa  O TK  analyzed  the  data.  All  authors  contributed  to  the  design  T,  Hazama  H,  et  al.  Fatty  liver  in  non-alcoholic  non- Hepatobiliary Pancreat Dis Int,Vol 8,No 4 • August 15,2009 • www.hbpdint.com • 381
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