Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study
The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to assess the recent prevalence of NAFLD and to predict the prevalence of nonalcoholic steatohepatitis (NASH) with liver fibrosis using established scoring systems in the general population.
A cross-sectional study was conducted among 8352 subjects who received health checkups from 2009 to 2010 in three health centers in Japan. Subjects with an intake over 20 g of alcohol/day or with other chronic liver diseases were excluded. Fatty liver was detected by ultrasonography. The probability of NASH with advanced fibrosis was calculated according to the body mass index, age, ALT, and triglyceride (BAAT) and FIB-4 (based on age, aspartate aminotransferase and alanine aminotransferase levels, and platelet counts) indices.
A total of 5075 subjects were enrolled. The overall prevalence of NAFLD was 29.7%. There was a significant threefold difference in the mean prevalence between males (41.0%) and females (17.7%). This prevalence showed a linear increase with body mass index, triglycerides, and low-density lipoprotein cholesterol regardless of threshold values, even without obesity. The estimated prevalence of NASH according to the BAAT index ≥3 was 2.7%, and according to the FIB-4 index it was 1.9%.
The prevalence of NAFLD has increased in the general population, especially in males. There is a linear relationship between the prevalence of NAFLD and various metabolic parameters, even in nonobese subjects. The prevalence of NASH with advanced fibrosis is estimated to be considerably high in subjects with NAFLD.
KeywordsAbdominal obesity Central obesity Metabolic syndrome
Body mass index
Fasting plasma glucose
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
The authors would like to thank Professor Kyuichi Tanikawa (International Institute for Liver Research) for excellent advice, Yukie Watanabe, Chieko Ogawa, Natsumi Izumi, Hisae Ariki, Ikuko Hirotaki, Reiko Sonoda, and all the co-medical staff at Saga Medical School Hospital, Eguchi Hospital, Kochi Medical School, and Kawamura Clinic for assistance, and members of the Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD) for excellent advice. This work was supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan (2010) (#22590741 to Y.E. and #20590785 to M.O.).
Conflict of interest
- 9.Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–31.PubMedCrossRefGoogle Scholar
- 18.Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.PubMedCrossRefGoogle Scholar
- 21.Kirovski G, Schacherer D, Wobser H, Huber H, Niessen C, Beer C, et al. Prevalence of ultrasound-diagnosed non-alcoholic fatty liver disease in a hospital cohort and its association with anthropometric, biochemical and sonographic characteristics. Int J Clin Exp Med. 2010;3:202–10.PubMedGoogle Scholar
- 28.Tokunaga K, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Fujioka S, et al. Ideal body weight estimated from the body mass index with the lowest morbidity. Int J Obes. 1991;15:1–5.Google Scholar