Journal of Gastroenterology

, Volume 47, Issue 5, pp 586–595 | Cite as

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

  • Yuichiro Eguchi
  • Hideyuki Hyogo
  • Masafumi OnoEmail author
  • Toshihiko Mizuta
  • Naofumi Ono
  • Kazuma Fujimoto
  • Kazuaki Chayama
  • Toshiji Saibara
Original Article—Liver, Pancreas, and Biliary Tract



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.


Abdominal obesity Central obesity Metabolic syndrome 



Body height


Body weight


Body mass index


Aspartate aminotransferase


Alanine aminotransferase


AST/ALT ratio


Alkaline phosphatase


Gamma-glutamyl transferase




Fasting plasma glucose






Total cholesterol




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



  1. 1.
    Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology. 2003;37:1202–19.PubMedCrossRefGoogle Scholar
  3. 3.
    Argo CK, Caldwell SH. Epidemiology and natural history of non-alcoholic steatohepatitis. Clin Liver Dis. 2009;13:511–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Bedogni G, Bellentani S. Fatty liver: how frequent is it and why? Ann Hepatol. 2004;3:63–5.PubMedGoogle Scholar
  5. 5.
    Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28:339–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Everhart JE, Bambha KM. Fatty liver: think globally. Hepatology. 2010;51:1491–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Chitturi S, Farrell GC, George J. Non-alcoholic steatohepatitis in the Asia-Pacific region: future shock? J Gastroenterol Hepatol. 2004;19:368–74.PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Ploeg RJ, D’Alessandro AM, Knechtle SJ, Stegall MD, Pirsch JD, Hoffmann RM, et al. Risk factors for primary dysfunction after liver transplantation—a multivariate analysis. Transplantation. 1993;55:807–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Hui JM, Kench JG, Chitturi S, Sud A, Farrell GC, Byth K, et al. Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C. Hepatology. 2003;38:420–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Cadranel JF. Good clinical practice guidelines for fine needle aspiration biopsy of the liver: past, present and future. Gastroenterol Clin Biol. 2002;26:823–4.PubMedGoogle Scholar
  13. 13.
    Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, et al. Liver fibrosis in overweight patients. Gastroenterology. 2000;118:1117–23.PubMedCrossRefGoogle Scholar
  14. 14.
    Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:1104–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Ishibashi E, Eguchi Y, Eguchi T, Matsunobu A, Oza N, Nakashita S, et al. Waist circumference correlates with hepatic fat accumulation in male Japanese patients with non-alcoholic fatty liver disease, but not in females. J Gastroenterol Hepatol. 2008;23:908–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Kojima S, Watanabe N, Numata M, Ogawa T, Matsuzaki S. Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical background. J Gastroenterol. 2003;38:954–61.PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol. 2007;22:788–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Jimba S, Nakagami T, Takahashi M, Wakamatsu T, Hirota Y, Iwamoto Y, et al. Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults. Diabet Med. 2005;22:1141–5.PubMedCrossRefGoogle Scholar
  21. 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
  22. 22.
    Ong JP, Elariny H, Collantes R, Younoszai A, Chandhoke V, Reines HD, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Mofrad P, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37:1286–92.PubMedCrossRefGoogle Scholar
  24. 24.
    Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48:792–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Wong VW, Hui AY, Tsang SW, Chan JL, Tse AM, Chan KF, et al. Metabolic and adipokine profile of Chinese patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2006;4:1154–61.PubMedCrossRefGoogle Scholar
  26. 26.
    Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol. 1999;94:1018–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Nanji AA, French SW, Freeman JB. Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients. Enzyme. 1986;36:266–9.PubMedGoogle Scholar
  28. 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
  29. 29.
    WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.CrossRefGoogle Scholar
  30. 30.
    Yatsuji S, Hashimoto E, Tobari M, Tokushige K, Shiratori K. Influence of age and gender in Japanese patients with non-alcoholic steatohepatitis. Hepatol Res. 2007;37:1034–43.PubMedCrossRefGoogle Scholar
  31. 31.
    Hashimoto E, Farrell GC. Will non-invasive markers replace liver biopsy for diagnosing and staging fibrosis in non-alcoholic steatohepatitis? J Gastroenterol Hepatol. 2009;24:501–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol. 1991;43:26–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology. 1990;12:1106–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Hałoń A, Patrzałek D, Rabczyński J. Hepatic steatosis in liver transplant donors: rare phenomenon or common feature of donor population? Transpl Proc. 2006;38:193–5.CrossRefGoogle Scholar
  35. 35.
    Yamamoto K, Takada Y, Fujimoto Y, Haga H, Oike F, Kobayashi N, et al. Nonalcoholic steatohepatitis in donors for living donor liver transplantation. Transplantation. 2007;83:257–62.PubMedCrossRefGoogle Scholar
  36. 36.
    Tran TT, Changsri C, Shackleton CR, Poordad FF, Nissen NN, Colquhoun S, et al. Living donor liver transplantation: histological abnormalities found on liver biopsies of apparently healthy potential donors. J Gastroenterol Hepatol. 2006;21:381–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Sumida Y, Yoneda M, Hyogo H, Yamaguchi K, Ono M, Fujii H, et al. A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46:257–68.PubMedCrossRefGoogle Scholar
  38. 38.
    Tobari M, Hashimoto E, Yatsuji S, Torii N, Shiratori K. Imaging of nonalcoholic steatohepatitis: advantages and pitfalls of ultrasonography and computed tomography. Intern Med. 2009;48:739–46.PubMedCrossRefGoogle Scholar
  39. 39.
    Eguchi Y, Eguchi T, Mizuta T, Ide Y, Yasutake T, Iwakiri R, et al. Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol. 2006;41:462–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Eguchi Y, Mizuta T, Sumida Y, Ishibashi E, Kitajima Y, Isoda H, et al. The pathological role of visceral fat accumulation in steatosis, inflammation, and progression of nonalcoholic fatty liver disease. J Gastroenterol. 2011;46:70–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Yuichiro Eguchi
    • 1
  • Hideyuki Hyogo
    • 2
  • Masafumi Ono
    • 3
    Email author
  • Toshihiko Mizuta
    • 4
  • Naofumi Ono
    • 5
  • Kazuma Fujimoto
    • 4
  • Kazuaki Chayama
    • 2
  • Toshiji Saibara
    • 3
    • 6
  1. 1.Department of General MedicineSaga Medical SchoolSagaJapan
  2. 2.Department of Medicine and Molecular Sciences, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  3. 3.Department of Gastroenterology and HepatologyKochi Medical SchoolNankokuJapan
  4. 4.Department of Internal MedicineSaga Medical SchoolSagaJapan
  5. 5.Clinical GastroenterologyEguchi HospitalSagaJapan
  6. 6.Japan Study Group of Nonalcoholic Fatty Liver DiseaseNaraJapan

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