Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3480–3488 | Cite as

Survey of Nonalcoholic Fatty Liver Disease Knowledge, Nutrition, and Physical Activity Patterns Among the General Public in Beijing, China

  • Stephanie ChenEmail author
  • Samantha Chao
  • Monica Konerman
  • Wei Zhang
  • Huiying Rao
  • Elizabeth Wu
  • Andy Lin
  • Lai Wei
  • Anna S. Lok
Original Article



Despite high prevalence of nonalcoholic fatty liver disease in China, understanding of the disease appears to be low.


We assessed the knowledge of NAFLD among the public in Beijing, China, as well as diet and physical activity patterns, which may provide information useful for NAFLD prevention and management.


We surveyed adult patients and family members in the Peking University Health Science Center (PUHSC) ultrasound clinic and office staff in Beijing, China. Participants provided demographic and medical history data. NAFLD-related knowledge and diet and physical activity were assessed.


A total of 1296 participants at the PUHSC clinic (51% female, median age 35, 61% college-educated) and 494 participants in offices (61% female, median age 43, 74% college-educated) completed the survey. Response rate was 68.4% and 96.7%, respectively. In clinic and offices, 44% versus 48% were overweight/obese, 5% had a history of diabetes in both groups, and 14% versus 23% had a personal history of NAFLD. Median knowledge score was 15 out of 25 in clinic versus 16 in offices. 44.9% reported minimal physical activity. Factors associated with higher NAFLD knowledge scores (> 16) on multivariate analysis included college education or higher (OR 1.7, p = 0.01), family history of hyperlipidemia (OR 1.96, p < 0.001), and number of sugary drinks per week (OR 0.74, p = 0.006). No factors were significantly associated with physical activity levels.


Adults in Beijing had low knowledge about NAFLD, and most were not physically active. Programs to increase public awareness of NAFLD and promote physical activity are critical to curb this growing epidemic.


Metabolic syndrome Obesity Health literacy Patient education Lifestyle intervention 



Nonalcoholic fatty liver disease


Peking University Health Science Center


International Physical Activity Questionnaire


Alcoholic fatty liver disease


Body mass index


Hepatitis B virus


Hepatocellular carcinoma



This study was supported by the University of Michigan Medical School Global REACH Program, University of Michigan—Peking University Health Science Center Joint Institute for Clinical and Translational Research, and Tuktawa Foundation.

Compliance with Ethical Standards

Conflict of interest

Anna Lok has received research funding from BMS, Gilead, and TARGET Pharma and serves as an advisor/consultant for Gilead, Reseverlogix, Roche, Spring Bank, and Viravaxx. Lai Wei receives research funding from Abbvie and BMS and serves as an advisor/consultant for Abbvie, Ascletis, BMS, Gilead, and MSD. Stephanie Chen, Samantha Chao, Monica Konerman, Wei Zhang, Huiying Rao, Elizabeth Wu, and Andy Lin declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committees of University of Michigan and Peking University and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10620_2019_5709_MOESM1_ESM.docx (118 kb)
Supplementary material 1 (DOCX 118 kb)


  1. 1.
    Fan JG. Epidemiology of alcoholic and nonalcoholic fatty liver disease in China. J Gastroenterol Hepatol. 2013;28:11–17.CrossRefGoogle Scholar
  2. 2.
    Zhao J, Su C, Wang H, Wang Z, Zhang B. New evidence on the effect of medical insurance on the obesity risk of rural residents: findings from the China health and nutrition survey. Int J Environ Res Public Health. 2018;15:383.CrossRefGoogle Scholar
  3. 3.
    IDF Western Pacific members. Brussels (Belgium): International Diabetes Federation; 2018. Available at: Accessed 1 July 2018.
  4. 4.
    Lu Y, Wang P, Zhou T, et al. Comparison of prevalence, awareness, treatment, and control of cardiovascular risk factors in China and the United States. J Am Heart Assoc. 2018;7:e007462.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Leung CM, Lai LS, Wong WH, et al. Nonalcoholic fatty liver disease: an expanding problem with low levels of awareness in Hong Kong. J Gastroenterol Hepatol. 2009;24:1786–1790.CrossRefGoogle Scholar
  6. 6.
    Goh GB, Kwan C, Lim SY, et al. Perceptions of nonalcoholic fatty liver disease—an Asian community-based study. Gastroenterol Rep. 2016;4:131–135.CrossRefGoogle Scholar
  7. 7.
    Ghevariya V, Sandar N, Patel K, et al. Knowing what’s out there: awareness of nonalcoholic fatty liver disease. Front Med. 2014;1:4.CrossRefGoogle Scholar
  8. 8.
    Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–1101.CrossRefGoogle Scholar
  9. 9.
    The International Physical Activity Questionnaire (IPAQ)—Short Form; 2001. Available at: Accessed 22 Mar 2017.
  10. 10.
    Criteria of weight for adults. The National Health and Family Planning Commission of the People’s Republic of China; 2013. Available at: Accessed 18 Apr 2013.
  11. 11.
    Guideline for data processing and analysis of the International Physical Activity Questionnaire (IPAQ); 2001. Available at: Accessed 22 Oct 2017.
  12. 12.
    Lu ZY, Shao Z, Li YL, Wulasihan M, Chen XH. Prevalence of and risk factors for nonalcoholic fatty liver disease in a Chinese population: An 8-year follow-up study. World J Gastroenterol. 2016;22:3663–3669.CrossRefGoogle Scholar
  13. 13.
    Gold DT, McClung B. Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med. 2006;119:32S–37S.CrossRefGoogle Scholar
  14. 14.
    Pais R, Barritt AS 4th, Calmus Y, et al. NAFLD and liver transplantation: current burden and expected challenges. J Hepatol. 2016;65:1245–1257.CrossRefGoogle Scholar
  15. 15.
    Said A, Ghufran A. Epidemic of nonalcoholic fatty liver disease and hepatocellular carcinoma. World J Clin Oncol. 2017;8:429–436.CrossRefGoogle Scholar
  16. 16.
    Williams KH, Shackel NA, Gorrell MD, McLennan SV, Twigg SM. Diabetes and nonalcoholic fatty liver disease: a pathogenic duo. Endocr Rev. 2013;34:84–129.CrossRefGoogle Scholar
  17. 17.
    Ahmed M. Nonalcoholic fatty liver disease in 2015. World J Hepatol. 2015;7:1450–1459.CrossRefGoogle Scholar
  18. 18.
    Mlynarsky L, Schlesinger D, Lotan R, et al. Nonalcoholic fatty liver disease is not associated with a lower health perception. World J Gastroenterol. 2016;22:4362–4372.CrossRefGoogle Scholar
  19. 19.
    Block JP, Condon SK, Kleinman K, et al. Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study. Brit Med J. 2013;346:f2907.CrossRefGoogle Scholar
  20. 20.
    Harris CL, George VA. Dietary restraint influences accuracies in estimating energy expenditure and energy intake among physically inactive males. Am J Mens Health. 2010;4:33–40.CrossRefGoogle Scholar
  21. 21.
    Oseini A, Sanyal A. Therapies in nonalcoholic steatohepatitis (NASH). Liver Int. 2017;37:97–103.CrossRefGoogle Scholar
  22. 22.
    Hendricks E. Off-label drugs for weight management. Diabetes Metab Syndr Obes. 2017;10:223–234.CrossRefGoogle Scholar
  23. 23.
    Walter J, Navarro V, Rossi S. Drug-induced liver injury associated with weight loss supplements. Curr Hepatol Rep. 2018;17:245–253.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Stephanie Chen
    • 1
    Email author
  • Samantha Chao
    • 1
  • Monica Konerman
    • 2
  • Wei Zhang
    • 2
    • 3
  • Huiying Rao
    • 3
  • Elizabeth Wu
    • 2
  • Andy Lin
    • 2
  • Lai Wei
    • 3
  • Anna S. Lok
    • 2
  1. 1.University of Michigan Medical SchoolAnn ArborUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborUSA
  3. 3.Peking University People’s Hospital, Peking University Hepatology Institute, Peking University Health Science CenterBeijingChina

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