Prevalence, Incidence, and Determinants of Non-alcoholic Fatty Liver Disease in Hyperendemic Hepatitis B/C Area: A Population-based Prospective Study
Date Issued
2005
Date
2005
Author(s)
Lai, Chun-Lung
DOI
en-US
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease. However, little is known about prevalence and incidence rate and its determinants in hyperendemic hepatitis B/C area.
Objectives We aimed to (1) estimate prevalence and incidence of NAFLD; (2) to develop early indicators other than abdominal sonography to identify suspected NAFLD; (3) and to elucidate the effect of determinants, particularly metabolic syndrome (MS), on NAFLD and fatty liver taking viral hepatitis and other life style factors into account.
Methods A total of 67804 study subjects were enrolled for analysis derived from a community-based screening program in Keelung, Taiwan. One of the diseases for screening in this program was liver cancer with two stage method where participants were assessed by positive results of five markers, HBsAg (+), Anti-HCV (+), abnormal aspartate aminotranferase(AST) and abnormal alanine aminotranferase(ALT), and high level of α-fetoprotein of whom were subsequently referred to undergo sonography to identify liver diseases including fatty liver, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. To estimate prevalence and incidence of fatty liver, we classified the memberships of screened population into two groups, case cohort who had already fatty liver disease and normal cohort who were free of NAFLD while participants attended first screen. To estimate the prevalence of NAFLD, we used data from the results of first screen to estimate prevalence of NAFLD. To estimate the incidence of FLD, the normal cohort was followed up at regular interval of one year to ascertain newly diagnosed NAFLD. Likelihood ratio test or Receiver operating characteristics (ROC) was applied to determine the optimal cutoff point based on ALT, serum uric acid and BMI. Prevalence/Incidence Ratio method was used to estimate average duration staying in NAFLD. Cox regression time-dependent model was used to assess the influence of relevant determinants on NAFLD.
Results By using abdominal sonography as the method for detecting NAFLD, the overall prevalence rate for the high risk group with positive results participants aged 20 years or older was 35.38%, with being 38.22% for male and 33.25% for female. The overall incidence rate of NAFLD in this high-risk group was 14.92% with 15.11% for male and 14.82% for female. By the application of cut-off score, -0.59, with the combination of three variables (log(ALT), BMI, and log(serum)), overall prevalence and incidence of NAFLD for the underlying general population were 28% and 7.5%. The application of the concept of the ratio of prevalence to incidence yielded 2.37 years of average duration of NAFLD among this high-risk group. For the general population of NAFLD with the application of three variables, the application of the concept of the ratio of prevalence to incidence rate yielded 3.76 years of average duration of NAFLD.
After controlling for these factors in the univariate analysis in each other, the effect of MS on elevated ALT still remained statistically significant (aOR=2.57 (2.41-2.75)). The most remarkable effect was seen in subject without HBV and HCV infection (aOR=3.28 (3.03-3.54)), followed by HBV (+) and HCV (+) (aOR=2.61 (1.14-5.95)) , and HBV (+) and HCV (-) (aOR=1.53 (1.29-1.83)). In addition to MS, other significant risk factors included hypercholesterolemia (aOR=1.15 (1.08-1.22)), hyperurecemia (aOR=1.70 (1.61-1.81)), and betel quids chewing (aOR=1.19 (1.08-1.31)).
After controlling for these factors in the univariate analysis in each other, the effect of MS on the risk for NAFLD was dependent on the presence of viral hepatitis B/C. The most remarkable effect was seen in subject with HBV and HCV infection (aOR=7.76 (1.31-45.90)), followed by HBV (+) and HCV (-) (aOR=1.89 (1.31-2.72)). The effect of MS on the risk for NAFLD was statistically significant in subjects in the absence of HCV and absence of HBV (1.71 (1.36-2.15)).The effect of MS on the risk for NAFLD was marginally statistically significant in subjects in the presence of HCV but absence of HBV (1.82 (0.99-3.33)). , and HBV (+) and HCV (-) (aOR=1.53 (1.29-1.83)). In addition to MS, only Hyperuricemia (aOR=1.30 (1.03-1.63)), and exercise (aOR=0.76 (0.67-0.87)). The equivalent association in subjects with ALT < 45 mg/dL found that the effect of MS on NAFLD was statistically significant after controlling other significant factors. Hyperuricemia was another independent risk factor for NAFLD after controlling for other significant risk factors.
Conclusions The present study used a population-based prospective study to estimate incidence and prevalence of NAFLD for high-risk group as well as general population. The effect of relevant correlates, particularly MS (direct and indirect effect through elevated ALT), on NAFLD was heterogeneous with the presence of hepatitis B/C infection. Hyperuricemia and high BMI may be considered as another two independent factors for NAFLD.
Subjects
非酒精性脂肪肝病變
盛行率
發生率
代謝症候群
整合式篩檢
B型肝炎
C型肝炎
時間依存性Cox回歸模式
Non-alcoholic fatty liver disease
prevalence
incidence
metabolic syndrome
community-based screening program
hepatitis
Cox regression time-dependent model
SDGs
Type
thesis
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