Introduction On July 28, 2024, the Journal of Hepatology (CAS 1st Tier, IF: 26.8), a leading international journal in hepatology, published a prospective study conducted by the LiverHome research group. This study, based on the general population in China, assessed the prevalence of fatty liver disease and liver fibrosis, providing the latest evidence for chronic liver disease screening in China. The study's corresponding authors are Xiaolong Qi, a CHESS founder, and Jie Shen from Shunde Hospital of Southern Medical University. The co-first authors are Shanghao Liu (Zhongda Hospital, Southeast University) and Heng Wan (Shunde Hospital of Southern Medical University).The latest guidelines jointly issued by three major European societies—the European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD), and the European Association for the Study of Obesity (EASO)—recommend further evaluation of fatty liver disease (SLD) and liver fibrosis when steatosis is incidentally detected. The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is now estimated to exceed 30% in the general population. A comprehensive understanding of the prevalence of SLD and liver fibrosis in the general population is crucial for public health policy development. China bears the highest burden of chronic liver disease worldwide; however, epidemiological data from the general Chinese population are scarce. Previously, only a small-scale study from Chinese Hong Kong, conducted between 2008 and 2010, evaluated the prevalence of steatosis and liver fibrosis in the Chinese population. Significant lifestyle changes in China over the past decade may have led to notable shifts in these prevalence rates. Therefore, there is an urgent need for larger-scale studies to determine the current prevalence of SLD and liver fibrosis in the general population in China.
Study Overview
This community-based prospective study was conducted from November 2021 to September 2022. Using a multi-stage stratified sampling method, participants aged 18 years and older were recruited from 10 study sites. All participants underwent liver stiffness measurements and controlled attenuation parameter assessments. A total of 9,013 participants were included in the study. The prevalence rates of liver steatosis were 38.97% for grade ≥S1, 26.13% for grade ≥S2, and 19.94% for severe steatosis (S3). The prevalence rates of liver fibrosis were 35.45% for grade ≥F1, 7.53% for grade ≥F2, 2.55% for grade ≥F3, and 1.16% for cirrhosis (F4). The prevalence of MASLD was 36.69%.
The study further assessed the prevalence of SLD and liver fibrosis in high-risk populations, including those who are obese, diabetic, or elderly. The prevalence of SLD increased with higher BMI categories (underweight, normal weight, overweight, and obesity). Notably, underweight individuals showed a higher proportion of liver fibrosis grades compared to those with normal or overweight BMI. Patients with diabetes and elderly individuals also had higher grades of SLD and liver fibrosis. In general, the prevalence rates of advanced liver fibrosis were 6.80% in obese patients, 5.62% in diabetic patients, and 4.08% in elderly individuals (Figure 2). Additionally, the study found that an increasing number of cardiometabolic risk factors in the general population correlated with a greater severity of SLD and liver fibrosis, highlighting the importance of managing comorbidities in the general population.
Conclusion
The study reveals that over one-third of the general population in China has liver steatosis and liver fibrosis. Extrapolating these findings to the entire population, it is estimated that approximately 280 million people in China have severe fatty liver disease, and about 36 million people have advanced liver fibrosis. The study underscores the urgent need to develop public health policies that promote effective interventions to reduce the incidence of cirrhosis and liver cancer, providing a valuable reference for future liver disease research in China.
