Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Eun Haeng Jeong; Dae Won Jun; Yong Kyun Cho; Young Gil Choe; Seungho Ryu; Seung Min Lee; Eun Chul Jang

doi:10.3350/cmh.2013.19.3.266

Articles

Page Path

Original Article

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Eun Haeng Jeong¹, Dae Won Jun², Yong Kyun Cho¹, Young Gil Choe¹, Seungho Ryu³, Seung Min Lee⁴, Eun Chul Jang⁵

Clinical and molecular hepatology 2013;19(3):266-272.
Published online: September 30, 2013

DOI: https://doi.org/10.3350/cmh.2013.19.3.266

¹Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.

³Department of Occupational Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

⁴Department of Food and Nutrition, Sungshin Women's University, Seoul, Korea.

⁵Department of Occupational and Environmental Medicine, Soonchunhyang University College of Medicine, Chunan, Korea.

Corresponding author: Yong Kyun Cho. Depar tment of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongrogu, Seoul 110-746, Korea. Tel. +82-2-2001-8557, Fax. +82-2-2001-2049, choyk2004.cho@samsung.com

^*These authors contributed equally to this work.

• Received: April 30, 2013 • Revised: July 25, 2013 • Accepted: July 31, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

12,776 Views
106 Download
75 Crossref
72 Scopus

prev next

Full Article

Download PDF

ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ACKNOWLEDGMENTS
Acknowledgements
FOOTNOTES
REFERENCES

ABSTRACT

Background/Aims
The prevalence of nonalcoholic fatty liver disease (NAFLD) in Korea has increased recently. The aim of the present study was to determine the regional differences in the prevalence and characteristics of NAFLD.
Methods
From January 2009 to December 2010, 161,891 Seoul and Gyeonggi-do residents receiving a health examination at our institution were enrolled in this cross-sectional study. After applying exclusion criteria, the data of 141,610 subjects (80,943 males, 60,667 females) were analyzed. The presence of NAFLD was established by ultrasound examination.
Results
The overall prevalence of NAFLD was 27.3% (38.3% in men, 12.6% in women). When standardized according to age, area, and sex, the prevalence of NAFLD was 25.2%. The age and area standardized prevalence of NAFLD was higher for men (34.4%) than for women (12.2%; P<0.001). The overall prevalence of NAFLD was higher in Gyeonggi-do (27.7%) than in Seoul (26.9%; P<0.001). Among the men, the prevalence of NAFLD was higher in Gyeonggi-do (39.2%) than in Seoul (37.4%; P<0.001), while for the women it was higher in Seoul (13.2%) than in Gyeonggi-do (12.0%; P<0.001).
Conclusions
The regional prevalence of NAFLD differed between Seoul and Gyeonggi-do. Further studies are needed to establish the etiology of this difference.
Keywords: Non-alcoholic fatty liver disease; Body mass index; Prevalence

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is a wide spectrum of diseases that range from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis.1 Prevalence of NAFLD has increased and comprises more than 20% of the general population in the United States and Europe.2

As Korea is also experiencing increased prevalence of Western diseases due to westernized pattern in diet and life style, it is probable that the prevalence of NAFLD among Koreans will increase. However, few large scale studies have been performed in Korea. Data from smaller scale studies that examined the preva lence of NAFLD among Koreans are not representative of the population.3,4 Also, no study has explored geographic differences in NAFLD prevalence in Korea. This study was undertaken to estimate the overall prevalence of NAFLD among Koreans. We included 161,891 adults aged between 18 and 80 years old residing in Seoul and Gyeonggi-do, where about half of the entire population of Korea resides. We also estimated the prevalence of NAFLD by region.

METHODS

Study subjects

From January 2009 to December 2010, 161,891 Seoul and Gyeonggi-do residents 18-80 years of age who received a routine health examination at the Heath Promotion Center in Kangbuk Samsung Hospital, Korea, were enrolled in this cross-sectional study. Patients with viral hepatitis with positive serologic markers for hepatitis B or C, liver cirrhosis, liver transplantation, malignant tumor, or other hepatobiliary disease including cholecystitis, Clonorchis sinensis, or chronic pancreatitis were excluded. After exclusion, 141,610 subjects (80,943 men, 60,667 women) were analyzed (Fig. 1). Ethics approval for this study was obtained from the institutional review board of Kangbuk Samsung Hospital.

Measurements

Medical history including hypertension, diabetes, dyslipidemia, cardiovascular disease, or cerebrovascular disease and alcohol consumption were assessed using a standard questionnaire. Height and body weight were measured with automated instruments (FA-94H; Fanics, Seoul, Korea) while subjects were barefoot and wearing light clothing. Waist circumference was measured with a flexible tape under fasting conditions, at the level of the umbilicus in a standing position. Body mass index (BMI) was calculated as body weight (kilograms) divided by squared height (meters).

Blood samples were collected from the antecubital vein after fasting overnight. An Advia 1650 automated chemistry analyzer (Bayer Diagnostics, Leverkusen, Germany) was used to measure fasting blood glucose, triglyceride (TG), high-density lipoprotein (HDL) cholesterol, serum aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels. Hepatitis B surface antigen (HBsAg) and antibody (HBsAb) were measured by chemiluminescent micro-particle immunoassay using an Architect i2000SR apparatus (Abbott Laboratories, Abbott Park, IL, USA). Hepatitis C virus (HCV) antibody was measured by polymerase chain reaction using a COBAS Anplicor HCV assay (Roche, Basel, Switzerland).

The non-significant alcohol consumption was applied to subjects who consumed less than 210 grams on average per week in men and 140 grams on average per week in women according to AASLD (American Association for the Study of Liver Diseases) guideline.5 NAFLD was defined as a fatty liver found on sonography in the absence of viral hepatitis in non-significant alcohol consumption. Sonographic fatty liver was defined according to a diffuse hyperechoic echotexture, hepatorenal echo contrast in reference to the cortex of the right kidney, vascular blurring, and deep echo attenuation, using an ASPEN 3.5 MHz probe (Acuson, Malvern, PA, USA).6 Five sonographers blinded to the clinical status of the subjects performed and interpreted the liver ultrasounds. We did not assess interobserver reliability.

Statistical analyses

All data were analyzed using PASW Statistics 18.0 (IBM, Armonk, NY, USA). In univariate analysis, normal continuous variables were compared with the independent sample t-test. Categorical variables were compared using the Chi-square test. Logistic regression analysis was carried out to analyze relationships between risk factors and NAFLD. To obtain the age, area, and sex standardized prevalence of NAFLD, we used direct standardized method by grouping age (≤ 30, 31-39, 40-49, 50-59, ≥ 60 years) for real population which was registered to Korean Statistical Information Service in 2010. Data are presented by mean and standard deviations for continuous variables; percentage for categorical variables. A P-value <0.05 was considered statistically significant.

RESULTS

Overall prevalence of NAFLD was 27.3% (38.3% in men, 12.6% in women). The prevalence of NAFLD after standardization for age, area, and sex was 25.2%. The age and area standardized prevalence of NAFLD was higher in men (34.4%) than in women (12.2%) (P<0.001). Overall prevalence of obesity (BMI ≥ 25 kg/m²) was 28.9% (39.6% in men, 14.7% in women). The age, area, and sex standardized prevalence of obesity was 28.6%.

Clinical characteristics of the subjects among men and women are given in Table 1. The mean age of the subjects was 41.8±8.4 years for men and 41.3±8.9 years for women. The mean BMI in men and women were 24.5±2.9 and 22.0±3.0 kg/m², respectively. The proportion of subjects with results that were out of normal range in each variable was higher in men.

The regional clinical characteristics of the subjects among Gyeonggi-do and Seoul are given in Table 2. The mean age of the subjects was 40.0±7.7 years in Gyeonggi-do and 43.4±9.3 years in Seoul. The mean BMI of residents of Gyeonggi-do and Seoul was 23.4±3.3 and 23.4±3.2 kg/m², respectively. The proportion of subjects with levels that were out of normal range in fasting glucose, waist circumference, and blood pressure was higher in Gyeonggi-do, whereas Seoul had higher proportion of subject with level that were out of normal range in AST, γ-Glutamyltransferase, and HDL cholesterol. The prevalence of hypertension, diabetes mellitus, hyperlipidemia, history of cardiovascular disease, and cerebrovascular disease in Seoul was higher than Gyeonggi-do.

The prevalence of NAFLD was higher in Gyeonggi-do (27.7%) than in Seoul (26.9%) (P <0.001) (Fig. 2). The prevalence of NAFLD for men was higher in Gyeonggi-do (39.2%) than Seoul (37.4%) (P <0.001). But, among women, the prevalence was higher in Seoul (13.2%) than Gyeonggi-do (12.0%) (P<0.001). The prevalence of obesity was higher in Gyeonggi-do (29.2%) than Seoul (28.7%) (P =0.042). But there were no differences between male and female gender (Fig. 3). The prevalence of metabolic syndrome was also higher in Gyeonggi-do (14.9%) than in Seoul (13.6%) (P <0.001). Among men, it was higher in Gyeonggi-do (19.2%) than in Seoul (17.0%) (P <0.001). But there was no significant difference among women (Fig. 4).

Table 3 shows results of logistic regression analysis. The age adjusted odds ratio (OR) of obesity was 7.41 (95% confidence interval [CI], 7.22-7.61; P <0.001). That of metabolic syndrome was 6.53 (95%CI, 6.32-6.74; P <0.001). The multivariate adjusted OR including age and metabolic components (raised TG, reduced HDL cholesterol, raised fasting plasma glucose, waist circumference, and raised blood pressure) was highest in raised TG (OR, 3.74; 95%CI, 3.64-3.85; P <0.001). And second highest OR was waist circumference (OR, 2.99; 95%CI, 2.91-3.07; P <0.001). The multivariate adjusted OR including age, metabolic components, and obesity was highest in obesity (OR, 5.10; 95% CI, 4.96-5.25; P <0.001). And second highest OR was in raised TG (OR, 2.99; 95%CI, 2.90-3.08; P <0.001). We used IDF (International Diabetes Federation) definition for metabolic syndrome.

The age standardized prevalence of NAFLD showed an increasing tendency with age until more than 60 years (Fig. 5). When analyzed separately between men and women, the prevalence of NAFLD in men peaked at 41-50 years and then decreased. The prevalence of NAFLD in women showed increasing tendencies with age, with an especially sharp increase in the prevalence of NAFLD for subjects 51-60 years of age.

DISCUSSION

In this study, we tried to estimate the overall prevalence of NAFLD in Korea. For this, we calculated the prevalence of NAFLD among 141,610 adult subjects who resided in the Seoul and Gyeonggi-do area, where about half of total Korean population resides, and also analyzed the regional difference and age standardized distribution of NAFLD.

In previous studies, the prevalence of NAFLD in Korea has been reported in various results depending on the study populations and methods. Those were 17.9% in 1997,7 23.4% in 2001,4 28.1% in 2008,8 and 27.4% in 2009,9 substantially increased. Prevalence of NAFLD in 589 potential living liver donors in Korea by liver biopsies was 51.4% in 2005.10 These studies included specific study population, so were not representative of the whole Korean population.

In contrast, the present study included large number of popula tion and various regions. And we did estimate age, area, and sex standardized prevalence of NAFLD with a direct standardization method using an actual resident population registered in 2010. Therefore, we infer that the results are close to the true prevalence of NAFLD in the general population of Seoul and Gyeonggi-do.

To analyze the regional difference in the prevalence, we compared Gyeonggi-do which is an urban and rural area, and Seoul which is the capital city of Korea. Regional prevalence of NAFLD differed in Gyeonggi-do and Seoul, with the prevalence of NAFLD higher in Gyeonggi-do. Among men, the prevalence of Gyeonggi-do was higher than Seoul, but among women, it was lower than Seoul. Both prevalence of obesity and metabolic syndrome in Gyeonggi-do were higher than Seoul. It is well known that obesity and metabolic syndrome are associated with NAFLD.5,11,12 Thus higher prevalence of NAFLD in Gyeonggi-do is associated with higher prevalence of obesity and metabolic syndrome. As adjusted OR of obesity was higher than that of metabolic syndrome in development of NAFLD, obesity would have more affected to the prevalence of NAFLD than metabolic syndrome. Among the metabolic components, raised TG the most would influence, then waist circumference would influence prevalence of NAFLD.

Advanced age has been associated with increasing prevalence of NAFLD.13 In this study, the age and area standardized prevalence of NAFLD increased with age among women. But among men, it showed a peak between 41 to 50 years and decreased thereafter. This tendency is similar to the results of a study about 3,175 people in Shanghai.14 This trend in women was reported as an estrogen hormone effect.8 However, in men, data about on its age distribution and trend is lacking. So, further studies are needed to understand the reason for our observation of a peak in the prevalence of NAFLD among men in their 40s.

Our study had several limitations. The major limitation is that subjects were voluntary health-check examinees rather than general population. Another limitation is that fatty liver was detected by sonographic findings without assessing interobserver reliability, even though all of the radiologists were very experienced. Alcohol intake was assessed by self-reported questionnaires, which may have the possibility of underestimating the amounts of alcohol intake.

The strengths of this study are the inclusion of a large population of 141,610 subjects, which enabled the detection of regional difference in the prevalence of NAFLD. Also, for direct standardization for age, area, and sex, we used distribution of actual residing population, so the estimations for the prevalence of NAFLD in this study must be very close to a true value.

In conclusion, there were differences of regional prevalence of NAFLD and obesity in Seoul and Gyeonggi-do in Korea. Further studies will be needed to learn the cause of the differences.

ACKNOWLEDGMENTS

Acknowledgements

This study was supported by the Ministry Food & Drug Safety (12162-KFDA-159).

FOOTNOTES

The authors have no conflicts to disclose

REFERENCES

1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221-1231. 11961152.
Article
PubMed
2. Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis 2008;28:339-350. 18956290.
Article
PubMed
PDF
3. Park SH, Jeon WK, Kim SH, Kim HJ, Park DI, Cho YK, et al. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. J Gastroenterol Hepatol 2006;21:138-143. 16706825.
Article
PubMed
4. Kim HJ, Kim HJ, Lee KE, Kim DJ, Kim SK, Ahn CW, et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med 2004;164:2169-2175. 15505132.
Article
PubMed
5. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012;55:2005-2023. 22488764.
Article
PubMed
6. Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed) 1986;292:13-15.
Article
PubMed
PMC
7. Seo SH, Lee HW, Park HW, Jang BG, Chung WJ, Park KS, et al. Prevalence and associated factors of nonalcoholic fatty liver disease in the health screen examinees. Korean J Med 2006;70:26-32.
8. Bae JC, Cho YK, Lee WY, Seo HI, Rhee EJ, Park SE, et al. Impact of nonalcoholic fatty liver disease on insulin resistance in relation to HbA1c levels in nondiabetic subjects. Am J Gastroenterol 2010;105:2389-2395. 20628364.
Article
PubMed
PDF
9. Sinn DH, Gwak GY, Park HN, Kim JE, Min YW, Kim KM, et al. Ultrasonographically detected non-alcoholic fatty liver disease is an independent predictor for identifying patients with insulin resistance in non-obese, non-diabetic middle-aged Asian adults. Am J Gastroenterol 2012;107:561-567. 22108448.
Article
PubMed
PDF
10. Lee JY, Kim KM, Lee SG, Yu E, Lim YS, Lee HC, et al. Prevalence and risk factors of non-alcoholic fatty liver disease in potential living liver donors in Korea: a review of 589 consecutive liver biopsies in a single center. J Hepatol 2007;47:239-244. 17400323.
Article
PubMed
11. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917-923. 12668987.
Article
PubMed
12. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005;42:44-52. 15895401.
Article
PubMed
13. Fan JG, Saibara T, Chitturi S, Kim BI, Sung JJ, Chutaputti A. What are the risk factors and settings for non-alcoholic fatty liver disease in Asia-Pacific? J Gastroenterol Hepatol 2007;22:794-800. 17498218.
Article
PubMed
14. Fan JG, Zhu J, Li XJ, Chen L, Li L, Dai F, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol 2005;43:508-514. 16006003.
Article
PubMed

Figure 1

Flow chart of study enrollment.

Figure 2

Regional prevalence of non-alcoholic fatty liver disease (NAFLD). ^*P<0.001.

Figure 3

Regional prevalence of obesity. Obesity is defined as BMI ≥25 kg/m². ^*P<0.05.

Figure 4

Regional prevalence of metabolic syndrome. IDF (International Diabetes Federation) definition was used for metabolic syndrome. ^*P<0.001.

Figure 5

Age and area standardized prevalence of non-alcoholic fatty liver disease (NAFLD).

Table 1.

Characteristics of the study population

Table 1.
Variables	Total (n=141610)	Men (n=80943)	Women (n=60667)	P-value
Age (yr)^*	41.6±8.6	41.8±8.4	41.3±8.9	<0.001
BMI (kg/m²)^*	23.4±3.2	24.5±2.9	22.0±3.0	<0.001
NAFLD^†	27.3	38.3	12.6	<0.001
BMI ≥25 kg/m^2,†	28.9	39.6	14.7	<0.001
AST ≥40 IU/L^†	4.9	6.9	2.2	<0.001
ALT ≥40 IU/L^†	12.7	19.2	3.5	<0.001
γ-Glutamyltransferase^† (≥63 IU/L in men; ≥35 IU/L in women)	11.9	16.4	5.9	<0.001
Metabolic syndrome^†,‡	14.3	18.2	9.1	<0.001
TG >150 mg/dL or treatment by medication^†	23.8	34.5	9.4	<0.001
HDL cholesterol or treatment by medication^† (<40 mg/dL in men; <50 mg/dL in women)	19.4	18.7	20.2	<0.001
Fasting glucose ≥ 100 mg/dL or type 2 diabetes^†	22.9	29.3	14.3	<0.001
Waist circumference^† (≥90 cm in men; ≥80 cm in women)	26.2	23.4	30.0	<0.001
Systolic BP≥130 or diastolic BP ≥85 mmHg or treatment of hypertension^†	17.2	22.8	9.7	<0.001
Hypertension^†	5.1	7.0	2.7	<0.001
Diabetes mellitus^†	1.9	2.6	0.9	<0.001
Hyperlipidemia^†	6.5	8.9	3.4	<0.001
History of cardiovascular disease^†	0.4	0.5	0.2	<0.001
History of cerebrovascular disease^†	0.2	0.2	0.1	<0.001

BMI, body mass index; NAFLD, non-alcoholic fatty liver disease; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HDL, high-density lipoprotein; TG, triglyceride.

^*Data are mean±standard deviation, P value by t-test.

^†Data are (%), P value by χ²-test.

^‡IDF (International Diabetes Federation) definition was used for metabolic syndrome.

Table 2.

Characteristics of the study population in Gyeonggi-do and Seoul

Table 2.
Variables	Gyeonggi-do (n=75402)	Seoul (n=66208)	P-value	Men			Women
Variables	Gyeonggi-do (n=75402)	Seoul (n=66208)	P-value	Gyeonggi-do (n=43437)	Seoul (n=37506)	P-value	Gyeonggi-do (n=31965)	Seoul (n=28702)	P-value
Age (yr)^*	40.01 ± 7.66	43.35 ± 9.27	<0.001	40.11± 7.56	43.72± 8.95	<0.001	39.89± 7.80	42.86± 9.66	<0.001
BMI (kg/m²)^*	23.44 ± 3.32	23.39 ± 3.15	0.003	24.48± 2.95	24.45± 2.82	0.127	22.02± 3.02	21.99±3.02	0.342
NAFLD^†	27.7	26.9	<0.001	39.2	37.4	<0.001	12.0	13.2	<0.001
BMI ≥25 kg/m^2,†	29.2	28.7	0.042	39.8	39.3	0.190	14.7	14.8	0.973
AST ≥40 IU/L^†	4.6	5.4	<0.001	6.5	7.2	<0.001	1.8	2.7	<0.001
ALT ≥40 IU/L^†	12.6	12.9	0.229	19.4	19.0	0.132	3.2	4.0	<0.001
γ -Glutamyltransferase^† (≥63 IU/L in men; ≥35 IU/L in women)	10.9	13.0	<0.001	15.1	18.0	<0.001	5.3	6.6	<0.001
Metabolic syndrome^†,‡	14.9	13.6	<0.001	19.2	17.0	<0.001	9.1	9.2	0.746
TG >150 mg/dL or treatment by me	23.9	23.6	0.080	34.7	34.4	0.394	9.3	9.2	0.412
H DL cholesterol or treatment by medication^† (<40 mg/dL in men; <50 mg/dL in women)	18.0	21.0	<0.001	17.1	20.7	<0.001	19.2	21.3	<0.001
Fasting glucose ≥100 mg/dL or type 2 diabetes^†	25.5	19.9	<0.001	32.3	25.8	<0.001	16.2	12.2	<0.001
Waist circumference^† (≥90 cm in men; ≥80 cm in women)	27.4	24.9	<0.001	24.1	22.7	<0.001	31.9	27.8	<0.001
S ystolic BP ≥130 or diastolic BP ≥85 mmHg or treatment of hypertension^†	20.5	19.4	<0.001	27.8	25.1	<0.001	10.5	12.0	<0.001
Hypertension^†	4.5	5.9	<0.001	6.2	7.9	<0.001	2.2	3.2	<0.001
Diabetes mellitus^†	1.5	2.3	<0.001	2.0	3.2	<0.001	0.7	1.1	<0.001
Hyperlipidemia^†	5.9	7.3	<0.001	6.4	7.7	<0.001	2.3	2.9	<0.001
History of cardiovascular disease^†	0.3	0.5	<0.001	0.3	0.6	<0.001	0.2	0.3	0.001
History of cerebrovascular disease^†	0.1	0.2	<0.001	0.2	0.3	0.010	0.1	0.1	0.004

BMI, body mass index; NAFLD, non-alcoholic fatty liver disease; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HDL, high-density lipoprotein; TG, triglyceride.

^*Data are mean±standard deviation, P-value by t-test.

^†Data are (%), P-value by χ²-test.

^‡IDF definition was used for metabolic syndrome.

Table 3.

Odds ratio of the association between obesity, metabolic syndrome and NAFLD

Table 3.
Variables	Age adjusted OR (95%CI)	Age,obesity and metabolic syndrome adjusted OR (95%CI)	Multivariate adjusted^* OR (95%CI)	Multivariate adjusted OR including obesity^†(95%CI)
Obesity^‡	7.41 (7.22-7.61)^§	5.54 (5.39-5.70)^§		5.10 (4.96-5.25)^§
Metabolic syndrome^∥	6.53 (6.32-6.74)^§	3.31 (3.19-3.43)^§
TG >150 mg/dL or treatment by medication	5.27 (5.13-5.41)^§		3.74 (3.64-3.85)^§	2.99 (2.90-3.08)^§
HDL cholesterol (<40 mg/dL in men; <50 mg/dL in women) or treatment by medication	2.76 (2.69-2.84)^§		1.78 (1.72-1.84)^§	1.84 (1.78-1.90)^§
Fasting glucose ≥100 mg/dL or type 2 diabetes	2.61 (2.54-2.68)^§		1.86 (1.80-1.91)^§	1.70 (1.65-1.75)^§
Waist circumference (≥90 cm in men; ≥80 cm in women)	3.93 (3.83-4.03)^§		2.99 (2.91-3.07)^§
Systolic BP≥130 or diastolic BP ≥85 mmHg or treatment of hypertension	2.46 (2.40-2.53)^§		1.65 (1.60-1.70)^§	1.43 (1.38-1.48)^§

NAFLD, non-alcoholic fatty liver disease; OR, odds ratio; CI, confidence interval; HDL, high-density lipoprotein; TG, triglyceride.

^*After adjusting for age, raised TG, reduced HDL cholesterol, raised fasting plasma glucose, waist circumference, and raised blood pressure.

^†After adjusting for age, obesity, raised TG, reduced HDL cholesterol, raised fasting plasma glucose, and raised blood pressure.

^‡Obesity is defined as BMI ≥25 kg/m².

^∥IDF definition was used for metabolic syndrome.

^§P<0.05.

Figure & Data

References

Citations

Citations to this article as recorded by

KASL clinical practice guidelines for the management of metabolic dysfunction-associated steatotic liver disease 2025
Won Sohn, Young-Sun Lee, Soon Sun Kim, Jung Hee Kim, Young-Joo Jin, Gi-Ae Kim, Pil Soo Sung, Jeong-Ju Yoo, Young Chang, Eun Joo Lee, Hye Won Lee, Miyoung Choi, Su Jong Yu, Young Kul Jung, Byoung Kuk Jang
Clinical and Molecular Hepatology.2025; 31(Suppl): S1. CrossRef
Enhancing Rectal Cancer Staging: Integrating Abbreviated Liver MRI into Standard Rectal MRI Protocols for Improved Diagnostic Utility
Hyunjin Lee, Mi Jeong Kim, Jaehyuk Yi, Jin Hyuk Paek, Seong Kyu Baek, Woon Kyung Jeong, Byoung Je Kim
Journal of the Korean Society of Radiology.2025; 86(5): 761. CrossRef
Geographic diversity of human liver cancers mirrors global social inequalities
Luis Cano, Fabien Foucher, Orlando Musso
Frontiers in Oncology.2025;[Epub] CrossRef
Metabolic Dysfunction-Associated Steatotic Liver Disease in the Korean General Population: Epidemiology, Risk Factors, and Non-Invasive Screening
Yong Jun Choi, Jooheon Park, Han-Ik Cho, Myung Geun Shin, Eun-Hee Nah
Metabolites.2025; 15(5): 299. CrossRef
Association between smoking status and non-alcoholic fatty liver disease
Hyun Joe, Jung-Eun Oh, Yong-Jin Cho, Hwang-Sik Shin, Marwan Al-Nimer
PLOS One.2025; 20(6): e0325305. CrossRef
Epigenetic information loss is a common feature of multiple diseases and aging
Naor Sagy, Chieh Chang, Maayan Gal, Daniel Z. Bar
GeroScience.2025;[Epub] CrossRef
Sugar-sweetened beverage consumption and metabolic dysfunction-associated steatotic liver disease: a beverage type-specific analysis using Korea National Health and Nutrition Examination Survey
Hong Jae Jeon, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Ha Neul Kim, Hei-Gwon Choi, Jaehee Seo, Hyuk Soo Eun, Sukyoung Jung
Epidemiology and Health.2025; 47: e2025038. CrossRef
Differences in the prevalence of NAFLD, MAFLD, and MASLD according to changes in the nomenclature in a health check-up using MRI-derived proton density fat fraction
Hee Jun Park, Sunyoung Lee, Jae Seung Lee
Abdominal Radiology.2024; 49(9): 3036. CrossRef
Effect of different exercise modalities on nonalcoholic fatty liver disease: a systematic review and network meta-analysis
Yaqi Xue, Yang Peng, Litian Zhang, Yi Ba, Gang Jin, Ge Liu
Scientific Reports.2024;[Epub] CrossRef
A Review on the Protecting Effects and Molecular Mechanisms of Berries Against a Silent Public Health Concern: Non-Alcoholic Fatty Liver Disease
Anshul Sharma, Hae-Jeung Lee
Antioxidants.2024; 13(11): 1389. CrossRef
Preventive effect of empagliflozin and ezetimibe on hepatic steatosis in adults and murine models
Dong Yun Kim, Kyu Sik Chung, Jun Yong Park, Heon Yung Gee
Biomedicine & Pharmacotherapy.2023; 161: 114445. CrossRef
Treatment of Autoimmune Hepatitis
Ja Kyung Kim
The Korean Journal of Gastroenterology.2023; 81(2): 72. CrossRef
Nonalcoholic Fatty Liver Disease: Disease Burden and Disease Awareness
Pegah Golabi, Vasily Isakov, Zobair M. Younossi
Clinics in Liver Disease.2023; 27(2): 173. CrossRef
Non-alcoholic fatty liver disease: Definition and subtypes
Seul Ki Han, Soon Koo Baik, Moon Young Kim
Clinical and Molecular Hepatology.2023; 29(Suppl): S5. CrossRef
Risk of Metabolic Syndrome and Fatty Liver Diseases in Gastric Cancer Survivors: A Propensity Score-Matched Analysis
Sang Jo Han, Su Jung Baik, Young Hoon Yoon, Jie Hyun Kim, Hye Sun Lee, Soyoung Jeon, Hyojin Park
The Korean Journal of Gastroenterology.2023; 81(4): 154. CrossRef
KASL clinical practice guidelines for management of autoimmune hepatitis 2022

Clinical and Molecular Hepatology.2023; 29(3): 542. CrossRef
Association of changes in body mass index and waist circumference with cardiovascular risk in non-alcoholic fatty liver disease: A nationwide study
Se Young Jang, Hwa Jung Kim, Jun Young Chang
Digestive and Liver Disease.2023; 55(11): 1509. CrossRef
Association between hypoglycemic agent use and the risk of occurrence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus
Choungwon Jung, Soyoung Park, Hyunah Kim, Han Eol Jeong
PLOS ONE.2023; 18(11): e0294423. CrossRef
The Clinical Diagnosis-Based Nationwide Epidemiology of Metabolic Dysfunction-Associated Liver Disease in Korea
Nam-Hun Lee, Seok-Ju Jeong, Jing-Hua Wang, Yu-Jin Choi, Hyeon-Muk Oh, Jung-Hyo Cho, Yo-Chan Ahn, Chang-Gue Son
Journal of Clinical Medicine.2023; 12(24): 7634. CrossRef
Management of non-alcoholic fatty liver disease in patients with sarcopenia
Ching-Sheng Hsu, Jia-Horng Kao
Expert Opinion on Pharmacotherapy.2022; 23(2): 221. CrossRef
The association between metabolic risk factors, nonalcoholic fatty liver disease, and the incidence of liver cancer: a nationwide population-based cohort study
Yu-Guang Chen, Chih-Wei Yang, Chi-Hsiang Chung, Ching-Liang Ho, Wei-Liang Chen, Wu-Chien Chien
Hepatology International.2022; 16(4): 807. CrossRef
Shifting Epidemiology of Hepatocellular Carcinoma in Far Eastern and Southeast Asian Patients: Explanations and Implications
Nguyen H. Tran
Current Oncology Reports.2022; 24(2): 187. CrossRef
Prevalence trends of non-alcoholic fatty liver disease among young men in Korea: A Korean military population-based cross-sectional study
Jaejun Lee, Taeyun Kim, Hyun Yang, Si Hyun Bae
Clinical and Molecular Hepatology.2022; 28(2): 196. CrossRef
SGLT-2 inhibitors and GLP-1 receptor agonists in metabolic dysfunction-associated fatty liver disease
Jun Sung Moon, Jun Hwa Hong, Yong Jin Jung, Ele Ferrannini, Michael A. Nauck, Soo Lim
Trends in Endocrinology & Metabolism.2022; 33(6): 424. CrossRef
Changes in Indices of Steatosis and Fibrosis in Liver Grafts of Living Donors After Weight Reduction
Jaehyuk Choi, YoungRok Choi, Su young Hong, Sanggyun Suh, Kwangpyo Hong, Eui Soo Han, Jeong-Moo Lee, Suk Kyun Hong, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh
Frontiers in Surgery.2022;[Epub] CrossRef
Short-term outcome of bariatric surgery on nonalcoholic fatty liver disease: a Korean perspective
Ki Hyun Kim, Yoonhong Kim, Kwang Il Seo, Kyung Won Seo
Annals of Surgical Treatment and Research.2022; 102(6): 353. CrossRef
Nonalcoholic Fatty Liver Disease: Current Global Burden
Mohamed El-Kassas, Joaquín Cabezas, Paula Iruzubieta Coz, Ming-Hua Zheng, Juan Pablo Arab, Abeer Awad
Seminars in Liver Disease.2022; 42(03): 401. CrossRef
Regional factors associated with the prevalence of metabolic syndrome: Focusing on the role of healthcare providers
Kyu‐Tae Han, Seung Ju Kim
Health & Social Care in the Community.2021; 29(1): 104. CrossRef
Non-alcoholic Fatty Liver Disease in Asian Indian Adolescents and Young Adults
Thaharullah Shah Mehreen, Ranjani Harish, Rajan Kamalesh, Ranjit Mohan Anjana, Viswanathan Mohan
Journal of Diabetology.2021; 12(2): 218. CrossRef
Urinary Phthalate Levels Associated with the Risk of Nonalcoholic Fatty Liver Disease in Adults: The Korean National Environmental Health Survey (KoNEHS) 2012–2014
Yun-Jung Yang, Taehyen Kim, Yeon-Pyo Hong
International Journal of Environmental Research and Public Health.2021; 18(11): 6035. CrossRef
KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease
Seong Hee Kang, Hye Won Lee, Jeong-Ju Yoo, Yuri Cho, Seung Up Kim, Tae Hee Lee, Byoung Kuk Jang, Sang Gyune Kim, Sang Bong Ahn, Haeryoung Kim, Dae Won Jun, Joon-Il Choi, Do Seon Song, Won Kim, Soung Won Jeong, Moon Young Kim, Hong Koh, Sujin Jeong, Jin-Wo
Clinical and Molecular Hepatology.2021; 27(3): 363. CrossRef
Liver Fibrosis Indices for the Prediction of Mortality in Korean Subjects: A 16-Year Prospective Cohort Study
Tae Jung Oh, Kyuho Kim, Jae Hoon Moon, Sung Hee Choi, Nam H Cho, Hak Chul Jang
Journal of the Endocrine Society.2021;[Epub] CrossRef
The Association Between Coffee Consumption and Nonalcoholic Fatty Liver Disease in the South Korean General Population
Li‐Juan Tan, Hyein Jung, Seong‐Ah Kim, Sangah Shin
Molecular Nutrition & Food Research.2021;[Epub] CrossRef
Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association
Byung-Wan Lee, Yong-ho Lee, Cheol-Young Park, Eun-Jung Rhee, Won-Young Lee, Nan-Hee Kim, Kyung Mook Choi, Keun-Gyu Park, Yeon-Kyung Choi, Bong-Soo Cha, Dae Ho Lee
Diabetes & Metabolism Journal.2020; 44(3): 382. CrossRef
Estimated Cardiorespiratory Fitness Attenuates the Impacts of Sarcopenia and Obesity on Non-Alcoholic Fatty Liver in Korean Adults
Inhwan Lee, Jeonghyeon Kim, Hyunsik Kang
International Journal of Environmental Research and Public Health.2020; 17(11): 3902. CrossRef
Noninvasive Evaluation of Nonalcoholic Fatty Liver Disease
Dae Ho Lee
Endocrinology and Metabolism.2020; 35(2): 243. CrossRef
Fruit and vegetable consumption and non-alcoholic fatty liver disease among Korean adults: a prospective cohort study
Seong-Ah Kim, Sangah Shin
Journal of Epidemiology and Community Health.2020; 74(12): 1035. CrossRef
Trends in the Prevalence of Non-Alcoholic Fatty Liver Disease and Its Future Predictions in Korean Men, 1998–2035
Seo Young Kang, Ye-Jee Kim, Hye Soon Park
Journal of Clinical Medicine.2020; 9(8): 2626. CrossRef
The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease
Mohammed Eslam, Shiv K. Sarin, Vincent Wai-Sun Wong, Jian-Gao Fan, Takumi Kawaguchi, Sang Hoon Ahn, Ming-Hua Zheng, Gamal Shiha, Yusuf Yilmaz, Rino Gani, Shahinul Alam, Yock Young Dan, Jia-Horng Kao, Saeed Hamid, Ian Homer Cua, Wah-Kheong Chan, Diana Paya
Hepatology International.2020; 14(6): 889. CrossRef
Association between high fatty liver index and development of colorectal cancer: a nationwide cohort study with 21,592,374 Korean
Yoon Jin Choi, Dong Ho Lee, Kyung-Do Han
The Korean Journal of Internal Medicine.2020; 35(6): 1354. CrossRef
Analysis of Metabolic Biomarkers in Non-Alcoholic Fatty Liver Disease (NAFLD); A Comprehensive Review
Shagufta Akhtar, Azhar Khan
Advanced Journal of Graduate Research.2020; 9(1): 46. CrossRef
The changing epidemiology of liver diseases in the Asia–Pacific region
Martin C. S. Wong, Jason L. W. Huang, Jacob George, Junjie Huang, Colette Leung, Mohammed Eslam, Henry L. Y. Chan, Siew C. Ng
Nature Reviews Gastroenterology & Hepatology.2019; 16(1): 57. CrossRef
Crosstalk between nonalcoholic fatty liver disease and cardiometabolic syndrome
Soo Lim, Marja‐Riitta Taskinen, Jan Borén
Obesity Reviews.2019; 20(4): 599. CrossRef
Nonalcoholic Fatty Liver Disease in Diabetes. Part I: Epidemiology and Diagnosis
Yong-ho Lee, Yongin Cho, Byung-Wan Lee, Cheol-Young Park, Dae Ho Lee, Bong-Soo Cha, Eun-Jung Rhee
Diabetes & Metabolism Journal.2019; 43(1): 31. CrossRef
Fecal and blood microbiota profiles and presence of nonalcoholic fatty liver disease in obese versus lean subjects
Yeojun Yun, Han-Na Kim, Eun-ju Lee, Seungho Ryu, Yoosoo Chang, Hocheol Shin, Hyung-Lae Kim, Tae Hun Kim, Kwon Yoo, Hwi Young Kim, Ming-Lung Yu
PLOS ONE.2019; 14(3): e0213692. CrossRef
The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke
Minyoul Baik, Seung Up Kim, Hyo Suk Nam, Ji Hoe Heo, Young Dae Kim
Frontiers in Neurology.2019;[Epub] CrossRef
The haemoglobin glycation index is associated with nonalcoholic fatty liver disease in healthy subjects
Jee Hee Yoo, Yu Mi Kang, Yun Kyung Cho, Jiwoo Lee, Chang Hee Jung, Joong‐Yeol Park, Ohk‐Hyun Ryu, Hong‐Kyu Kim, Woo Je Lee
Clinical Endocrinology.2019; 91(2): 271. CrossRef
Pharmacological Activities of Alisma orientale against Nonalcoholic Fatty Liver Disease and Metabolic Syndrome: Literature Review
Eunsol Choi, Eungyeong Jang, Jang-Hoon Lee
Evidence-Based Complementary and Alternative Medicine.2019; 2019: 1. CrossRef
The grade of nonalcoholic fatty liver disease is an independent risk factor for gallstone disease
Young-Kyu Kim, Oh-Sung Kwon, Kyu Hee Her
Medicine.2019; 98(27): e16018. CrossRef
Nonalcoholic Fatty Liver Disease and Diabetes: An Epidemiological Perspective
Eun-Jung Rhee
Endocrinology and Metabolism.2019; 34(3): 226. CrossRef
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Zobair Younossi, Quentin M. Anstee, Milena Marietti, Timothy Hardy, Linda Henry, Mohammed Eslam, Jacob George, Elisabetta Bugianesi
Nature Reviews Gastroenterology & Hepatology.2018; 15(1): 11. CrossRef
Non‐alcoholic fatty liver disease and the development of reflux esophagitis: A cohort study
Yang Won Min, Youngha Kim, Geum‐Youn Gwak, Seonhye Gu, Danbee Kang, Soo Jin Cho, Eliseo Guallar, Juhee Cho, Dong Hyun Sinn
Journal of Gastroenterology and Hepatology.2018; 33(5): 1053. CrossRef
Moderate to severe vasomotor symptoms are risk factors for non-alcoholic fatty liver disease in postmenopausal women
Ki-Jin Ryu, Hyuntae Park, Yong Jin Kim, Kyong Wook Yi, Jung Ho Shin, Jun Young Hur, Tak Kim
Maturitas.2018; 117: 22. CrossRef
Is nonalcoholic fatty liver disease associated with the development of prostate cancer? A nationwide study with 10,516,985 Korean men
Yoon Jin Choi, Dong Ho Lee, Kyung-Do Han, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Giovanni Targher
PLOS ONE.2018; 13(9): e0201308. CrossRef
Clinical Effectiveness of Acupuncture in the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review
Joon Hyun, Joo-bok Lee, So-yeon Kim, Chang-woo Han
The Journal of Internal Korean Medicine.2018; 39(6): 1206. CrossRef
Nonalcoholic fatty liver disease in Asia: emerging perspectives
Wai-Kay Seto, Man-Fung Yuen
Journal of Gastroenterology.2017; 52(2): 164. CrossRef
Association between a High-fat Low-carbohydrate Diet and Non-alcoholic Fatty Liver Disease: Truth or Myth?
Hyunwoo Oh, Jaehee Ahn, Dae Won Jun
The Korean Journal of Medicine.2017; 92(2): 112. CrossRef
External validation of the non‐alcoholic fatty liver disease fibrosis score for assessing advanced fibrosis in Korean patients
Dae Won Jun, Sang Gyune Kim, Sang Hoon Park, So‐Young Jin, Ji Sung Lee, Jin‐Woo Lee, Moon Young Kim, Dae Hee Choi, Yong Kyun Cho, Jong Eun Yeon, Joo Hyun Sohn
Journal of Gastroenterology and Hepatology.2017; 32(5): 1094. CrossRef
Emerging Gastrointestinal and Liver Diseases in Asia Pacific: Implications to Health Care in the Region (World Gastroenterology Organization: Asian Pacific Association of Gastroenterology Distinguished Global Lecture 2015)
Khean-Lee Goh
Journal of Clinical Gastroenterology.2017; 51(6): 479. CrossRef
An update on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in Asia
Ching-Sheng Hsu, Jia-Horng Kao
Expert Review of Gastroenterology & Hepatology.2017; 11(8): 759. CrossRef
Association of Blood Fatty Acid Composition and Dietary Pattern with the Risk of Non-Alcoholic Fatty Liver Disease in Patients Who Underwent Cholecystectomy
Poyoung Shim, Dongho Choi, Yongsoon Park
Annals of Nutrition and Metabolism.2017; 70(4): 303. CrossRef
Clinical Characteristics of Non-Alcoholic Fatty Liver Disease Based on Analyses from the Kangbuk Samsung Health Study
Eun-Jung Rhee
The Journal of Korean Diabetes.2017; 18(2): 81. CrossRef
Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World
Mehmet Sayiner, Aaron Koenig, Linda Henry, Zobair M. Younossi
Clinics in Liver Disease.2016; 20(2): 205. CrossRef
Fatty liver index as a simple predictor of incident diabetes from the KoGES-ARIRANG study
Dhananjay Yadav, Eunhee Choi, Song Vogue Ahn, Sang Baek Koh, Ki-Chul Sung, Jang-Young Kim, Ji Hye Huh
Medicine.2016; 95(31): e4447. CrossRef
Non-alcoholic fatty liver diseases: update on the challenge of diagnosis and treatment
Hyunwoo Oh, Dae Won Jun, Waqar K Saeed, Mindie H Nguyen
Clinical and Molecular Hepatology.2016; 22(3): 327. CrossRef
Prevalence and sonographic changes compatible with fatty liver disease in patients referred for abdominal ultrasound examination in Aracaju, SE
Josilda Ferreira Cruz, Mário Augusto Ferreira Cruz, José Machado Neto, Demetrius Silva de Santana, Cristiane Costa da Cunha Oliveira, Sônia Oliveira Lima
Radiologia Brasileira.2016; 49(1): 1. CrossRef
Development and Application of Low-Carbohydrates and Low-Simple Sugar Nutrition Education Materials for Non-Alcoholic Fatty Liver Disease Patients
Yoo-Min An, Dae Won Jun, Seung Min Lee
Clinical Nutrition Research.2015; 4(4): 250. CrossRef
Association between Diabetes Mellitus and Fatty Liver Based on Ultrasonography Screening in the World's Highest Cholangiocarcinoma Incidence Region, Northeast Thailand
Kavin Thinkhamrop, Narong Khuntikeo, Pichai Phonjitt, Nittaya Chamadol, Bandit Thinkhamrop, Malcolm Anthony Moore, Supannee Promthet
Asian Pacific Journal of Cancer Prevention.2015; 16(9): 3931. CrossRef
Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification
Seng Chan You, Kwang Joon Kim, Seung Up Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang‐Hyub Han
Journal of Gastroenterology and Hepatology.2015; 30(10): 1536. CrossRef
Prevalence of Nonalcoholic Fatty Liver Disease and Economy
Jin-Zhou Zhu, Yi-Ning Dai, Yu-Ming Wang, Qin-Yi Zhou, Chao-Hui Yu, You-Ming Li
Digestive Diseases and Sciences.2015; 60(11): 3194. CrossRef
Use of Liver Magnetic Resonance Imaging After Standard Staging Abdominopelvic Computed Tomography to Evaluate Newly Diagnosed Colorectal Cancer Patients
Kichang Han, Seong Ho Park, Kyung Won Kim, Hyoung Jung Kim, Seung Soo Lee, Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, Yo-Sub Joo, Ah Young Kim, Hyun Kwon Ha
Annals of Surgery.2015; 261(3): 480. CrossRef
The Burden of Non-alcoholic Fatty Liver Disease (NAFLD) in the Asia Pacific Region
Neeraj Bhala, Jacob George
Current Hepatology Reports.2015; 14(2): 77. CrossRef
4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine—recommendations for facing obesity, fatty liver and fibrosis epidemics
Francesca Maria Trovato, Daniela Catalano, Giuseppe Musumeci, Guglielmo M Trovato
EPMA Journal.2014;[Epub] CrossRef
Clinical Correlation between Serum Cytokeratin-18 and Metabolic Parameters in Patients with Sonographic Non-alcoholic Fatty Liver Disease
Dong Shin Kwak, Dae Won Jun, Yong Kyun Cho, Seung Min Lee, Se Hwan Lee, In Sub Jung, Sung Won Lee, Jae Keun Park, JungHoon Lee, Eun Young Lee, Min Rho, Kang Lok Lee, Jun Kwon Ko, Soon-Eung Park
The Korean Journal of Gastroenterology.2014; 64(4): 206. CrossRef
Epidemiology and Candidate Genes of Non-alcoholic Fatty Liver Disease
Soo Lim
The Journal of Korean Diabetes.2014; 15(2): 71. CrossRef

Cite

CITE

export

Copy Download

Format
XML Download

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Clin Mol Hepatol. 2013;19(3):266-272. Published online September 30, 2013

DOI: https://doi.org/10.3350/cmh.2013.19.3.266

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
bib — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Clin Mol Hepatol. 2013;19(3):266-272. Published online September 30, 2013

DOI: https://doi.org/10.3350/cmh.2013.19.3.266

Figure

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Figure 1 Flow chart of study enrollment.

Figure 2 Regional prevalence of non-alcoholic fatty liver disease (NAFLD). *P<0.001.

Figure 3 Regional prevalence of obesity. Obesity is defined as BMI ≥25 kg/m2. *P<0.05.

Figure 4 Regional prevalence of metabolic syndrome. IDF (International Diabetes Federation) definition was used for metabolic syndrome. *P<0.001.

Figure 5 Age and area standardized prevalence of non-alcoholic fatty liver disease (NAFLD).

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Variables	Total (n=141610)	Men (n=80943)	Women (n=60667)	P-value
Age (yr)^*	41.6±8.6	41.8±8.4	41.3±8.9	<0.001
BMI (kg/m²)^*	23.4±3.2	24.5±2.9	22.0±3.0	<0.001
NAFLD^†	27.3	38.3	12.6	<0.001
BMI ≥25 kg/m^2,†	28.9	39.6	14.7	<0.001
AST ≥40 IU/L^†	4.9	6.9	2.2	<0.001
ALT ≥40 IU/L^†	12.7	19.2	3.5	<0.001
γ-Glutamyltransferase^† (≥63 IU/L in men; ≥35 IU/L in women)	11.9	16.4	5.9	<0.001
Metabolic syndrome^†,‡	14.3	18.2	9.1	<0.001
TG >150 mg/dL or treatment by medication^†	23.8	34.5	9.4	<0.001
HDL cholesterol or treatment by medication^† (<40 mg/dL in men; <50 mg/dL in women)	19.4	18.7	20.2	<0.001
Fasting glucose ≥ 100 mg/dL or type 2 diabetes^†	22.9	29.3	14.3	<0.001
Waist circumference^† (≥90 cm in men; ≥80 cm in women)	26.2	23.4	30.0	<0.001
Systolic BP≥130 or diastolic BP ≥85 mmHg or treatment of hypertension^†	17.2	22.8	9.7	<0.001
Hypertension^†	5.1	7.0	2.7	<0.001
Diabetes mellitus^†	1.9	2.6	0.9	<0.001
Hyperlipidemia^†	6.5	8.9	3.4	<0.001
History of cardiovascular disease^†	0.4	0.5	0.2	<0.001
History of cerebrovascular disease^†	0.2	0.2	0.1	<0.001

Variables	Gyeonggi-do (n=75402)	Seoul (n=66208)	P-value	Men			Women
Variables	Gyeonggi-do (n=75402)	Seoul (n=66208)	P-value	Gyeonggi-do (n=43437)	Seoul (n=37506)	P-value	Gyeonggi-do (n=31965)	Seoul (n=28702)	P-value
Age (yr)^*	40.01 ± 7.66	43.35 ± 9.27	<0.001	40.11± 7.56	43.72± 8.95	<0.001	39.89± 7.80	42.86± 9.66	<0.001
BMI (kg/m²)^*	23.44 ± 3.32	23.39 ± 3.15	0.003	24.48± 2.95	24.45± 2.82	0.127	22.02± 3.02	21.99±3.02	0.342
NAFLD^†	27.7	26.9	<0.001	39.2	37.4	<0.001	12.0	13.2	<0.001
BMI ≥25 kg/m^2,†	29.2	28.7	0.042	39.8	39.3	0.190	14.7	14.8	0.973
AST ≥40 IU/L^†	4.6	5.4	<0.001	6.5	7.2	<0.001	1.8	2.7	<0.001
ALT ≥40 IU/L^†	12.6	12.9	0.229	19.4	19.0	0.132	3.2	4.0	<0.001
γ -Glutamyltransferase^† (≥63 IU/L in men; ≥35 IU/L in women)	10.9	13.0	<0.001	15.1	18.0	<0.001	5.3	6.6	<0.001
Metabolic syndrome^†,‡	14.9	13.6	<0.001	19.2	17.0	<0.001	9.1	9.2	0.746
TG >150 mg/dL or treatment by me	23.9	23.6	0.080	34.7	34.4	0.394	9.3	9.2	0.412
H DL cholesterol or treatment by medication^† (<40 mg/dL in men; <50 mg/dL in women)	18.0	21.0	<0.001	17.1	20.7	<0.001	19.2	21.3	<0.001
Fasting glucose ≥100 mg/dL or type 2 diabetes^†	25.5	19.9	<0.001	32.3	25.8	<0.001	16.2	12.2	<0.001
Waist circumference^† (≥90 cm in men; ≥80 cm in women)	27.4	24.9	<0.001	24.1	22.7	<0.001	31.9	27.8	<0.001
S ystolic BP ≥130 or diastolic BP ≥85 mmHg or treatment of hypertension^†	20.5	19.4	<0.001	27.8	25.1	<0.001	10.5	12.0	<0.001
Hypertension^†	4.5	5.9	<0.001	6.2	7.9	<0.001	2.2	3.2	<0.001
Diabetes mellitus^†	1.5	2.3	<0.001	2.0	3.2	<0.001	0.7	1.1	<0.001
Hyperlipidemia^†	5.9	7.3	<0.001	6.4	7.7	<0.001	2.3	2.9	<0.001
History of cardiovascular disease^†	0.3	0.5	<0.001	0.3	0.6	<0.001	0.2	0.3	0.001
History of cerebrovascular disease^†	0.1	0.2	<0.001	0.2	0.3	0.010	0.1	0.1	0.004

Variables	Age adjusted OR (95%CI)	Age,obesity and metabolic syndrome adjusted OR (95%CI)	Multivariate adjusted^* OR (95%CI)	Multivariate adjusted OR including obesity^†(95%CI)
Obesity^‡	7.41 (7.22-7.61)^§	5.54 (5.39-5.70)^§		5.10 (4.96-5.25)^§
Metabolic syndrome^∥	6.53 (6.32-6.74)^§	3.31 (3.19-3.43)^§
TG >150 mg/dL or treatment by medication	5.27 (5.13-5.41)^§		3.74 (3.64-3.85)^§	2.99 (2.90-3.08)^§
HDL cholesterol (<40 mg/dL in men; <50 mg/dL in women) or treatment by medication	2.76 (2.69-2.84)^§		1.78 (1.72-1.84)^§	1.84 (1.78-1.90)^§
Fasting glucose ≥100 mg/dL or type 2 diabetes	2.61 (2.54-2.68)^§		1.86 (1.80-1.91)^§	1.70 (1.65-1.75)^§
Waist circumference (≥90 cm in men; ≥80 cm in women)	3.93 (3.83-4.03)^§		2.99 (2.91-3.07)^§
Systolic BP≥130 or diastolic BP ≥85 mmHg or treatment of hypertension	2.46 (2.40-2.53)^§		1.65 (1.60-1.70)^§	1.43 (1.38-1.48)^§

Table 1. Characteristics of the study population

BMI, body mass index; NAFLD, non-alcoholic fatty liver disease; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HDL, high-density lipoprotein; TG, triglyceride.

Data are mean±standard deviation, P value by t-test.

†

Data are (%), P value by χ²-test.

‡

IDF (International Diabetes Federation) definition was used for metabolic syndrome.

Table 2. Characteristics of the study population in Gyeonggi-do and Seoul

BMI, body mass index; NAFLD, non-alcoholic fatty liver disease; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HDL, high-density lipoprotein; TG, triglyceride.

Data are mean±standard deviation, P-value by t-test.

†

Data are (%), P-value by χ²-test.

‡

IDF definition was used for metabolic syndrome.

Table 3. Odds ratio of the association between obesity, metabolic syndrome and NAFLD

NAFLD, non-alcoholic fatty liver disease; OR, odds ratio; CI, confidence interval; HDL, high-density lipoprotein; TG, triglyceride.

After adjusting for age, raised TG, reduced HDL cholesterol, raised fasting plasma glucose, waist circumference, and raised blood pressure.

†

After adjusting for age, obesity, raised TG, reduced HDL cholesterol, raised fasting plasma glucose, and raised blood pressure.

‡

Obesity is defined as BMI ≥25 kg/m².

∥

IDF definition was used for metabolic syndrome.

P<0.05.

Articles

Page Path

Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea

Full Article

ABSTRACT

INTRODUCTION

METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

Acknowledgements

FOOTNOTES

REFERENCES

Figure & Data

References

Citations

CITE

Download Citation

Format:

Include:

Figure

Related articles

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Table 1.

Table 2.

Table 3.

ABOUT

BROWSE ARTICLES

FOR CONTRIBUTORS