Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography
- Vincent Wai-Sun Wong1,2,
- Winnie Chiu-Wing Chu1,3,
- Grace Lai-Hung Wong1,2,
- Ruth Suk-Mei Chan4,
- Angel Mei-Ling Chim1,2,
- Arlinking Ong1,2,5,
- David Ka-Wai Yeung6,
- Karen Kar-Lum Yiu1,2,
- Shirley Ho-Ting Chu1,2,
- Jean Woo2,4,
- Francis Ka-Leung Chan1,2,
- Henry Lik-Yuen Chan1,2
- 1Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
- 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- 3Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
- 4Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong, China
- 5Department of Medicine, Section of Gastroenterology, University of Santo Tomas Hospital, Espana Manila, Philippines
- 6Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence to Dr Henry Lik-Yuen Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, Hong Kong, China; Dr Winnie Chiu-Wing Chu, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, 30–32 Ngan Shing Street Shatin, Hong Kong, China;
Contributors Study conception, VWW, WCC, HLC; data collection, VWW, WCC, GLW, RSC, AMC, AO, DKY, KKY, SHC; data analysis, VWW, HLC; administrative support, JW, FKC, HLC; manuscript drafting, VWW, WCC, HLC. All authors read and approved the final version of the manuscript.
- Revised 30 May 2011
- Accepted 10 June 2011
- Published Online First 16 August 2011
Objective Knowledge of the epidemiology of non-alcoholic fatty liver disease (NAFLD) is incomplete because liver biopsy cannot be performed on the general population to assess disease severity. New non-invasive tests allow accurate and safe assessment in healthy individuals. The aim of this study was to examine the prevalence of NAFLD and advanced fibrosis in the general Hong Kong Chinese population.
Methods Subjects were recruited from the community by random selection from the government census database. Liver fat and fibrosis were assessed by proton-magnetic resonance spectroscopy and transient elastography, respectively.
Results Overall, 264 of 922 (28.6%) subjects had intrahepatic triglyceride content ≥5%. Excluding 12 subjects with significant alcohol consumption, the population prevalence of NAFLD was 27.3% (95% CI 24.5% to 30.2%). Each component of the metabolic syndrome increased the risk of fatty liver in a dose-dependent manner (prevalence of 4.5% in subjects without any component and 80.0% in those with all five components). 8 (3.7%) patients with fatty liver had liver stiffness ≥9.6 kPa, a level suggestive of advanced fibrosis. Body mass index and alanine aminotransferase level were independent factors associated with liver stiffness. Together with other clinical prediction scores, the estimated prevalence of advanced fibrosis in patients with fatty liver in the community was <10%. Compared with non-drinkers, modest drinkers (<10 g per day) did not have higher risk of fatty liver after adjustment for demographic and metabolic factors. The liver stiffness was 4.7±1.9 kPa in modest drinkers and 4.6±1.7 kPa in non-drinkers (p=0.54).
Conclusion NAFLD is found in over a quarter of the general adult Chinese population, but the proportion of patients with advanced fibrosis is low. Modest alcohol consumption does not increase the risk of fatty liver or liver fibrosis.
- Non-alcoholic steatohepatitis
- metabolic syndrome
- liver fibrosis
- magnetic resonance spectroscopy
- fatty liver
- hepatitis B
- antiviral therapy
- liver cirrhosis
- liver biopsy
- non-steroidal anti-inflammatory drugs
- hepatic fibrosis
- hepatocellular carcinoma
- gene mutation
Funding The study was supported by a grant from the Health and Health Services Research Fund sponsored by the Government of Hong Kong SAR (Reference number 07080081).
Competing interests VWW and GLW have received paid lecture fees from Echosens. HL-KC is an advisory board member of Echosens.
Ethics approval This study was approved by the Clinical Research Ethics Committee, The Chinese University of Hong Kong.
Provenance and peer review Not commissioned; externally peer reviewed.