Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample

Abstract

Aim Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population. Methods A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross‐sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests. Results Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56 years; interquartile range, 45–68 years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60 years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5–6.9; p = 0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0–68.4; p = 0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1–6.2; p = 0.0317) are independent risk factors. Conclusions In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low‐cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.

Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2014 to 2018 in Japan: A large‐scale multicenter retrospective study

“…Recently, Nagaoki et al. reported that liver stiffness measurement found cirrhosis in 1.0%, and severe fibrosis in 1.8% 51 . In our data, 1.0% of all participants had a high risk of advanced fibrosis according to NFS, with no difference in percentage between patients with or without NAFLD (Table 4).…”

“…48 Although NFS can be used as a first-line tool in primary healthcare settings to identify patients without advanced fibrosis who require no further assessment, 16,18,19 reported that liver stiffness measurement found cirrhosis in 1.0%, and severe fibrosis in 1.8%. 51 In our data, 1.0% of all participants had a high risk of advanced fibrosis according to NFS, with no difference in percentage between patients with or without NAFLD (Table 4).…”

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

“…A cross-sectional study conducted in Japan in 2020 randomly selected 6000 general citizens from 2 cities, and 488 individuals underwent fatty liver and advanced fibrosis screening. The prevalence of cirrhosis based on liver stiffness measurement (LSM) was 1%, with a markedly higher prevalence in men than in women (1.6% compared to 0.4%)[ 11 ]. Finally, a study using a commercial medical claims database yielded an adult prevalence of 0.21% for cirrhosis in 2018 (estimated at 536856 cases)[ 12 ].…”

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area

“…CAP can be used as a screening tool due to its negative predictive value that is sufficiently sensitive and specific at the suggested threshold values [ 5 , 9 , 12 ]. In a large Japanese study, it was demonstrated that CAP could be the most time- and cost-effective method of choice for screening large patient populations [ 35 ]. The FibroScan enables simultaneous LS and LF estimation during the same clinical session [ 10 ].…”