| ObjectiveBased on the epidemiological survey,screening,gastroscopy and laboratory examination data and abdominal ultrasound data of a natural population cohort of gastric cancer in Wuwei,the prevalence of non-alcoholic fatty liver disease(NAFLD)and its subgroups(obese NAFLD and non-obese NAFLD)and related risk factors were investigated for the formulation of NAFLD prevention and health decisions in this population.MethodNAFLD was diagnosed through abdominal ultrasound examination data excluding excessive alcohol consumption and other liver diseases.NAFLD subjects was divided into obese NAFLD group(BMI?25 kg/m~2)and non-obese NAFLD group(BMI<25kg/m~2)according to the body mass index(BMI)results.And risk factors associated with NAFLD are explored by analyzing the relationship between NAFLD and demographic sociology,lifestyle H.pylori infection,medical history,gastric duodenal disease and biochemical indicators.Rates were compared using the chi-square test and Fisher's exact probability method,and risk factors were analyzed using one-way analysis of variance and logistic regression modelling methods.Results1.In the Wuwei cohort,abdominal ultrasound examinations were performed on15,855 subjects.The prevalence of NAFLD was 12.68%(2011/15855),10.60%(876/8286)in women and 14.96%(1135/7587)in men,with a higher prevalence in men than in women(P<0.001).The prevalence of obese NAFLD was 8.17%(1296/15855)and the prevalence of non-obese NAFLD was 4.51%(715/15855).The prevalence of NAFLD was 6.57%,11.47%,15.12%and 12.47%in the age groups<40,40-49,50-59and>60 years old respectively.2.Multi-factor logistic regression analysis showed that the risk of NAFLD increased by 18%for each 10-year increase in age,that the risk of NAFLD was 1.35times higher in people with high BMI than low BMI and that the risk of NAFLD was1.02,1.01 and 1.01 times higher in people with high neck circumference,high waist circumference and high hip circumference than low neck circumference,low waist circumference and low hip circumference respectively(all P<0.05).The risk of NAFLD was 1.42 and 1.7 times higher in those with normal SBP and hypertension respectively,1.24 times higher in those with a history of hypertension than in those without a history of hypertension,and 2.13 times higher in those with a history of diabetes than in those without a history of diabetes(both P<0.05).Those with a history of pancreatitis were9.32 times more likely than those with no history of pancreatitis to develop NAFLD and those with a history of gallbladder disease was 1.68 times more likely than those with no history of gallbladder disease(P<0.05 for both)to develop NAFLD.The risk of NAFLD was 1.97 times higher in those who preferred fried foods than in those without this preference(P<0.05).Compared to non-farmers,farmers had a 35%lower risk of NAFLD,H.pylori infected people had an 11%lower risk of NAFLD,people with a history of peptic ulcer had a 27%lower risk,people with a history of gastric polyps and chronic gastritis had a 59%and 53%lower risk of NAFLD,people who ate fruit and vegetables for more than 6 months a year had a 29%lower risk of NAFLD,and people with a history of hot and fast food had a 25%lower risk of NAFLD.The risk of NAFLD among those with a history of hot food and fast food decreased by 13%and 18%,and the risk of NAFLD among those with insomnia decreased by 25%(P<0.05 for both).Compared to non-farmers,farmers had a 35%lower risk of NAFLD.H.pylori infected people had an 11%lower risk of NAFLD.People with a history of peptic ulcer had a 27%lower risk while people with a history of gastric polyps and chronic gastritis had a 59%and 53%lower risk of NAFLD respectively.Also,people who ate fruit and vegetables for more than 6months a year had a 29%lower risk of NAFLD.And people with a history of eating hot and fast food had a 25%lower risk of NAFLD.The risk of NAFLD among those with a history of eating hot food and fast food decreased by 13%and 18%respectively and the risk of NAFLD among those with insomnia decreased by 25%(P<0.05 for both).3.In the analysis of the risk of obese NAFLD,multifactorial logistic regression analysis showed that the risk of NAFLD was 1.41 times higher in men than in women,and the risk of NAFLD increased by 13%for each 10-year increase in age.Compared to normotensive people,the risk of obese NAFLD was 1.28 and 1.59 times greater in normal hypertension and hypertensive people respectively.The risk was 1.54 times greater in those with a history of diabetes than those without,and 1.63 times greater in those with a history of gallbladder disease than those without(P<0.05).People with high BMI were 1.26 times more likely to be at risk of obese NAFLD than those with low BMI,and those with high hip circumference were 1.03 times more likely to be at risk than those with low hip circumference(both P<0.05).The risk of obese NAFLD was 2.09 times higher in those who preferred fried foods than in those who did not,and the risk of NAFLD was 0.6 times higher in those who ate fruits and vegetables for 1month per year(all P<0.05).Those with a history of hypertension was 1.26 times more likely to develop obese NAFLD than those without,but the difference was not statistically significant(P>0.05).Compared to non-farmers,the risk of obese NAFLD was reduced by 46%in farmers,and by 15%and 22%in those who liked eating hot food and fast eaters respectively(P<0.05 for both).21%NAFLD risk was reduced in those with H.pylori infection,and 48%and 47%in those with a history of gastric polyposis and chronic gastritis respectively(P<0.05 for both).The risk of obese NAFLD was reduced by 29%in those with a history of peptic ulcer,but the difference was not statistically significant(P>0.05).4.In the analysis of the risk of non-obese NAFLD,multifactorial logistic regression analysis showed that the risk of NAFLD increased by 31%with each 10-year increase in age and was 1.58 times higher for the married than for the unmarried.High BMI was 1.45 times higher than low BMI and high waist circumference was 1.03times higher than low waist circumference(both P<0.05).The risk of non-obese NAFLD was 1.54 and 1.64 times higher in people with normal hypertension and hypertension compared to those without a history of hypertension,3.08 times higher in people with a history of diabetes than those without a history of diabetes,and 1.76 times higher in people with a history of gallbladder disease than those without a history of gallbladder disease(both P<0.05).The risk of NAFLD in those eating fried foods was1.78 times higher than that of people without this habit,but the difference was not statistically significant(P>0.05).The risk was reduced by 39%for those with insomnia,22%for those who smoked,41%and 49%for those who ate fruits and vegetables for 4-6 months and more than 6months per year,and 90%and 60%for those with a history of polyps and chronic gastritis(both P<0.05).5.ALT,AST,TC,TG,LDL-C and Glu values were higher in the NAFLD group than in the control group(P<0.05),while DBIL and HDL-C values were lower in the NAFLD group than in the control group(P<0.05).Apart from that,differences in TBIL and IBIL values between the two groups were not statistically significant(P>0.05).The obese NAFLD group had higher ALT,AST,TC,TG,LDL-C and Glu values than the obese control group(P<0.05),and the obese NAFLD group had lower HDL-C values than the obese control group(P<0.001),and the differences in TBIL,DBIL and IBIL values between the two groups were not statistically significant(P>0.05).The non-obese NAFLD group had higher ALT values than the control group(P<0.05),and the non-obese NAFLD group had lower DBIL values than the control group(P<0.05).The differences in AST,TBIL and IBIL values between the two groups were not statistically significant(P>0.05).6.The NAFLD group had higher co-morbidity with atrophic gastritis and gastric polyps than the control group,and lower co-morbidity with non-atrophic gastritis than the control group.In the distribution of pathological diagnosis,the proportion of non-atrophic gastritis was higher in the NAFLD group than the control group,and the proportion of intestinal epithelial hyperplasia and low-grade intraepithelial neoplasia was lower in the NAFLD group than the control group(both P<0.05).The obese NAFLD group had a higher proportion of co-occurring atrophic gastritis and a lower proportion of co-occurring non-atrophic gastritis than the control group;in the distribution of pathological diagnosis,the NAFLD group had a higher proportion of non-atrophic gastritis and a lower proportion of low-grade intraepithelial neoplasia than the control group(both P<0.05).The co-occurrence of atrophic gastritis and gastric polyps was higher in the non-obese NAFLD group than in the control group,and the co-occurrence of non-atrophic gastritis was lower than in the control group.In the distribution of pathological diagnoses,the proportion of non-atrophic gastritis distribution was higher in the NAFLD group than in the control group(P<0.05),and the proportion of intestinal epithelial hyperplasia distribution was lower in the NAFLD group than in the control group(P<0.05).7.Compared with obese NAFLD,the non-obese NAFLD population was older and less educated with less family income.The proportion of males was low while that of farmers was high.In addition,the proportion of smokers,those take in enough vegetables and fruits and fast eaters is also low.(P<0.05)What's more,the proportion of people with a history of gastritis,gastric polyps,pancreatitis and hypertension was low,too.(all P<0.05)There were lower ALT,AST and DBIL values in non-obese NAFLD patients(P<0.05)and higher HDL-C values in non-obese(P<0.05)ones while there was no significant difference in TC,TG,LDL-C,Glu,TBIL and IBIL values between the two groups(P>0.05).Conclusions1.The prevalence of NAFLD in the Wuwei cohort was 12.68%,with a higher prevalence in men than in women,peaking at the age of 50-59 years and decreasing thereafter.2.Risk factors for NAFLD include increasing age,history of diabetes,hypertension,pancreatitis,gallbladder disease,high BMI,high neck circumference,high waist circumference,high hip circumference,high blood pressure,preference for fried foods,higher lipid levels.ALT,AST and blood glucose levels in NAFLD patients are higher than in the control group,but their DBIL levels were lower than those in the control group.H.pylori infection,peptic ulcer disease,history of gastric polyps,and peptic ulcer disease.H.pylori infection,history of peptic ulcer disease,history of gastric polyps,history of gastritis,history of chronic anaemia,high consumption of vegetables and fruits,hot food habit,fast food habit and insomnia were negatively associated with NAFLD.3.The risk factors for obese NAFLD patients included increased age,male,history of diabetes,history of gallbladder disease,high BMI,high hip circumference,hypertension and preference for fried food.The levels of blood lipid,ALT,AST and blood glucose in NAFLD patients were higher than those in the control group.Farmer,H.pylori infection,adequate intake of vegetables and fruits,habit of eating hot food,habit of eating fast food,history of gastric polyp and gastritis were negatively correlated with obese NAFLD.4.Risk factors for non-obese NAFLD included increased age,being married,history of diabetes,history of hypertension,history of pancreatitis,high BMI,high waist circumference,preference for fried foods,history of gall bladder disease,high blood pressure,higher lipid levels,ALT and blood glucose levels in NAFLD patients than in controls.Current smoking,adequate consumption of fruits and vegetables,insomnia,history of gastric polyps and gastritis were negatively associated with non-obese NAFLD.5.Different clinical features between the non-obese and obese NAFLD groups were observed.However,the biochemical indicators of TC,TG,LDL-C,Glu,TBIL and IBIL were similar among subgroups. |
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