Abstract
Background
The prevalence of non-alcoholic fatty liver disease (NAFLD) in the Malaysian population is not known. Malaysia has a multiracial Asian population with three major Asian races: Malay, Chinese, and Indian living together. The aim of the study is to determine the prevalence and risk factors in a suburban Malaysian population.
Methods
Consecutive subjects who came for a health checkup at a suburban medical facility were recruited for the study. All individuals had clinical assessments, anthropometric measurements, blood tests, and ultrasonography of the liver performed. Those with significant alcohol consumption and history of chronic liver disease were excluded.
Results
Of the 1,621 “health screened” individuals analyzed, 368 (22.7 %) were found to have NAFLD. They comprised Chinese 1,269 (78.3 %), Malay 197 (12.1 %), and Indian 155 (9.6 %). Males and “older” age group ≥45 years had high prevalence rates with the highest in Indian (68.2 %) and Malay (64.7 %) males. Chinese females <45 years had the lowest prevalence of 5.2 %. A significant increase in the prevalence of fatty liver between age <45 years and ≥45 years was seen in female of all three races but in male, this increase was seen only among the Indians. NAFLD was strongly associated with diabetes mellitus, glucose intolerance, body mass index ≥23, low high-density lipoprotein cholesterol, hypertriglyceridemia, and hypertension.
Conclusion
NAFLD is common in suburban Malaysian population. Older Indian and Malay males have an inordinately high prevalence of the disease.
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References
Ludwig J, Viggiano TR, McGill DB, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434–8.
Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000;132:112–7.
Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.
Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol. 2006;40:S5–10.
Yoshiike N, Seino F, Tajima S, et al. Twenty-year changes in the prevalence of overweight in Japanese adults: the National Nutrition Survey 1976–1995. Obes Rev. 2002;3:183–90.
Gu D, Reynolds K, Wu X, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365:1398–405.
Huang KC. Obesity and its related diseases in Taiwan. Obes Rev. 2008;9(Suppl 1):32–4.
Ding EL, Malik VS. Convergence of obesity and high glycemic diet on compounding diabetes and cardiovascular risks in modernizing China: an emerging public health dilemma. Global Health. 2008;4:4.
Cheng TO. Rising prevalence of diabetes in China. J Natl Med Assoc. 2003;95:1115–6.
Chan JC, Ng MC, Critchley JA, et al. Diabetes mellitus—a special medical challenge from a Chinese perspective. Diabetes Res Clin Pract. 2001;54(Suppl 1):S19–27.
Farrell GC. Non-alcoholic steatohepatitis: what is it, and why is it important in the Asia-Pacific region? J Gastroenterol Hepatol. 2003;18:124–38.
Chitturi S, Wong VW, Farrell G. Nonalcoholic fatty liver in Asia: firmly entrenched and rapidly gaining ground. J Gastroenterol Hepatol. 2011;26(Suppl 1):163–72.
Omagari K, Kadokawa Y, Masuda J, et al. Fatty liver in non-alcoholic non-overweight Japanese adults. Incidence and clinical characteristics. J Gastroenterol Hepatol. 2002;17:1098–105.
Fan JG, Zhu J, Li XJ, et al. Prevalence of, and risk factors for, fatty liver in a general population of Shanghai, China. J Hepatol. 2005;43:508–14.
Jimba S, Nakagami T, Takahashi M, et al. Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults. Diabet Med. 2005;22:1141–5.
Park SH, Jeon WK, Kim SH, et al. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. J Gastroenterol Hepatol. 2006;21:138–43.
Chen CH, Huang MH, Yang JC, et al. Prevalence and risk factors of non-alcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of non-alcoholic fatty liver disease in non-obese adults. J Clin Gastroenterol. 2006;40:745–52.
Zhou YJ, Li YY, Nie YQ, et al. Prevalence of fatty liver disease and its risk factors in the population of South China. World J Gastroenterol. 2007;13:6419–24.
Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161–3.
Dassanayake AS, Kasturiratne A, Rajindrajith S, et al. Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population. J Gastroenterol Hepatol. 2009;24:1284–8.
Farrell GC, Chitturi S, Lau GK, et al. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol. 2007;22:775–7.
Khalid BA, Usha R, Ng ML, et al. Prevalence of diabetes, hypertension and renal disease amongst railway workers in Malaysia. Med J Malaysia. 1990;45:8–13.
Khebir BV, Osman A, Khalid BA. Changing prevalence of diabetes mellitus amongst rural Malays in Kuala Selangor over a 10 year period. Med J Malaysia. 1996;51:41–7.
Rampal L, Rampal S, Khor GL, et al. A national study on the prevalence of obesity among 16,127 Malaysians. Asia Pac J Clin Nutr. 2007;16:561–6.
Malik A, Cheah PL, Hilmi I, et al. Non-alcoholic fatty liver in Asians: a demographic, anthropometric, biochemical and histological study. J Dig Dis. 2007;8:58–64.
Department of Statistics, Malaysia (2012) http://www.statistics.gov.my. Cited January 20, 2012.
Health Communications Australia. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000.
Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC7 report. JAMA. 2003;289:2560–72.
Fan JG, Saibara T, Chitturi S, et al. What are the risk factors and settings for non-alcoholic fatty liver disease in Asia-Pacific? J Gastroenterol Hepatol. 2007;22:794–800.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications—part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization; 1999. p. 20–1.
Khoo KL, Tan H, Khoo TH. Cardiovascular mortality in Peninsular Malaysia: 1950–1989. Med J Malaysia. 1991;46:7–20.
Hughes K, Lun KC, Yeo PP. Cardiovascular disease in Chinese Malays and Indian in Singapore: difference in mortality. J Epidemiol Community Health. 1990;44:24–8.
Danaraj TJ, Acker MS, Danaraj W, et al. Ethnic group differences in coronary heart disease in Singapore: an analysis of necropsy records. Am Heart J. 1959;58:516–26.
Lee J, Heng D, Chia KS, et al. Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study. Int J Epidemiol. 2001;30(5):983–8.
Mak KH, Chia KS, Kark JD, et al. Ethnic differences in acute myocardial infarction in Singapore. Eur Heart J. 2003;24:151–60.
Wilkinson P, Sayer J, Laji K, et al. Comparison of case fatality in South Asians and White patients after acute myocardial infarction. BMJ. 1996;312:1330–3.
Ismail MN, Chee SS, Nawawi H, et al. Obesity in Malaysia. Obes Rev. 2002;3:203–8.
Rampal S, Rampal L, Rahmat R, et al. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia. Asia Pac J Public Health. 2010;22:194–202.
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Goh, SC., Ho, E.LM. & Goh, KL. Prevalence and risk factors of non-alcoholic fatty liver disease in a multiracial suburban Asian population in Malaysia. Hepatol Int 7, 548–554 (2013). https://doi.org/10.1007/s12072-012-9359-2
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DOI: https://doi.org/10.1007/s12072-012-9359-2