Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults

BACKGROUND: The prevalence of nonalcoholic fatty liver disease (NAFLD) is rarely reported in Taiwan. GOALS: To determine the prevalence and risk factors of NAFLD in an adult population of Taiwan. STUDY: The cross-sectional community study examined 3245 adults in a rural village of Taiwan. The diagnostic criteria for NAFLD included no excessive alcohol intake, no chronic viral hepatitis, no known etiologies of liver disease, and ultrasonography consistent with fatty liver. RESULTS: The prevalence of NAFLD was 11.5% (372/3245). The risk factors for NAFLD in the general population were male sex [odds ratio (OR), 1.44; 95% confidence interval (CI), 1.09-1.90], elevated alanine aminotransferase (ALT) (OR, 5.66; 95% CI, 3.99-8.01), obesity (OR, 7.21; 95% CI, 5.29-9.84), fasting plasma glucose > or =126 mg/dL (OR, 2.08; 95% CI, 1.41-3.05), total cholesterol > or =240 mg/dL (OR, 1.50; 95% CI, 1.06-2.13), triglyceride > or =150 mg/dL (OR, 1.76; 95% CI, 1.32-2.35), and hyperuricemia (OR, 1.53; 95% CI, 1.16-2.01). Age > or =65 years was inversely related to NAFLD (OR, 0.53; 95% CI, 0.36-0.77). The only NAFLD risk factors among nonobese subjects were age between 40 and 64 years (OR, 2.35; 95% CI, 1.34-4.11, P=0.003), elevated ALT (OR, 15.45; 95% CI, 8.21-29.09, P<0.001), and triglyceride > or =150 mg/dL (OR, 2.48; 95% CI, 1.42-4.32, P=0.001). In subjects with NAFLD, the prevalence of elevated ALT in the presence of each metabolic risk factor, such as obesity, fasting plasma glucose > or =126 mg/dL, total cholesterol > or =240 mg/dL, triglyceride > or =150 mg/dL, and hyperuricemia, did not differ from that of subjects with normal ALT levels. CONCLUSIONS: NAFLD is closely associated with elevated ALT, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and hyperuricemia. Among the metabolic disorders, only hypertriglyceridemia was related to NAFLD in nonobese subjects. Serum ALT level was not a good predictor of metabolic significance in subjects with NAFLD.     

Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan

BACKGROUND: The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population-based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed. METHODS: A cross-sectional community study in a rural village of Taiwan was conducted in 3260 Chinese adults (age >or=18 years) undergoing ultrasonography (US), blood tests, and interviews with a structured questionnaire. The diagnostic criteria of non-alcoholic fatty liver disease (NAFLD) included alcohol intake <20 g/week for women or <30 g/week for men, negative hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, no known etiologies of liver disease, and US consistent with fatty liver. RESULTS: The prevalence of elevated ALT was 11.4% (372/3260). The probable cause of this elevation was excess alcohol consumption in 0.8%, HBV in 28.5%, HCV in 13.2%, both HBV and HCV in 2.2%, NAFLD in 33.6%, and unexplained cause in 21.8%. The etiologic distribution of elevated ALT was similar in both genders, although elevation was more common in men compared to women (17.3%vs 6.1%, P < 0.05). The prevalence of elevated ALT in NAFLD was 18.1% (125/691), and the positive predictive value was 33.6% (125/372). The development of NAFLD was related to increasing age (age between 40 years and 64 years, odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.25-2.01; age >or= 65 years, OR 1.46, 95%CI: 1.08-1.96), fasting plasma glucose (FPG) >or= 126 mg/dL (OR 1.54, 95%CI: 1.11-2.14), body mass index (BMI) >or= 25 kg/m(2) (OR 5.01, 95%CI: 4.13-6.26), triglyceridemia >or= 150 mg/dL (OR 1.96, 95%CI: 1.58-2.42), and hyperuricemia (OR 1.50, 95%CI: 1.22-1.84). Elevated ALT was related to male gender, BMI >or= 25 kg/m(2), and triglyceridemia >or= 150 mg/dL in subjects without known etiologies of liver disease (all P < 0.05). CONCLUSIONS: Non-alcoholic fatty liver disease appears to be the commonest cause of elevated ALT and presumed liver injury in Taiwan. The development of NAFLD is closely associated with many metabolic disorders. Metabolic disorders are also related to elevated ALT in subjects without known etiologies of liver disease.     

Serum insulin, insulin resistance, p-cell dysfunction, and gallstone disease among type 2 diabetics in Chinese population： A community-based study in Kinmen, Taiwan

AIM: To explore the association of serum insulin, insulin resistance, and beta-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and beta-cell dysfunction (HOMA beta-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4(th) vs 1(st) quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4(th) vs 1(st) quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA beta-cell function was significantly related to decreased risk of GSD [4(th) vs 1(st) quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA beta-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and beta-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.     

广西城市社区居民高尿酸血症流行病学调查及其与慢性肾脏病的关系

目的 通过社区人群筛查了解广西城市原住民中高尿酸血症(HUA)的患病率及其与慢性肾脏病(CKD)的关系,并探讨影响HUA肾损害的风险因素.方法 选择桂林市城区原住居民集中的象山社区,对18～75岁居民(n=6 273)采取横断面进行筛查.收集空腹血及晨尿进行血糖、肾功能、血脂、胰岛素和尿蛋白等检测,同时进行问卷调查和体格检查.结果 社区居民中HUA总患病率为23.5%,其中男性HUA患病率显著高于女性(28.4%对19.7%,P＜0.01).社区居民中CKD患病率为21.6%,其中男性居民CKD患病率较女性显著增高(24.9%对19.0%,P＜0.01).在HUA人群中CKD检出率显著高于尿酸正常人群(30.4%对18.9%,P＜0.01).男性HUA人群CKD检出率显著高于同性别正常血尿酸人群(34.3%对21.2%,P＜0.01),也显著高于女性HUA人群(25.9%,P＜0.01).Logistic回归分析发现,CKD仅与收缩压、低密度脂蛋白胆固醇和血糖水平独立相关(P＜0.01).结论 广西城市社区居民中HUA患病率显著增加,与CKD患病率增高有关,且血尿酸轻度增高即增加CKD患病率.

Abstract：

Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P＜0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P＜0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P＜0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P＜0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.     

Serum insulin, insulin resistance, β-cell dysfunction, and gallstone disease among type 2 diabetics in Chinese population: A community-based study in Kinmen, Taiwan

AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics.METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and β-cell dysfunction (HOMA β-cell).RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4th vs 1st quartile odds ratios (OR)= 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4th vs 1st quartile OR = 4.46 (95% CI: 1.71-11.66)]. Better HOMA β-cell function was significantly related to decreased risk of GSD [4th vs 1st quartile OR = 0.16 (95% CI: 0.03-1.70)].Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA β-cell was observed among males.CONCLUSION: Serum insulin, insulin resistance, and β-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.     

Prevalence,awareness, treatment,and control of hypertension among China’s Sichuan Tibetan population: A cross-sectional study

Background: Our aim is to investigate the prevalence, awareness, treatment, and control status of hypertension and explore the associated factors among Sichuan Tibetan population.Methods: A cross-sectional investigation was conducted in the Sichuan Tibetan region from to September 2013 to March to 2014. Three thousand two hundred and forty persons were included in the study through a multi-stage stratified clustering sampling. Participants received questionnaires and physical examination. Blood pressure (BP) was recorded three times after 5 min of rest with the mean taken as the final BP. Hypertension was defined according the 2010 Chinese guidelines for the management of hypertension.Results: Prevalence of hypertension was 45.7%. The proportion of different stages (1–3) of hypertension was 31.7%, 9.2%, and 7.6% for males and 26.3%, 9.5%, and 6.0% for females. The rate of awareness, treatment, and control of hypertension were 4.9%, 21.3%, and 3.0% for males and 7.5%, 24.5%, and 3.1% for females. Multiple-factor analysis found that age, overweight or obesity (odds ratio(OR)=1.16), drinking alcohol (OR = 1.29, 95% confidence interval (CI):1.07–1.54), increased waist circumference (OR = 1.81, 95%CI: 1.39–2.36), family history of hypertension (OR = 1.51, 95%CI; 1.28–1.78), higher salt intakes (OR = 1.62, 95%CI: 1.24–2.11), long duration of sleep (OR = 1.05, 95%CI: 1.01–1.09), rural area (OR = 1.99, 95%CI: 1.64–2.41), and drinking coffee at times (OR = 0.71, 95%CI:0.57–0.87) were related to hypertension.Conclusion: Prevalence of hypertension in Sichuan Tibetan was significantly higher than the national level with low rates of awareness, treatment, and control of hypertension. Intervention measurements are needed to change some unhealthy lifestyles, behaviors, and habits in this region.     

An association of serum ALT with elevated blood pressure in senior adults: a case-control study

Hypertension is a major risk factor for cardiovascular diseases in China; hence, identifying good serum markers might provide cost benefits in terms of reducing morbidity rates. In this population-based case-control study, participants were recruited from five districts in Hunan province, and 416 cases were matched with an equal number of controls. Markers related to elevated blood pressure were assessed: Body Mass Index, total cholesterol, triglycerides, fasting blood glucose, and creatinine. Three potential serum markers homocysteine (HCY), C-reactive protein (CRP), and alanine aminotransferase (ALT) were dichotomized as normal or high level. Binary logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs). The findings showed that ALT is a powerful serum marker for predicting high risk of high blood pressure with OR = 2.94, 95% CI (1.44–6.02), while there were no significant differences between cases and controls for HCY and CRP. Additionally, it seems likely that high concentrations of HCY conferred a protective effect against elevated blood pressure. When adjusted for sex, ORs for hypertensive females were nearly five times higher than for hypertensive males (OR = 4.34, 95% CI = 1.17–16.04). The study strongly supports findings showing ALT is a potential indicator for patients with hypertension.     

Clinical correlation of gallstone disease in a Chinese population in Taiwan： Experience at Cheng Hsin General Hospital

AIM: To explore the prevalence of gallstone disease (GSD) in Taiwan and condition-associated factors related to it. METHODS: We studied a total of 2386 healthy adults (1235 males and 1151 females) voluntarily admitted to Cheng Hsin General Hospital for a paid physical check-up between January 2002 and December 2002. Blood samples and ultrasound sonography results were collected. RESULTS: The overall prevalence of GSD among this study-population was 5.3%, including 1.7% (n=40) having a single stone, 2.3% (n=55) having multiple stones, and 1.3% (n=31) having cholecystectomy. The prevalence revealed a statistically significant increase with increasing age (P<0.0001). Females exhibited a greater prevalence of multiple stones than did males (3.0% vs 1.7%, P=0.04). Using multiple logistic regression analysis, the following appeared to be significantly related to the prevalence of GSD: older age (40-49 years vs < 40 years, OR=1.63 [95% CI: 0.76-3.48], 50-59 years vs < 40 years, OR=4.93 [95% CI: 2.43-9.99], 60-69 years vs < 40 years, OR=6.82 [95% CI: 3.19-14.60], > or = 70 years vs < 40 years, OR=10.65 [95% CI: 4.78-23.73]), higher BMI (> or = 27 kg/m2 vs < 24 kg/m2, adjusted OR=1.74 [95% CI: 1.04-2.88]), and higher FPG (> or = 126 mg/dL vs < 110 mg/dL, OR=1.71, 95%CI: 1.01-2.96). CONCLUSION: Older age (> or = 50 years), obesity (BMI > or = 27 kg/m2), and type 2 diabetes (FPG > or = 126 mg/dL) are associated with the prevalence of GSD.     

Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis.

OBJECTIVE: To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB). METHODS: Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB. RESULTS: Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P < 0.001), absolute lymphocyte count < 1625/ mm3 (OR 4.5, 95%CI 1.1-19.3; P = 0.04) and serum ALT > 100 IU (OR 15.7, 95%CI 3.0-81.1, P < 0.001) were independent predictors of ARDS development. Twelve cases died (41.4%). Patients with APACHE II score >18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die. CONCLUSIONS: In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.     

Prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women

AIM: To evaluate the prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women. METHODS: The baseline survey was conducted in November 2006. Subjects were 925 women aged 70 years and older who participated in a comprehensive health examination which included a face-to-face interview, body composition, and physical fitness tests. The participants were classified, the based on percentage of body fat, as normal (<30.0), mild obesity (30.0 to 34.9), and obesity (>or=35.0) groups. To evaluate the differences among the groups with regard to the physical fitness and the interview data, one-way analysis of variance performed for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with obesity in elderly women. RESULTS: Although obese women had a higher prevalence of urinary incontinence than the normal and mild obese women, there were no significant differences in history of falls during the last year, or fear of falling. A high percentage of body fat was significantly associated with a higher level of instrumental activities of daily living (IADL) and intellectual activity disability, use of 3 or more medications, pain, and circumference (abdominal, hip, calf), and was associated with a lower level of balance and walking ability. According to the logistic model, history of hypertension (odds ratio (OR)=1.70, 95%confidence intervals (CI)=1.25-2.32), pain (OR=1.46, 95%CI=1.07-2.01), urinary incontinence (OR=1.44, 95%CI=1.08-1.92), SBP (OR=1.02, 95%CI=1.01-1.03), and usual walking speed (OR=0.43, 95%CI=0.24-0.75) were independent variables significantly associated with obesity. CONCLUSIONS: These cross-sectional data show that a higher percentage of body fat is associated with high prevalence of urinary incontinence, IADL and intellectual activity disability, and is related to lower level of walking ability and balance. The present study suggests that regular physical activity and weight control may contribute to the prevention of IADL disability and improvement of physical fitness in obese elderly women.     

The prevalence of hyperuricemia and its correlates in an inland Chinese adult population, urban and rural of Jinan

Economy has developed rapidly in China, and the clustering of cardiovascular risk factors in subjects increased remarkably over the past two decades. However, no data are available regarding the temporal prevalence of hyperuricemia and its correlates in this rapidly developing area, especially in the inland area. The cross-sectional survey was based on a random sample of 4,218 residents aged 35–64 years in the Jinan area. Hyperuricemia was defined as serum uric acid ≥416 μmol/L in men and ≥357 μmol/L in women. Subjects underwent physical examination and fasting blood testing. Complete data were available for analysis from 1,979 men and 2,062 women. The age-adjusted prevalence of hyperuricemia was 6.4 % for men and 2.1 % for women. The prevalence of hyperuricemia was greater in urban (6.7 %) than in rural areas (1.7 %) of Jinan city. Multivariate logistic regression models revealed hyperuricemia associated with hypertriglyceridemia [men: odds ratio (OR) = 6.101, 95 % confidence interval (CI) 4.064–9.159; women: OR = 7.103, 95 % CI 3.578–14.099] and high serum creatinine level (men: OR = 2.603, 95 % CI 1.602–4.230; women: OR = 5.237, 95 % CI 2.667–10.284). Hyperuricemia was also significantly associated with male sex, urban residence, hypertension, obesity, and hypercholesterolemia. Age (1-year increase) was negatively associated with hyperuricemia in men but positively associated with hyperuricemia in women. In conclusion, the prevalence of hyperuricemia is higher in urban than rural areas of Jinan, China. Male sex, urban residence, hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, and high serum creatinine level contributed to hyperuricemia in this population.     

普通人群尿白蛋白排泄率与血尿酸的关系

目的 探讨普通人群中尿白蛋白排泄率(UAE)与血尿酸之间的关系.方法 对象来自于北京市平谷区代谢综合征肾损害流行病学调查的受试者,共992例(男463例、女529例).留取8 h过夜尿且行问卷调查、体格检查和实验室检查.结果 (1)微量白蛋白尿患病率为12.9%,临床蛋白尿患病率为1.8%,高尿酸血症患病率为4.3%.高尿酸血症组的UAE异常比例(37.2%)明显高于尿酸正常组(13.7%,P＜0.01).(2)根据血尿酸水平的四分位数(25%、50%、75%)将受试者分成4组,男性中UAE异常比例分别为13.2%、13.9%、17.2%、25.4%,女性中UAE异常比例分别为8.4%、6.2%、9.6%、24.8%.(3)多因素logistic回归显示血尿酸为女性对象UAE升高的独立危险因素(OR=2.31,95%CI1.15～4.68;P=0.02),而男性中未见血尿酸的明显作用.除外肾功能下降受试者后,仍可得到类似结果.结论 随着血清尿酸水平的升高,UAE异常的患病率逐渐增加,血尿酸水平是UAE升高的独立危险因素,该危险性在女性人群中更为明显.

Abstract：

Objective To investigate the relationship between the urinary albumin excretion (UAE) and serum uric acid in general population. Methods The study participants were derived from the epidemiological study on the association of metabolic syndrome and chronic kidney disease (CKD) in Pinggu district, Beijing. A total of 992 participants (463 men and 529 women) aged from 30 to 75 years were enrolled in this study. For each participant, UAE, serum uric acid, serum creatinine, and serum lipids were detected and other potential risk factors for CKD were surveyed. Results ( 1 ) The frequencies of microalbuminuria, macroalbuminuria and hyperuricemia were 12.9% , 1.8% and 4.3% respectively. The persons with hyperuricemia had significantly higher frequency of albuminuria than those without hyperuricemia (37. 2% vs 13. 7% , P ＜0. 01). (2) The participants were divided according to the quartiles (25% , 50% , 75% ) of serum uric acid level, and the frequencies of albuminuria in males were 13. 2% , 13. 9% , 17. 2% and 25.4% , while those in females were 8. 4% , 6. 2% , 9. 6% and 24. 8%. ( 3 ) Multivariate logistic regression analysis showed, hyperuricemia was significantly associated with albuminuria in females (OR =2. 31, 95% CI 1. 15-4. 68; P=0.02), but not in males. If the persons with reduced renal function were excluded, similar result still could be gained. Conclusions The prevalence of albuminuria increases gradually with uric acid elevation. Serum uric acid is an independent risk factor of elevated UAE, especially in females.     

Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993-96)

OBJECTIVE: To evaluate the prevalence of hyperuricemia in Taiwan. METHODS: A multi-stage stratified sampling scheme was used in Nutrition and Health Survey, which was conducted in Taiwan between 1993 and 96. Complete biochemical and questionnaire data for 2754 males and 2953 females aged 4 years and older were included in the analysis. The colorimetric enzymatic method was used to measure plasma uric acid in fasting blood samples. Information on self-reported, physician-diagnosed gout was also obtained. RESULTS: The uric acid values of males were found to reach a peak between the ages of 13 and 18 and decrease slightly after 18. The uric acid values of females were stable before the age of 18, decreasing slightly between 19 and 44 years, and increasing in the mid to older age groups (> or = 45 years). Twenty-six percent of adult males (> or = 19 years) and 22% of older males (> or = 45 years) either had hyperuricemia (serum uric acid > 458.0 microM or 7.7 mg/dl) or were taking medication for it. Seventeen percent of adult females and 23% of older females either had hyperuricemia (serum uric acid > 392.57 microM or 6.6 mg/dl) or were taking medication for it. Both adult males and females in mountainous areas, who were primarily aboriginal, had the highest prevalence of hyperuricemia (> 50%) among the 7 survey areas. Mean body mass index (BMI), alcohol consumption, and prevalence of gout were among the highest in mountainous people compared to all included in the study. Multivariate analysis showed that mountainous area, age and BMI are important factors associated with hyperuricemia in males, whereas mountainous area, Class II townships, and BMI are the factors associated with hyperuricemia in females. CONCLUSIONS: We found a high prevalence of hyperuricemia in Han Chinese in Taiwan despite a lack both of obesity and high alcohol consumption. Mountainous people (mainly aborigines) in Taiwan have an even higher prevalence of hyperuricemia, which cannot be completely explained by obesity and alcohol consumption. Genetic components and other environmental factors may have contributed to this pattern of hyperuricemia.     

Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures.

BACKGROUND/AIMS: Only a few studies have assessed the epidemiology of non-alcoholic fatty liver disease (NAFLD). The aim was to evaluate the prevalence of primary NAFLD in a population-based study in Israel and to determine independent risk factors. METHODS: A cross-sectional study of a subsample of the Israeli national health survey (n=352). Individuals with a known etiology for secondary NAFLD were excluded. Each participant underwent an abdominal ultrasound, biochemical tests and an anthropometric evaluation. RESULTS: Three hundred and twenty-six subjects (53.4% male, mean age 50.5+/-10.3 standard deviaton [SD]) met the inclusion criteria. The prevalence of primary NAFLD was 30% (25-35% 95% confidence intervals [CI]). NAFLD was more prevalent in men than women (38% vs. 21%; P=0.001). Compared with ultrasonography, the sensitivity of serum alanine transaminase (ALT) for the diagnosis of primary NAFLD was 8.2%. Risk factors independently associated with NAFLD included male gender (odds ratios (OR)=2.8, 95% CI 1.5-5.3), abdominal obesity (OR=2.9, 95% CI 1.3-6.4), homeostasis model assessment (OR=5.8, 95% CI 2.0-17.2), hyperinsulinemia (OR=2.3, 95% CI 1.2-4.3, P=0.01) and hypertriglyceridemia (OR=2.4, 95% CI 1.3-4.5). CONCLUSIONS: NAFLD is prevalent in the general Israeli population and closely related to the metabolic syndrome. The use of ALT as a marker for NAFLD seriously underestimates its prevalence.     

Prevalence of metabolic syndrome in the Spanish working population: MESYAS registry

INTRODUCTION AND OBJECTIVES: To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD: Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS: Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS: One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.     

Sex-influenced association of non-alcoholic fatty liver disease with colorectal adenomatous and hyperplastic polyps

AIM To investigate the relationship between non-alcoholic fatty liver disease(NAFLD) and colorectal adenomatous and hyperplastic polyps.METHODS A retrospective cross-sectional study was conducted on 3686 individuals undergoing health checkups(2430 males and 1256 females). All subjects underwent laboratory testing,abdominal ultrasonography,colonoscopy,and an interview to ascertain the baseline characteristics and general state of health. Multinomial logistic regression analysis was performed to examine the association between NAFLD and the prevalence of colorectal adenomatous and hyperplastic polyps.Furthermore,the relationship was analyzed in different sex groups. Subgroup analysis was performed based on number,size,and location of colorectal polyps.RESULTS The prevalence of colorectal polyps was 38.8% in males(16.2% for adenomatous polyps and 9.8% for hyperplastic polyps) and 19.3% in females(8.4% for adenomatous polyps and 3.9% for hyperplastic polyps). When adjusting for confounding variables,NAFLD was significantly associated with the prevalence of adenomatous polyps(OR = 1.28,95%CI: 1.05-1.51,P 0.05) and hyperplastic polyps(OR = 1.35,95%CI: 1.01-1.82,P 0.05). However,upon analyzing adenomatous and hyperplastic polyps in different sex groups,the significant association remained in males(OR = 1.53,95%CI: 1.18-2.00,P 0.05; OR = 1.42,95%CI: 1.04-1.95,P 0.05) but not in females(OR = 0.44,95%CI: 0.18-1.04,P 0.05; OR = 1.18,95%CI: 0.50-2.78,P 0.05). CONCLUSION NAFLD is specifically associated with an increased risk of colorectal adenomatous and hyperplastic polyps in men. However,NAFLD may not be a significant factor in the prevalence of colorectal polyps in women.     

Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States

BACKGROUND & AIMS: In the absence of other causes, overweight and obesity increase the risk of liver disease. We examined whether central adiposity and metabolic markers explain the association of body mass index (BMI as kg/m(2)) with abnormal serum alanine aminotransferase (ALT) activity in a national, population-based study. METHODS: Adult participants (5724) in the third U.S. National Health and Nutrition Examination Survey (1988-1994) underwent anthropometric measures and phlebotomy after an overnight fast. Participants with excessive alcohol consumption, hepatitis B, hepatitis C, iron overload, or known diabetes were excluded. RESULTS: Elevated ALT levels were found in 2.8% of the population. In univariate analysis, factors associated with elevated ALT levels (P < 0.05) included younger age, male sex, Mexican-American ethnicity, and higher BMI, waist-to-hip circumference ratio (WHR), and fasting serum leptin, triglyceride, insulin, and glucose concentrations. The proportion of elevated ALT activity due to overweight and obesity (BMI > or =25 kg/m(2)) was 65%. In multivariate logistic regression analysis, control for WHR, demographic factors, and glucose concentration diminished but did not eliminate the association of higher BMI with elevated ALT activity. After adding leptin and insulin concentrations, abnormal ALT activity was most strongly associated with higher WHR (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.12-1.56) and leptin (OR, 1.12; 95% CI, 1.01-1.24) and insulin (OR, 1.27; 95% CI, 1.01-1.60) concentrations, whereas BMI was not independently related. CONCLUSIONS: In this large, national, population-based study, central adiposity, hyperleptinemia, and hyperinsulinemia were the major determinants of the association of overweight with elevated serum ALT activity.     

Clinical significance of hepatic derangement in severe acute respiratory syndrome

ABM: Elevation of alanine aminotransferase (ALT) level is commonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient. METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death. RESULTS: Two hundred and ninety-four patients were included in this study. Seventy (24%) patients had elevated serum ALT on admission and 204 (69%) patients had elevated ALT during the subsequent course of illness. Using peak ALT >5xULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peak ALT >5x ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P= 0.018), ICU care was 3.70 (95%CI 1.38-9.89, P= 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P= 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes. CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.     

High prevalence of hepatitis C virus infection in the largest province of Pakistan

OBJECTIVE: To estimate the prevalence and spectrum of hepatitis C virus (HCV) infection in the general population of Pakistan. METHODS: A total of 6817 blood samples were collected randomly from apparently healthy people in the Punjab, Pakistan from March 1999 to April 2001 and September 2006 to August 2007. Detailed socioeconomic information for each participant was recorded. All the samples were tested for anti-HCV antibodies and all seropositive samples were further tested for HCV RNA by polymerase chain reaction (PCR). RESULTS: Of the total 6817 serum samples tested, 998 (14.63%) were positive for anti-HCV antibodies. HCV RNA PCR was detected in 494 (49.50%) anti-HCV-positive samples. The prevalence of anti-HCV antibodies were significantly higher in males (15.09%) than in females (12.3%) (P < 0.009). A significant difference was also noted in the anti-HCV prevalence rate among different age groups tested (P < 0.01). In a multivariate logistic regression analysis, injected drug use (adjusted OR 6.6 [95%CI 4.1-9.9]), blood transfusion (adjusted OR 5.9 [95%CI 2.9-12.3]), pricked with a needle (adjusted OR 2.2 [95%CI 1.6-3.1]), re-use of syringes (adjusted OR 1.7 [95%CI 0.8-3.6]) and being over 35 years old (adjusted OR 1.3 [95%CI 0.9-1.9]) were independent risk factors for HCV infection. CONCLUSION: The study showed a high seroprevalence of anti-HCV antibodies in a general and apparently healthy population of the Punjab province of Pakistan. Drug injection, blood transfusion and needle stuck were the factors most strongly associated with HCV infection.     

代谢相关性脂肪性肝病患者发生明显肝纤维化的危险因素研究

目的分析经肝活检确诊的代谢相关性脂肪性肝病(metabolic associated fatty liver disease, MAFLD)患者发生明显肝纤维化的危险因素。方法回顾性分析193例经肝活检确诊的MAFLD患者发生明显肝纤维化的危险因素。结果与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者中女性比例更高、年龄更大、肥胖更多见、伴高血压病者更多(P均<0.05);与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者外周血中血红蛋白水平及血小板计数更低(P<0.05),血清中白蛋白及尿酸水平更低(P<0.05),而TBA及空腹血糖水平更高(P<0.05)。单因素回归分析发现,女性(OR=2.277, 95%CI:1.181~4.390)、高血压病(OR=3.305, 95%CI:1.606~6.801)、BMI(OR=1.083, 95%CI:1.006~1.167)、年龄(OR=1.030,95%CI:1.006~1.055)、血红蛋白(OR=0.978,95%CI:0.958~0.997)及血小板计数(OR=0.998,95%CI:0.989~1.000)是MAFLD患者发生明显肝纤维化的危险因素,而多因素回归分析发现,高血压病(OR=2.662,95%CI:1.092~6.489)、BMI(OR=1.163,95%CI:1.062~1.275)及血小板计数(OR=0.993,95%CI:0.987~0.999)是MAFLD患者发生明显肝纤维化的独立危险因素。结论高血压、BMI及血小板计数是肝活检确诊的MAFLD患者发生明显肝纤维化的独立危险因素。