Article Figures & Data
Figures
- Figure 1
- Flow diagram of the studies’ enrollment and geographical regions of China. A) Flow diagram of the studies’ enrollment by PRISMA. B) The geographical regions of China included in this meta-analysis.
- Figure 2
- Forest plot for the lean/nonobese NAFLD prevalence by meta-analysis. A) NAFLD prevalence in lean subjects of China. B) NAFLD prevalence in nonobese subjects of China.
- Figure 3
- Summary of subgroup analysis of NAFLD prevalence by different BMI cut-offs, regions, genders, study year, and population source. A) NAFLD prevalence in lean/nonobese population by different BMI cut-offs, regions, and population source. B) NAFLD prevalence in lean/nonobese population by study year. C) NAFLD prevalence in lean/nonobese men or women of China by different BMI cut-offs. *Sample size refers to the total number of lean/nonobese subjects in the study. BMI: body mass index, CI: confidence interval, NAFLD: nonalcoholic fatty liver disease
- Appendix 3
- Funnel plot of publication bias. A) Funnel plot of the 25 original studies included in the analysis. B) Funnel plot of the 25 original studies included in the analysis (black dots) and the missing studies imputed by the trim-and-fill procedure (white dots).
- Appendix 5
- Subgroup analysis of NAFLD prevalence in lean/nonobese population by different regions. A) Studies in north China. B) Studies in south China
- Appendix 6
- Subgroup analysis of NAFLD prevalence in lean/nonobese Chinese population by source of population. A) Studies based on population. B) Studies based on health check-up.
Tables
References Region Population Diagnostics used N NAFLD prevalence (%) Overall In lean In nonobese Zhang YN et al17 Zhejiang Health checkup Ultrasonography 6285 10.4% Li C et al18 Heilongjiang Health checkup Ultrasonography 1779 50.5% 18.3% Wang Q et al19 Zhejiang Health checkup Ultrasonography 2538 33.6% 13.1% Xu C et al20 Zhejiang Population based Ultrasonography 6905 7.3% Wei JL et al21 Hong Kong Population based H-MRS 911 28.8% 19.3% Zeng J et al22 Shanghai Health checkup Ultrasonography 2715 40.5% 21.4% 28.1% Zheng X et al23 Chongqing Health checkup Ultrasonography 95924 8.2% Luo Z et al24 Chongqing Health checkup Ultrasonography 34306 3.4% Wang L et al25 Shanghai Health checkup Ultrasonography 8817 29.0% 7.1% Li Y et al26 Zhejiang Population based Ultrasonography 9767 8.6% Li Q et al27 Shanghai Population based Ultrasonography 2668 10.9% Lu Z et al28 Zhejiang Health checkup Ultrasonography 5916 11.7% Lin H et al29 Hong Kong Population based H-MRS 904 28.6% 12.5% 19.2% Wong VWS et al30 Hong Kong Population based H-MRS 565 13.8% 8.0% 11.2% Chen CH et al31 Taiwan Population based Ultrasonography 1444 11.5% Huang JF et al32 Taiwan Health checkup Ultrasonography 2483 44.5% 26.2% Hsu CL et al33 Taiwan Health checkup Ultrasonography 4000 18.5% Zou Y et al34 Zhejiang Health checkup Ultrasonography 12127 17.7% You G et al35 Shandong Health checkup Ultrasonography 2029 16.6% Wu L et al36 Zhejiang Health checkup Ultrasonography 11906 17.2% Lu CW et al37 Taiwan Population based Ultrasonography 606 32.2% Xiao SJ et al38 Chongqing Health checkup Ultrasonography 18676 22.0% 6.5% Lee SW et al39 Taiwan Health checkup Ultrasonography 2008 24.5% 10.4% Wang Z et al40 Hubei Health checkup Ultrasonography 25032 24.6% 12.2% Hu PF et al41 Shanghai Population based Ultrasonography 3717 32.7% 16.3% NAFLD: nonalcoholic fatty liver disease, H-MRS: H-magnetic resonance spectroscopy
- Table 2
- Multivariable meta-regression of included studies to identify heterogeneous sources affecting the prevalence of nonobese nonalcoholic fatty liver disease in China.
Covariate Coefficient Standard error Lower bound Upper bound P-values Study year 0.0789 0.0283 0.0234 0.1344 0.0053* Region -0.0288 0.0646 -0.1555 0.0979 0.6558 Population type -0.0677 0.0442 -0.1542 0.0189 0.1256 Diagnostic methods 0.0667 0.0779 -0.0860 0.2193 0.3920 BMI cut-offs 0.0509 0.0241 0.0037 0.0981 0.0346* Sample size -0.0573 0.0178 -0.0922 -0.0224 0.0013* ↵* Statistically significant. BMI: body mass index
- Table 3
- Comparison of characteristics between lean/nonobese and overweight/obese nonalcoholic fatty liver disease patients.
Events Estimation of merged value Mean difference Lean/nonobese Overweight/obese OR (95% CI) I2 P-values Male 52.7% 66.4% 0.61 (0.44-0.83) 89.0% 0.0020* Hypertension 41.4% 57.8% 0.44 (0.34-0.56) 0.0% <0.0001* Type 2 diabetes mellitus 12.6% 15.9% 0.88 (0.57-1.34) 0.0% 0.5427 Age, years (median range) 49.95 (42.60-54.84) 50.06 (43.70-56.44) 0.27(-0.29-0.84) 56.4% 0.3506 Systolic BP (mmHg) 128.86 (121.60- 137.81) 136.09 (130.40-142.85) -7.34 (-9.22-5.45) 79.1% <0.0001* Diastolic BP (mmHg) 80.48 (77.20- 85.22) 84.98 (82.20-91.00) -4.45(-5.88-3.02) 55.4% <0.0001* Waist circumference(cm) 80.63 (76.27 - 85.00) 92.73 (90.80-94.00) -12.13 (-14.21-10.04) 97.3% <0.0001* Fasting plasma glucose(mmol/L) 5.53 (4.74-5.91) 5.69 (5.23-6.02) -0.17(-0.33-0.01) 68.1% 0.0379* Uric acid (μmol/L) 339.14 (305.66- 378.81) 365.46 (311.17-415.80) -26.85 (-46.76-6.95) 89.0% 0.0082* Triglycerides (mmol/L) 1.63 (1.23-2.02) 1.94 (1.81-2.17) -0.30 (-0.51-0.09) 70.0% 0.0047* Total cholesterol(mmol/L) 5.14 (4.88-5.40) 5.13 (4.93-5.30) -0.005 (-0.06; 0.05) 0.0% 0.8633 LDL cholesterol(mmol/L) 3.07 (2.83-3.24) 3.12 (2.79-3.48) -0.023 (-0.066-0.0196) 1.0% 0.2866 HDL cholesterol(mmol/L) 1.33 (1.12-1.48) 1.26 (1.04-1.35) 0.073 (0.005-0.141) 88.3% 0.0347* ALT (IU/L) 30.28 (28.21-34.0) 33.12 (30.78-37.00) -3.14 (-5.46-0.82) 0.0% 0.0081* GGT (IU/L) 29.91 (24.31-35.50) 43.68 (40.49-46.87) -13.94 (-31.16-3.27) 95.9% 0.1124 ↵* Indicates statistically significant. The overweight/obese group is the reference group, and the mean difference or OR is calculated as lean/nonobese versus overweight/obese. NAFLD: nonalcoholic fatty liver disease, OR: odds ratio, ALT: alanine aminotransferase, BMI: body mass index, BP: blood pressure, GGT: γ-glutamyl transferase, HDL: high-density lipoprotein cholesterol, LDL: low-density lipoprotein cholesterol, MD: standardized mean difference, CI: confidence interval
- Appendix 1
- Quality assessment of included studies in the epidemiology of lean/nonobese NAFLD in China using the JBI-prevalence critical appraisal checklist.14
Studies Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Zhang et al17 Y Y Y Y Y Y Y Y NA Li et al18 Y Y Y Y Y Y Y Y NA Wang et al19 Y Y Y Y Y Y Y Y NA Xu et al20 Y Y Y Y Y Y Y Y NA Wei et al21 Y Y Y Y Y Y Y Y NA Zeng et al22 Y Y Y Y Y Y Y Y NA Zheng et al23 Y Y Y Y Y Y Y Y NA Luo et al24 Y Y Y Y Y Y Y Y NA Wang et al25 Y Y Y Y Y Y Y Y NA Li et al26 Y Y Y Y Y Y Y Y NA Li et al27 Y Y Y Y Y Y Y Y NA Lu et al28 Y Y Y Y Y Y Y Y NA Lin et al29 Y Y Y Y Y Y Y Y NA Wong et al30 Y Y Y Y Y Y Y Y NA Chen et al31 Y Y Y Y Y Y Y Y NA Huang et al32 Y Y Y Y Y Y Y Y NA Hsu et al33 Y Y Y Y Y Y Y Y NA You et al34 Y Y Y Y Y Y Y Y NA Zou et al35 Y Y Y Y Y Y Y Y NA Wu et al36 Y Y Y Y Y Y Y Y NA Lu et al37 Y Y Y Y Y Y Y Y NA Xiao et al38 Y Y Y Y Y Y Y Y NA Lee et al39 Y Y Y Y Y Y Y Y NA Wang et al40 Y Y Y Y Y Y Y Y NA Hu et al41 Y Y Y Y Y Y Y Y NA Y: yes, N: no, U: unclear, NA: not applicable
Databases and trial registers Citations Pubmed 748 Embase 3518 The Cochrane Library 30 Web of Science 4413 Total 8709 - Appendix 4
- Egger’s test of subgroups for meta-analysis of clinical characteristics between lean (or non-obese) vs. non-lean or (obese) NAFLD patients.
Subgroups Number of studies P-values The proportion of males 8 0.9417 The prevalence of hypertension 3 0.9795 Age 6 0.3531 Systolic pressure 6 0.2077 Diastolic pressure 6 0.9027 Waist circumference 6 0.0971 Fasting plasma glucose level 6 0.8471 Uric acid level 3 0.5153 Triglyceride level 4 0.2522 Total cholesterol level 5 0.8127 Low-density lipoprotein level 6 0.5453 High-density lipoprotein level 6 0.4959 Alanine transaminase 3 0.0774
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