Prevalence and risk factors associated with hepatic fibrosis in general population, as defined by MR elastography

Abstract

Background:

Liver fibrosis is the most important histologic feature associated with long-term outcome in chronic liver disease. However, data on the prevalence of liver fibrosis in the general population are scarce, owing to the fact that liver biopsy is neither feasible nor ethical in the community setting. Using the most accurate tool available, magnetic resonance elastography (MRE), we investigated the prevalence and risk factors of significant fibrosis in a community-based cohort.

Methods:

The study analyzed 2,170 participants who underwent the MR chemical shift technique and MRE at the clinics of the Kangbuk Samsung Hospital Healthcare Screening Center in Seoul and Suwon, South Korea. We also conducted subgroup analyses for participants with non-alcoholic fatty liver disease (NAFLD), metabolic syndrome, and diabetes mellitus (DM). For generalization, sex-and age-standardized prevalence estimates were calculated based on the Korean Statistical Information Service (KOSIS) in 2015-2018.

Results:

The prevalence of F2 (≥3.0 kPa) and F3 fibrosis (≥3.6 kPa) in the overall cohort was 5.1% and 1.3%, respectively (sex-and age-adjusted prevalence of 3.8% and 1.3%). NAFLD prevalence (>5% fat fraction) was 27.7% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 8.0% and 1.5%, respectively. In participants with diabetes, 12.5% had ≥F2 and 4.3% ≥F3. In participants with fatty liver plus diabetes, 23.3% had ≥F2 and 7.5% ≥F3. On multivariate analysis, only age, insulin, diabetes and fatty liver on MR were independently associated with significant fibrosis.

Conclusion:

In general population, the prevalence of significant and advanced fibrosis was 5.1% and 1.3% (sex-and age-adjusted prevalence of 3.8% and 1.3%, respectively). The presence of diabetes, especially in concurrent presence of steatosis, resulted in increased prevalence of hepatic fibrosis.