Gut and Liver (Jul 2024)
The Association between Educational Attainment and the Risk of Nonalcoholic Fatty Liver Disease among Chinese Adults: Findings from the REACTION Study
- Yuanyue Zhu,
- Long Wang,
- Lin Lin,
- Yanan Huo,
- Qin Wan,
- Yingfen Qin,
- Ruying Hu,
- Lixin Shi,
- Qing Su,
- Xuefeng Yu,
- Li Yan,
- Guijun Qin,
- Xulei Tang,
- Gang Chen,
- Shuangyuan Wang,
- Hong Lin,
- Xueyan Wu,
- Chunyan Hu,
- Mian Li,
- Min Xu,
- Yu Xu,
- Tiange Wang,
- Zhiyun Zhao,
- Zhengnan Gao,
- Guixia Wang,
- Feixia Shen,
- Xuejiang Gu,
- Zuojie Luo,
- Li Chen,
- Qiang Li,
- Zhen Ye,
- Yinfei Zhang,
- Chao Liu,
- Youmin Wang,
- Shengli Wu,
- Tao Yang,
- Huacong Deng,
- Lulu Chen,
- Tianshu Zeng,
- Jiajun Zhao,
- Yiming Mu,
- Weiqing Wang,
- Guang Ning,
- Yufang Bi,
- Yuhong Chen,
- Jieli Lu
Affiliations
- Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Long Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Lin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yanan Huo
- Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
- Qin Wan
- The Affiliated Hospital of Luzhou Medical College, Luzhou, China
- Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Lixin Shi
- Affiliated Hospital of Guiyang Medical University, Guiyang, China
- Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Xulei Tang
- The First Hospital of Lanzhou University, Lanzhou, China
- Gang Chen
- Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
- Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xueyan Wu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China
- Guixia Wang
- The First Hospital of Jilin University, Changchun, China
- Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Xuejiang Gu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Li Chen
- Qilu Hospital of Shandong University, Jinan, China
- Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Yinfei Zhang
- Central Hospital of Shanghai Jiading District, Shanghai, China
- Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
- Youmin Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Shengli Wu
- Karamay Municipal People’s Hospital, Xinjiang, China
- Tao Yang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Huacong Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Lulu Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Tianshu Zeng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Jiajun Zhao
- Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
- Yiming Mu
- Chinese People’s Liberation Army General Hospital, Beijing, China
- Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- DOI
- https://doi.org/10.5009/gnl230220
- Journal volume & issue
-
Vol. 18,
no. 4
pp. 719 – 728
Abstract
Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusion : s: In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.
Keywords
