Gut Liver.
2024 Jul;18(4):719-728. 10.5009/gnl230220.
The Association between Educational Attainment and the Risk of Nonalcoholic Fatty Liver Disease among Chinese Adults: Findings from the REACTION Study
- Zhu Y
1,2 - Wang L1,2
- Lin L1,2
- Huo Y3
- Wan Q4
- Qin Y5
- Hu R6
- Shi L7
- Su Q8
- Yu X9
- Yan L10
- Qin G11
- Tang X12
- Chen G13
- Wang S1,2
- Lin H1,2
- Wu X1,2
- Hu C1,2
- Li M1,2
- Xu M1,2
- Xu Y1,2
- Wang T1,2
- Zhao Z1,2
- Gao Z14
- Wang G15
- Shen F16
- Gu X16
- Luo Z5
- Chen L17
- Li Q18
- Ye Z6
- Zhang Y19
- Liu C20
- Wang Y21
- Wu S22
- Yang T23
- Deng H24
- Chen L25
- Zeng T25
- Zhao J26
- Mu Y27
- Wang W1,2
- Ning G1,2
- Bi Y1,2
- Chen Y1,2
- Lu J1,2
- Affiliations
-
- 1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 3Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
- 4The Affiliated Hospital of Luzhou Medical College, Luzhou, China
- 5The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- 6Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- 7Affiliated Hospital of Guiyang Medical University, Guiyang, China
- 8Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 9Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 10Sun Yat-sen Memorial Hospital, Sun Yatsen University, Guangzhou, China
- 11The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 12The First Hospital of Lanzhou University, Lanzhou, China
- 13Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
- 14Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China
- 15The First Hospital of Jilin University, Changchun, China
- 16The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- 17Qilu Hospital of Shandong University, Jinan, China
- 18The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- 19Central Hospital of Shanghai Jiading District, Shanghai, China
- 20Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
- 21The First Affiliated Hospital of Anhui Medical University, Hefei, China
- 22Karamay Municipal People’s Hospital, Xinjiang, China
- 23The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 24The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 25Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 26Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
- 27Chinese People’s Liberation Army General Hospital, Beijing, China
- KMID: 2558177
- DOI: http://doi.org/10.5009/gnl230220
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.
Conclusions
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.
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