{
  "abstract": "Background Chronic liver disease is increasingly driven by metabolic dysfunction worldwide. China, home to the world’s largest population with metabolic disorders, lacks large-scale community-based data on liver fibrosis and steatotic liver disease (SLD). This study aimed to estimate the vibration-controlled transient elastography (VCTE)-based prevalence of liver fibrosis and steatotic liver disease (SLD) among community-dwelling adults in China.Methods The LiverHealth project is a prospective, investigator-initiated, community-based cohort conducted across 18 sites in 13 provinces in China between September 2024 and January 2026. Community-dwelling adults aged ≥18 years were enrolled. SLD was defined using controlled attenuation parameter (CAP) thresholds of ≥248 dB/m (≥S1), ≥268 dB/m (≥S2), and ≥280 dB/m (S3). Participants were further categorized into metabolic dysfunction–associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), and alcohol-related liver disease (ALD). Significant fibrosis, compensated advanced chronic liver disease (cACLD), and advanced fibrosis were defined as liver stiffness measurement (LSM) ≥8 kPa, ≥10 kPa, and ≥12 kPa, respectively. The potential aetiologies of liver fibrosis were classified using a hierarchical framework with priority given to viral hepatitis, followed by alcohol-related liver fibrosis, metabolic-related liver fibrosis, and other causes.Results A total of 25,805 community-dwelling adults were enrolled (median age 51.0 years; 44.8% men). The prevalence of steatosis was 43.7% for ≥S1, 30.7% for ≥S2, and 24.3% for S3. MASLD, MetALD, and ALD were present in 39.4%, 2.0%, and 1.6% of participants, respectively. Significant fibrosis, cACLD, and advanced fibrosis were identified in 4.4%, 1.6%, and 0.8% of individuals, respectively ( IDDF2026-ABS-0345 Figure 1). In multivariable analyses, male sex, older age, higher body mass index, larger waist circumference, heavy alcohol consumption, diabetes, hypertension, and dyslipidaemia were independently associated with both steatosis and liver fibrosis (IDDF2026-ABS-0345 Table 1). Metabolic-related liver fibrosis accounted for most fibrosis cases across disease stages (78.7% of significant fibrosis, 73.2% of cACLD, and 68.8% of advanced fibrosis) (IDDF2026-ABS-0345 Figure 2).Conclusions Liver fibrosis and SLD are highly prevalent in the Chinese community. These estimates correspond to nearly 49 million adults with significant fibrosis in China, with metabolic dysfunction accounting for most of the fibrosis burden. These findings indicate CLD as a major public health problem in China.Abstract IDDF2026-ABS-0345 Table 1Steatotic liver disease (CAP ≥ 248 dB/m)Significant fibrosis (LSM ≥ 8 kPa)UnivariateMultivariateUnivariateMultivariateSex Female1 (ref)1 (ref)1 (ref)1 (ref) Male1.71 (1.62-1.79)1.66 (1.57-1.76)1.62 (1.44-1.83)1.53 (1.34-1.76)Age groups, years18-391 (ref)1 (ref)1 (ref)1 (ref)40-591.44 (1.35-1.53)1.44 (1.35-1.54)1.39 (1.19-1.63)1.40 (1.18-1.67)≥601.48 (1.38-1.58)1.45 (1.34-1.56)1.91 (1.62-2.26)1.92 (1.60-2.32)Ethnicity Others1 (ref)1 (ref)1 (ref)1 (ref) Han1.16 (1.05-1.28)1.10 (0.99-1.22)0.98 (0.75-1.27)1.06 (0.80-1.42)Marital status Others1 (ref)1 (ref)1 (ref)1 (ref) Married/Living with partner1.25 (1.17-1.33)1.10 (1.02-1.18)1.02 (0.86-1.20)0.8. (0.66-0.96)Education Below high school graduation1 (ref)1 (ref)1 (ref)1 (ref) High school graduation or above0.93 (0.88-0.97)0.97 (0.91-1.03)0.86 (0.76-0.97)1.01 (0.87-1.16)Hukou Non-agricultural1 (ref)1 (ref)1 (ref)1 (ref) Agricultural0.95 (0.89-1.00)0.91 (0.85-0.96)0.94 (0.82-1.09)0.91 (0.78-1.06)Current smoking No1 (ref)1 (ref)1 (ref)1 (ref) Yes1.47 (1.38-1.57)1.08 (1.00-1.17)1.31 (1.13-1.52)1.04 (0.88-1.23)Alcohol consumption Low or no consumption1 (ref)1 (ref)1 (ref)1 (ref) Moderate consumption1.52 (1.33-1.73)1.14 (1.00-1.31)1.09 (0.81-1.47)0.88 (0.65-1.20) Heavy consumption1.77 (1.53-2.06)1.34 (1.15-1.57)2.12 (1.62-2.76)1.80 (1.36-2.37)BMI groups Normal1 (ref)1 (ref)1 (ref)1 (ref) Underweight0.18 (0.12-0.25)0.19 (0.13-0.27)0.83 (0.46-1.48)0.92 (0.51-1.66) Overweight3.93 (3.69-4.17)3.73 (3.51-3.97)1.66 (1.41-1.96)1.53 (1.29-1.80) Obesity11.72 (10.77-12.74)11.26 (10.34-12.26)4.86 (4.14-5.70)4.61 (3.91-5.44)Central obesity No central obesity1 (ref)1 (ref)1 (ref)1 (ref) Central obesity4.62 (4.37-4.88)4.71 (4.45-4.99)2.80 (2.44-3.21)2.72 (2.37-3.12) Severe central obesity6.97 (6.46-7.53)8.35 (7.70-9.05)4.14 (3.55-4.83)4.71 (4.01-5.54)Diabetes status No prediabetes1 (ref)1 (ref)1 (ref)1 (ref) Prediabetes2.13 (2.01-2.25)2.12 (2.00-2.25)1.50 (1.29-1.73)1.41 (1.21-1.64) Diabetes3.37 (3.12-3.65)3.23 (2.97-3.52)3.69 (3.18-4.29)3.27 (2.78-3.86)Hypertension No1 (ref)1 (ref)1 (ref)1 (ref) Yes2.24 (2.13-2.36)2.00 (1.89-2.12)2.23 (1.97-2.53)1.92 (1.68-2.20)Dyslipidemia No1 (ref)1 (ref)1 (ref)1 (ref) Yes3.07 (2.91-3.24)2.81 (2.66-2.97)1.57 (1.39-1.77)1.47 (1.30-1.67)Chronic viral hepatitis No1 (ref)1 (ref)1 (ref)1 (ref) Yes0.74 (0.66-0.83)0.68 (0.60-0.76)2.75 (2.27-3.34)2.60 (2.14-3.15)Number of cardiometabolic risk factors 01 (ref)1 (ref)1 (ref)1 (ref) 13.95 (3.32-4.71)4.18 (3.50-4.98)1.44 (1.00-2.06)1.31 (0.91-1.89) 29.78 (8.26-11.58)10.77 (9.06-12.79)1.94 (1.38-2.72)1.62 (1.14-2.30) 319.16 (16.18-22.67)21.80 (18.32-25.95)3.29 (2.37-4.56)2.68 (1.91-3.77) 431.83 (26.75-37.88)36.73 (30.69-43.96)4.44 (3.19-6.18)3.68 (2.61-5.20) 549.48 (40.78-60.03)60.57 (49.61-73.96)6.71 (4.75-9.48)5.71 (3.98-8.19)Abstract IDDF2026-ABS-0345 Figure 1Abstract IDDF2026-ABS-0345 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Zhongda Hospital, Medical School, Southeast University, China"
      ],
      "name": "Shanghao Liu"
    },
    {
      "affiliations": [
        "People’s Hospital of Huanghua, China"
      ],
      "name": "Xibin Liu"
    },
    {
      "affiliations": [
        "Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng Third People’s Hospital, China"
      ],
      "name": "Jianxiang Song"
    },
    {
      "affiliations": [
        "Zhongda Hospital, Medical School, Southeast University, China"
      ],
      "name": "Yilin Zhang"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Kangda College of Nanjing Medical University",
        "The Affiliated Lianyungang Hospital of Xuzhou Medical University",
        "Lianyungang Clinical College of Nanjing Medical University, China"
      ],
      "name": "Hui Shi"
    },
    {
      "affiliations": [
        "China National Health Development Research Center, China"
      ],
      "name": "Erdan Huang"
    },
    {
      "affiliations": [
        "Bozhou People’s Hospital, China"
      ],
      "name": "Lan Ma"
    },
    {
      "affiliations": [
        "Qingdao Public Health Clinical Center, China"
      ],
      "name": "Yuxia Qi"
    },
    {
      "affiliations": [
        "General Hospital of Ningxia Medical University, China"
      ],
      "name": "Yang Bo"
    },
    {
      "affiliations": [
        "Xuzhou Infectious Diseases Hospital, China"
      ],
      "name": "Ruyu Liu"
    },
    {
      "affiliations": [
        "Taihe Hospital, China"
      ],
      "name": "Yijun Tang"
    },
    {
      "affiliations": [
        "Lishui Central Hospital, China"
      ],
      "name": "JianSong Ji"
    },
    {
      "affiliations": [
        "Pu County People’s Hospital, China"
      ],
      "name": "Puqiang Liu"
    },
    {
      "affiliations": [
        "Baiyin Central Hospital, China"
      ],
      "name": "Yan Yang"
    },
    {
      "affiliations": [
        "Shenzhen Third People’s Hospital, China"
      ],
      "name": "Qing He"
    },
    {
      "affiliations": [
        "Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, China"
      ],
      "name": "Wenjuan Wang"
    },
    {
      "affiliations": [
        "Yichun People’s Hospital, China"
      ],
      "name": "Huizhen Fan"
    },
    {
      "affiliations": [
        "Huzhou Central Hospital, China"
      ],
      "name": "Qiang Yan"
    },
    {
      "affiliations": [
        "Sir Run-Run Shaw Hospital, China"
      ],
      "name": "Xiao Liang"
    },
    {
      "affiliations": [
        "The Second Affiliated Hospital of Guangzhou Medical University, China"
      ],
      "name": "Hui Yang"
    },
    {
      "affiliations": [
        "Mengchao Hepatobiliary Hospital of Fujian Medical University, China"
      ],
      "name": "Kunyu Ke"
    },
    {
      "affiliations": [
        "Medical Department of Shihezi City People’s Hospital, China"
      ],
      "name": "Xiongwei He"
    },
    {
      "affiliations": [
        "Zhengzhou Central Hospital Affiliated to Zhengzhou University, China"
      ],
      "name": "Yanhong Liu"
    },
    {
      "affiliations": [
        "Tangdu Hospital, China"
      ],
      "name": "Wen Kang"
    },
    {
      "affiliations": [
        "Chongqing University Fuling Hospital, China"
      ],
      "name": "Chaoyong Wang"
    },
    {
      "affiliations": [
        "People’s Hospital of Huanghua, China"
      ],
      "name": "Haiying Feng"
    },
    {
      "affiliations": [
        "Yandu District Health Commission of Yancheng, China"
      ],
      "name": "Zhiyong Li"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Kangda College of Nanjing Medical University",
        "The Affiliated Lianyungang Hospital of Xuzhou Medical University",
        "Lianyungang Clinical College of Nanjing Medical University, China"
      ],
      "name": "Caihong Gu"
    },
    {
      "affiliations": [
        "Bozhou People’s Hospital, China"
      ],
      "name": "Liping Wang"
    },
    {
      "affiliations": [
        "Qingdao Public Health Clinical Center, China"
      ],
      "name": "Jie Liu"
    },
    {
      "affiliations": [
        "General Hospital of Ningxia Medical University, China"
      ],
      "name": "Jing Wang"
    },
    {
      "affiliations": [
        "Xuzhou Infectious Diseases Hospital, China"
      ],
      "name": "Kai Hu"
    },
    {
      "affiliations": [
        "Taihe Hospital, China"
      ],
      "name": "Zhongji Meng"
    },
    {
      "affiliations": [
        "The Fifth Affiliated Hospital of Wenzhou Medical University, China"
      ],
      "name": "Lili Ye"
    },
    {
      "affiliations": [
        "Pu County People’s Hospital, China"
      ],
      "name": "Jianping Zhang"
    },
    {
      "affiliations": [
        "Baiyin Central Hospital, China"
      ],
      "name": "Yinyu Gao"
    },
    {
      "affiliations": [
        "Baiyin City Central Hospital, China"
      ],
      "name": "Jianquan Wu"
    },
    {
      "affiliations": [
        "Central Hospital of Baiyin City, China"
      ],
      "name": "Xiufeng Zhang"
    },
    {
      "affiliations": [
        "Shenzhen Third People’s Hospital, China"
      ],
      "name": "Fengjuan Chen"
    },
    {
      "affiliations": [
        "Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, China"
      ],
      "name": "Guo Zhang"
    },
    {
      "affiliations": [
        "Yichun People’s Hospital, China"
      ],
      "name": "Jianwen Sheng"
    },
    {
      "affiliations": [
        "Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University, China"
      ],
      "name": "Zhaowei Tong"
    },
    {
      "affiliations": [
        "Sir Run-Run Shaw Hospital, China"
      ],
      "name": "Yongfen Zhu"
    },
    {
      "affiliations": [
        "The Second Affiliated Hospital of Guangzhou Medical University, China"
      ],
      "name": "Yajuan Zhao"
    },
    {
      "affiliations": [
        "Mengchao Hepatobiliary Hospital of Fujian Medical University, China"
      ],
      "name": "Junchao Zhang"
    },
    {
      "affiliations": [
        "Medical Department of Shihezi City People’s Hospital, China"
      ],
      "name": "Jiangwen Liu"
    },
    {
      "affiliations": [
        "Zhengzhou Central Hospital Affiliated to Zhengzhou University, China"
      ],
      "name": "Lidong Xu"
    },
    {
      "affiliations": [
        "Tangdu Hospital, China"
      ],
      "name": "Jing Huang"
    },
    {
      "affiliations": [
        "Chongqing University Fuling Hospital, China"
      ],
      "name": "Yani Shi"
    },
    {
      "affiliations": [
        "Sun Yat-sen University, China"
      ],
      "name": "Xinrong Zhang"
    },
    {
      "affiliations": [
        "Beijing Friendship Hospital, China"
      ],
      "name": "Xinyu Zhao"
    },
    {
      "affiliations": [
        "The Chinese University of Hong Kong, China"
      ],
      "name": "Vincent Wai-Sun Wong"
    },
    {
      "affiliations": [
        "Huashan Hospital, China"
      ],
      "name": "Wenhong Zhang"
    },
    {
      "affiliations": [
        "Zhongda Hospital, Medical School, Southeast University, China"
      ],
      "name": "Gao-Jun Teng"
    },
    {
      "affiliations": [
        "Odense University Hospital, Denmark"
      ],
      "name": "Aleksander Krag"
    },
    {
      "affiliations": [
        "Liver Unit Hospital Clínic, University of Barcelona, Spain"
      ],
      "name": "Pere Ginès"
    },
    {
      "affiliations": [
        "Zhongda Hospital, Medical School, Southeast University, China"
      ],
      "name": "Xiaolong Qi"
    }
  ],
  "title": "IDDF2026-ABS-0345 High prevalence of liver fibrosis and steatotic liver disease among community-dwelling adults in China: results from the prospective liverhealth project in 25,805 participants",
  "uid": "43d75869-5100-5271-94f6-fabf440f7e84"
}