Background
Methods
Study design and population
Study tool
Ultrasound
Cardiovascular disease probability risk
Sample size determination
Sampling method and patient recruitment
Data collection
Study procedure
Anthropometric measurements
Blood investigations
Ultrasound
Framingham risk score
Data entry and statistical analysis
Results
Recruitment of participants
Prevalence of NAFLD according to the socio-demographics and clinical characteristics
Variables | NAFLD Status* | Total, N = 263 (%)** | Chi-squarea (df)/t-testb (df) | P-value*** | OR (95% CI)/Mean diff (95% CI)b | |
---|---|---|---|---|---|---|
Prevalence | Yes (n = 143, 54.4%) | No (n = 120, 45.6%) | ||||
Age (years): (Mean ± SD) | 53.31 (±13.34) | 51.04 (±16.15) | -1.246b (261) | 0.214 | −2.27 (− 5.85,1.31)b | |
Age Classification: n (%) | ||||||
18–29 | 7 (30.4) | 16 (69.6) | 23 (8.7) | 11.97(4)a | 0.018 | 1 |
30–39 | 21 (45.7) | 25 (54.3) | 46 (17.5) | 0.37(0.14,0.96) | ||
40–49 | 21 (72.4) | 8 (27.6) | 29 (11.0) | 0.70(0.35,1.40) | ||
50–59 | 32 (62.7) | 19 (37.3) | 51 (19.4) | 2.20(0.90,5.38) | ||
≥ 60 | 62 (54.4) | 52 (45.6) | 114 (43.4) | 1.41(0.72,2.78) | ||
Gender: n (%) | ||||||
Female | 60 (45.8) | 71 (54.2) | 131 (49.8) | 1 | ||
Male | 83 (62.9) | 49 (37.1) | 132 (50.2) | 7.729 (1)a | 0.005 | 2.00(1.23,3.28) |
Marital Status: n (%) | ||||||
Single | 17 (58.5) | 24 (41.5) | 41 (15.6) | 3.310 (2)a | 0.192 | 1 |
Married | 119 (56.9) | 90 (43.1) | 209 (79.5) | 0.61(0.17,2.13) | ||
Divorced/Widowed | 7 (53.8) | 6 (46.2) | 13 (4.9) | 1.13(0.37,3.49) | ||
Ethnicity: n (%) | ||||||
Malay | 111 (52.9) | 99 (47.1) | 210 (79.8) | 2.865 (2)a | 0.239 | 1 |
Chinese | 22 (55) | 18 (45.0) | 40 (15.2) | 1.09(0.55,2.15) | ||
India/others | 10 (76.9) | 3 (23.1) | 13 (5.0) | 2.97(0.80,11,11) | ||
Income group: n (%) | ||||||
B40 (≤ RM3000) | 84 (54.2) | 71(45.8) | 155 (58.9) | 0.005 (1)a | 1.00 | 1 |
M40 + T20 (> RM3000) | 59 (54.6) | 49 (45.4) | 108 (41.1) | 1.018 (0.621,1.667) | ||
Educational Level: n (%) | ||||||
No formal/primary | 7 (41.2) | 10 (58.8) | 17 (6.5) | 7.759 (3)a | 0.051 | 1 |
Secondary | 57 (60.6) | 37 (39.4) | 94 (35.7) | 2.20(0.77,6.29) | ||
Technical/Vocational/Diploma | 35 (63.6) | 20 (36.4) | 55 (20.9) | 2.50(0.82,7.59) | ||
Tertiary | 44 (45.4) | 53 (54.6) | 97 (36.9) | 1.18(0.42,3.37) | ||
Occupation: n (%) | ||||||
Unemployed | 61 (48.0) | 66 (52.0) | 127 (48.3) | 11.352 (3)a | 0.023 | 1 |
Employed | 82 (60.3) | 54 (39.7) | 136 (51.7) | 0.61(0.37,0.99) | ||
Smoking status n (%) | ||||||
Never | 132 (53.7) | 114 (46.3) | 246 (93.5) | 0.782 (1)a | 0.455 | 1.58(0.57,4.42) |
Active smoker | 11 (64.7) | 6 (35.3) | 17 (6.5) | |||
Co-morbidities, n (%) | ||||||
T2DM | ||||||
Yes | 63 (70.0) | 27 (30.0) | 90 (34.2) | 13.468 (1)a | < 0.001 | 2.713(1.58,4.65) |
No | 80 (46.2) | 93 (53.8) | 173 (65.8) | |||
Dyslipidaemia | ||||||
Yes | 92 (60.9) | 59 (39.1) | 151 (57.4) | 6.14 (1)a | 0.017 | 1.88(1.14,3.06) |
No | 51 (45.5) | 61 (54.5) | 112 (42.6) | |||
Hypertension | ||||||
Yes | 79 (59.0) | 55 (41.0) | 134 (51.0) | 2.31 (1)a | 0.139 | 1.46(0.9,2.38) |
No | 64 (49.6) | 65 (50.4) | 129 (49.0) | |||
BMI, kg/m2: (Mean ± SD) | 30.5 (±6.56) | 27.52 (±5.87) | −3.947 (261)b | < 0.001 | −3.06 (−4.58,-1.53) | |
BMI category: n (%) | ||||||
Not obese | 11 (30.6) | 25 (69.4) | 36 (13.7) | 23.316 (2) | < 0.001 | 1 |
Pre-obese | 35 (41.2) | 50 (58.8) | 85 (32.3) | 1.59(0.69,3.65) | ||
Obese | 97 (68.3) | 45 (31.7) | 142 (54.0) | 4.90(2.22,10.82) | ||
WC, cm: (Mean ± SD) | 99.04 (±14.4) | 90.71 (±11.57) | −5.099 (261)b | < 0,001 | −8.329 (−11.547,-5.113) | |
WC category, n (%) | ||||||
Normal | 19 (66.1) | 37 (33.9) | 56 (21.3) | 11.99 (1) | 0.001 | 2.909 (1.566,5.403) |
Abnormal | 124 (59.9) | 83 (40.1) | 207 (78.7) | |||
SBP: (Mean ± SD) | 134.76 (±15.72) | 127.99(±15.64) | −3.487 (261)b | 0.001 | −6.771 (−10.59,-2.94)b | |
SBP (mmHg) category: n (%) | ||||||
Normal < 130 | 49 (44.1) | 62 (55.9) | 111 (42.2) | 8.1 (1)a | 0.006 | 2.05 (1.25–3.37) |
Elevated ≥130 | 94 (61.8) | 58 (38.2) | 152 (57.8) | |||
DBP: (Mean ± SD) | 77.37 (±10.14) | 74.05 (±10.08) | −2.652 (261)b | 0.008 | −3.32 (−5.79,-.086)b | |
DBP (mmHg) category: n (%) | ||||||
< 85, n (%) | 110 (52.9) | 98 (47.1) | 208 (79.1) | 0.89 (1)a | 0.365 | 1.34 (0.73–2.45) |
≥ 85, n (%) | 33 (60.0) | 22 (40.0) | 55 (20.9) | |||
TC, mmol/L: (Mean ± SD) | 4.83 (±1.18) | 4.95 (±1.32) | 0.764 (261)b | 0.446 | 0.12 (−0.19,0.42)b | |
TC (mmol/L) category: n (%) | ||||||
< 5.0 mmol/L, | 84 (54.9) | 69 (45.1) | 153 (58.2) | 0.41 (1)a | 0.900 | 0.95 (0.58–1.55) |
≥ 5.0 mmol/L | 59 (53.6) | 51 (46.4) | 110 (41.8) | |||
TG, mmol/L: (Mean ± SD) | 1.62 (±0.82) | 1.42 (±1.04) | −1.854 (261)b | 0.065 | −0.212 (− 0.437,0.013)b | |
TG (mmol/L) category: n (%) | ||||||
Normal < 1.7 | 91 (49.2) | 94 (50.8) | 185 (70.3) | 6.76 (1)a | 0.01 | 2.07 (1.19–3.59) |
Elevated ≥1.7 | 52 (66.7) | 26 (33.3) | 78 (29.7) | |||
LDL-c, mmol/L: (Mean ± SD) | 2.82 (±1.05) | 2.89 (±1.14) | 0.478 (261)b | 0.633 | 0.064 (−0.201,0.330)b | |
LDL-c (mmol/L) category: n (%) | ||||||
Normal < 3.1 | 89 (54.3) | 75 (45.7) | 164 (62.4) | 0.002 (1)a | 1.0 | 1.01(0.61–1.67) |
Elevated ≥3.1 | 54 (54.5) | 45 (45.5) | 99 (37.6) | |||
HDL-c, mmol/L: (Mean ± SD) | 1.28 (±0.29) | 1.41 (±0.34) | 3.362 (261)b | 0.001 | 0.131(0.054,0.208)b | |
HDL-c (mmol/L) category: n (%) | ||||||
Low ≤1.0 in men | 12 (80.0) | 3 (20.0) | 15 (11.4) | 1.62 (1)a | 0.238 | 0.526 (0.194–1.430) |
Normal > 1.0 | 71 (60.7) | 46 (39.3) | 117 (88.6) | |||
HDL-c (mmol/L) category: n (%) | ||||||
Low ≤1.3 in women | 38 (67.9) | 18 (32.1) | 56 (21.3) | 5.215 (1)a | 0.024 | 0.488 (0.26–0.910) |
Normal > 1.3 | 105 (50.7) | 102 (49.3) | 207 (78.7) | |||
FPG, mmol/L: (Mean ± SD) | 6.833 (±4.30) | 5.481 (±1.434) | −3.253 (256)b | 0.001 | −1.35 (−2.17,-0.53)b | |
FPG (mmol/L) category: n (%) | ||||||
Normal < 5.6 | 56 (40.6) | 82 (59.4) | 138 (53.5) | 23.704 (1)a | < 0.001 | 3.55 (2.11–5.98) |
Elevated ≥5.6 | 85 (70.8) | 35 (29.2) | 120 (46.5) | |||
HbA1c in %: (Mean ± SD) | 7.63 (±1.62) | 7.37 (±1.50) | −0.741 (98)b | 0.461 | −0.26 (−0.96,0.434)b | |
HbA1c category: n (%) | ||||||
Controlled < 7.0% | 24 (75.0) | 8 (25.0) | 32 (32.0) | 1.210 (1)a | 0.812 | 0.80 (0.31–2.08) |
Uncontrolled ≥7.0% | 48 (70.6) | 20 (29.4) | 68 (68.0) | |||
ALT, U/L: (Mean ± SD) | 35.69 (±28.61) | 22.26 (±17.85) | −4.443 (258)b | < 0.001 | −13.44 (−19.39, −7.48)b | |
ALT (U/L) category: n (%) | ||||||
Normal ≤34 | 84 (44.9) | 103 (55.1) | 187 (71.9) | 23.26 (1)a | < 0.001 | 4.37 (2.34–8.16) |
Elevated > 34 | 57 (78.1) | 16 (21.9) | 73 (28.1) | |||
GGT, U/L: (Mean ± SD) | 48.95 (± 41.15) | 36.16 (±44.6) | −2.398 (257)b | 0.017 | −12.79 (−23.29,-2.289)b | |
GGT (U/L) category: n (%) | ||||||
Normal ≤60 | 102 (49.3) | 105 (50.7) | 207 (79.9) | 8.78 (1)a | 0.004 | 2.69 (1.38–5.28) |
Elevated > 60 | 38 (73.1) | 14 (26.9) | 52 (20.1) |
Prevalence of NAFLD according to the FRS categories
Factors associated with NAFLD
Variables | Adj Beta (SE) | Wald (df) | Adj. OR (95%CI) | P-value |
---|---|---|---|---|
Occupational sector: | – | – | – | |
Not working | REF | 1.00 | ||
Working | 0.89 (0.335) | 7.071 (1) | 2.44 (1.26,4.70) | 0.008 |
BMI: | ||||
Not-obese | REF | 1.00 | ||
Obese | 1.060 (0.445) | 5.679 (1) | 2.89 (1.21,6.91) | 0.017 |
FPG | ||||
< 5.6 mmol/L | REF | 1.00 | ||
≥ 5.6 mmol/L | 1.027 (0.339) | 9.169 (1) | 2.79 (1.44,5.43) | 0.002 |
ALT | ||||
≤ 34 U/L | REF | 1.00 | ||
> 34 U/L | 1.310 (0.355) | 13.587 (1) | 3.70 (1.85, 7.44) | < 0.001 |
FRS category | ||||
Low | REF | 1.00 | ||
Moderate | 0.388 (0.413) | 0.884 (1) | 1.47 (0.66,3.31) | 0.347 |
High | 1.038 (0.403) | 6.620 (1) | 2.82 (1.28,6.23) | 0.010 |