Meta analysis of the prevalence and risk factors of non-alcoholic fatty liver disease in overweight and obese children and adolescents in China

XIAO Yi; PAN Yu-Fan; DAI Yu; SUN Yu-Jian; ZHOU Yue; YU Yu-Feng

doi:10.7499/j.issn.1008-8830.2408148

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Chinese Journal of Contemporary Pediatrics ›› 2025, Vol. 27 ›› Issue (4) : 410-419. DOI: 10.7499/j.issn.1008-8830.2408148

CLINICAL RESEARCH

Meta analysis of the prevalence and risk factors of non-alcoholic fatty liver disease in overweight and obese children and adolescents in China

XIAO Yi, PAN Yu-Fan, DAI Yu, SUN Yu-Jian, ZHOU Yue, YU Yu-Feng

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Objective To systematically evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in overweight and obese children and adolescents in China. Methods Databases including China National Knowledge Infrastructure, Wanfang Data, VIP Database, China Biomedical Literature Database, PubMed, Embase, Web of Science, and Cochrane Library were searched, from database inception to October 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of the studies according to inclusion and exclusion criteria. A Meta analysis was conducted using Stata 16.0 software. Results A total of 42 studies involving 16 481 overweight and obese children and adolescents were included. The Meta analysis results showed that the prevalence of NAFLD among overweight and obese children in China was 43% (95%CI: 37%-48%). Factors associated with NAFLD included being male (OR=1.61, 95%CI: 1.17-2.04), increased weight (MD=10.33, 95%CI: 9.08-11.57), increased waist circumference (MD=5.49, 95%CI: 3.36-7.62), longer duration of obesity (MD=0.31, 95%CI: 0.02-0.61), higher body mass index (MD=3.11, 95%CI: 2.07-4.16), elevated fasting blood glucose levels (MD=0.17, 95%CI: 0.06-0.29), higher triglyceride levels (MD=0.32, 95%CI: 0.17-0.47), elevated total cholesterol levels (MD=0.15, 95%CI: 0.10-0.21), higher low-density lipoprotein cholesterol levels (MD=0.14, 95%CI: 0.04-0.23), increased alanine aminotransferase levels (MD=24.39, 95%CI: 18.57-30.20), increased aspartate aminotransferase levels (MD=12.49, 95%CI: 9.67-15.32), elevated serum insulin levels (MD=4.47, 95%CI: 2.57-6.36), higher homeostasis model assessment-insulin resistance (MD=0.45, 95%CI: 0.30-0.59), and elevated uric acid levels (MD=55.91, 95%CI: 35.49-76.32) (P<0.05). Conclusions The prevalence of NAFLD among overweight and obese children and adolescents in China is high. Male gender, increased weight, increased waist circumference, prolonged obesity duration, higher body mass index, dyslipidemia, and elevated levels of fasting blood glucose, liver enzymes, serum insulin, homeostasis model assessment-insulin resistance, and uric acid are potential risk factors for NAFLD in this population.

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Non-alcoholic fatty liver disease / Overweight / Obesity / Prevalence / Risk factor / Meta analysis / Child / Adolescent

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XIAO Yi, PAN Yu-Fan, DAI Yu, SUN Yu-Jian, ZHOU Yue, YU Yu-Feng. Meta analysis of the prevalence and risk factors of non-alcoholic fatty liver disease in overweight and obese children and adolescents in China[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(4): 410-419 https://doi.org/10.7499/j.issn.1008-8830.2408148

References

1 World Obesity. Atlas of childhood obesity[EB/OL]. [2024-08-24]. https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity.
2 中国营养学会. 中国肥胖预防和控制蓝皮书[M]. 北京: 北京大学医学出版社, 2019.
3 Sanyal AJ. Past, present and future perspectives in nonalcoholic fatty liver disease[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(6): 377-386. PMID: 31024089. DOI: 10.1038/s41575-019-0144-8.
4 中华医学会儿科学分会内分泌遗传代谢学组, 中华医学会儿科学分会消化学组, 中华医学会儿科学分会青春期医学专业委员会, 等. 儿童非酒精性脂肪肝病诊断与治疗专家共识[J]. 中国实用儿科杂志, 2018, 33(7): 487-492. DOI: 10.19538/j.ek2018070602.
5 Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)[J]. J Pediatr Gastroenterol Nutr, 2017, 64(2): 319-334. PMID: 28107283. PMCID: PMC5413933. DOI: 10.1097/MPG.0000000000001482.
6 Bonsembiante L, Targher G, Maffeis C. Non-alcoholic fatty liver disease in obese children and adolescents: a role for nutrition?[J]. Eur J Clin Nutr, 2022, 76(1): 28-39. PMID: 34006994. DOI: 10.1038/s41430-021-00928-z.
7 Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2023, 8(1): 20-30. PMID: 36400097. DOI: 10.1016/S2468-1253(22)00317-X.
8 Le MH, Le DM, Baez TC, et al. Global incidence of adverse clinical events in non-alcoholic fatty liver disease: a systematic review and meta-analysis[J]. Clin Mol Hepatol, 2024, 30(2): 235-246. PMID: 38281814. PMCID: PMC11016479. DOI: 10.3350/cmh.2023.0485.
9 Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?[J]. Mil Med Res, 2020, 7(1): 7. PMID: 32111253. PMCID: PMC7049186. DOI: 10.1186/s40779-020-00238-8.
10 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. PMID: 20652370. DOI: 10.1007/s10654-010-9491-z.
11 Chan DF, Li AM, Chu WC, et al. Hepatic steatosis in obese Chinese children[J]. Int J Obes Relat Metab Disord, 2004, 28(10): 1257-1263. PMID: 15278103. DOI: 10.1038/sj.ijo.0802734.
12 巴宏军, 陈红珊, 李燕虹, 等. 肥胖儿童非酒精性脂肪性肝病发病的相关危险因素分析[J]. 临床儿科杂志, 2009, 27(12): 1131-1134. DOI: 10.3969/j.issn.1000-3606.2009.12.008.
13 施红波, 傅君芬, 梁黎, 等. 肥胖儿童非酒精性脂肪肝病及代谢综合征发病情况分析[J]. 中华儿科杂志, 2009, 47(2): 114-118. PMID: 19573457. DOI: 10.3760/cma.j.issn.0578-1310.2009.02.010.
14 刘利蕊, 傅君芬, 梁黎, 等. 肥胖儿童非酒精性脂肪肝病与心血管疾病的相关性[J]. 中国当代儿科杂志, 2010, 12(7): 547-550. PMID: 20637154.
15 盛秋明, 李卫国, 张海涛. 超重肥胖儿童非酒精性脂肪肝病与代谢综合征相关性研究[J]. 中国儿童保健杂志, 2010, 18(6): 456-458.
16 范歆, 陈少科, 唐晴, 等. 南宁市超重、肥胖儿童非酒精性脂肪肝患病情况分析[J]. 中国儿童保健杂志, 2012, 20(2): 124-126.
17 康如彤, 钟燕, 蒋耀辉, 等. 肥胖儿童非酒精性脂肪肝影响因素分析[J]. 实用预防医学, 2013, 20(3): 277-279. DOI: 10.3969/j.issn.1006-3110.2013.03.007.
18 林胡, 傅君芬, 陈雪峰, 等. 肥胖儿童青少年非酒精性脂肪肝病早期肾功能状况研究[J]. 浙江大学学报（医学版）, 2013, 42(4): 381-387. PMID: 24022925. DOI: 10.3785/j.issn.1008-9292.2013.04.003.
19 周歆, 侯冬青, 段佳丽, 等. 北京市387名肥胖中学生非酒精性脂肪肝等代谢异常罹患状况调查[J]. 中华流行病学杂志, 2013, 34(5): 446-450. DOI: 10.3760/cma.j.issn.0254-6450.2013.05.008.
20 朱蓓, 张海瑛, 蔡锡顶. 肥胖儿童非酒精脂肪肝与糖、脂代谢的关系[J]. 中华全科医学, 2013, 11(11): 1732. DOI: 10.16766/j.cnki.issn.1674-4152.2013.11.076.
21 刘倩, 陈虹, 朱庆龄, 等. 学龄期儿童肥胖相关性脂肪肝及血脂代谢异常对照研究[J]. 中国儿童保健杂志, 2014, 22(8): 788-790. DOI: 10.11852/zgetbjzz2014-22-08-02.
22 Lin YC, Chang PF, Chang MH, et al. Genetic variants in GCKR and PNPLA3 confer susceptibility to nonalcoholic fatty liver disease in obese individuals[J]. Am J Clin Nutr, 2014, 99(4): 869-874. PMID: 24477042. DOI: 10.3945/ajcn.113.079749.
23 王莲革, 赵小元, 段佳丽, 等. 北京市密云县肥胖中小学生心血管代谢异常调查[J]. 中国学校卫生, 2015, 36(10): 1582-1585. DOI: 10.16835/j.cnki.1000-9817.2015.10.048.
24 徐玲玲, 陈红珊, 李燕虹, 等. 肥胖儿童代谢综合征临床特征及其代谢成分异常的相关性分析[J]. 中山大学学报（医学科学版）, 2015, 36(2): 301-305. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2015.0049.
25 闫银坤, 侯冬青, 段佳丽, 等. 肥胖儿童尿酸水平与心血管代谢异常及非酒精性脂肪肝的关系[J]. 中华实用儿科临床杂志, 2015, 30(13): 1000-1003. DOI: 10.3760/cma.j.issn.2095-428X.2015.13.011.
26 贲秀鸾, 季凤华. 儿童单纯性肥胖症与非酒精性脂肪性肝病的相关性研究[J]. 肝脏, 2016, 21(8): 705-707. DOI: 10.3969/j.issn.1008-1704.2016.08.029.
27 田江宣, 留佩宁, 郑超, 等. 温州超重肥胖少年儿童临床表型分析[J]. 中华全科医学, 2016, 14(5): 790-792. DOI: 10.16766/j.cnki.issn.1674-4152.2016.05.032.
28 代东伶, 周少明, 柳国胜, 等. 脂质代谢相关基因变异与肥胖儿童非酒精性脂肪肝易感性分析[J]. 临床儿科杂志, 2017, 35(4): 241-246. DOI: 10.3969/j.issn.1000-3606.2017.04.001.
29 林先强, 符清宇, 沙丹. 肥胖儿童非酒精性脂肪性肝病的危险因素分析[J]. 肝脏, 2019, 24(11): 1306-1309. DOI: 10.3969/j.issn.1008-1704.2019.11.033.
30 吕卓超, 蔡海芳, 何春霞, 等. 丽水地区儿童肥胖和NAFLD的流行现状及危险因素分析[J]. 中国妇幼健康研究, 2019, 30(6): 673-677. DOI: 10.3969/j.issn.1673-5293.2019.06.004.
31 王卓平, 黄雌友, 王雯, 等. 三酰甘油/高密度脂蛋白胆固醇比值对青少年肥胖人群非酒精性脂肪性肝病的预测价值[J]. 中国临床医学, 2019, 26(6): 875-879. DOI: 10.12025/j.issn.1008-6358.2019.20191033.
32 Wang R, Yang F, Qing L, et al. Decreased serum neuregulin 4 levels associated with non-alcoholic fatty liver disease in children with obesity[J]. Clin Obes, 2019, 9(1): e12289. PMID: 30411515. DOI: 10.1111/cob.12289.
33 何春霞, 蔡海芳, 刘晟, 等. 浙西南地区肥胖儿童的非酒精性脂肪肝的发生特点危险因素及针对性预防措施研究[J]. 中国妇幼保健, 2020, 35(20): 3821-3824. DOI: 10.19829/j.zgfybj.issn.1001-4411.2020.20.035.
34 陈新春, 寇永妹, 刘晓璐, 等. 唐山市7~14岁肥胖儿童非酒精性脂肪肝流行现状及危险因素初步分析[J]. 中国儿童保健杂志, 2021, 29(6): 669-673. DOI: 10.11852/zgetbjzz2020-1489.
35 蔡海芳, 何春霞, 刘晟, 等. 肥胖儿童非酒精性脂肪肝病与血清铁蛋白的相关性研究[J]. 中国食物与营养, 2021, 27(2): 85-88. DOI: 10.3969/j.issn.1006-9577.2021.02.018.
36 李印东, 李梦龙, 段军伟, 等. 北京市超重肥胖儿童内脏脂肪指数与非酒精性脂肪肝的关系[J]. 中国学校卫生, 2021, 42(5): 659-662. DOI: 10.16835/j.cnki.1000-9817.2021.05.005.
37 Peng L, Wu S, Zhou N, et al. Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity[J]. BMC Pediatr, 2021, 21(1): 122. PMID: 33711964. PMCID: PMC7953770. DOI: 10.1186/s12887-021-02595-2.
38 曹佳佳, 张俊峰, 聂文建, 等. 空腹C肽与肥胖儿童非酒精性脂肪性肝病的相关性[J]. 检验医学, 2022, 37(7): 618-622. DOI: 10.3969/j.issn.1673-8640.2022.07.004.
39 段小龙, 王丽明, 康玉蓉, 等. 人体测量指标预测肥胖儿童非酒精性脂肪肝的研究[J]. 中国儿童保健杂志, 2022, 30(5): 475-479. DOI: 10.11852/zgetbjzz2021-1509.
40 张毅, 廖燕薇, 麻静. 超重肥胖儿童泌乳素水平及其与非酒精性脂肪肝发病风险的关系[J]. 中国优生与遗传杂志, 2022, 30(6): 1040-1044. DOI: 10.13404/j.cnki.cjbhh.2022.06.020.
41 Wang J, Lin H, Chiavaroli V, et al. High prevalence of cardiometabolic comorbidities among children and adolescents with severe obesity from a large metropolitan centre (Hangzhou, China)[J]. Front Endocrinol (Lausanne), 2022, 13: 807380. PMID: 35663319. PMCID: PMC9160715. DOI: 10.3389/fendo.2022.807380.
42 白敏, 黄烈平, 朱蓓, 等. 瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的中介效应[J]. 中华全科医学, 2023, 21(12): 2086-2088. DOI: 10.16766/j.cnki.issn.1674-4152.003296.
43 戴文, 姚珍珍, 欧阳思思, 等. 超重/肥胖儿童非酒精性脂肪肝病患病率及其影响因素的横断面研究[J]. 中国当代儿科杂志, 2023, 25(5): 448-456. PMID: 37272169. PMCID: PMC10247205. DOI: 10.7499/j.issn.1008-8830.2211018.
44 窦豆, 朱晓华, 刘钊. 微小RNA-122、人去乙酰化酶4、网膜素-1对非酒精性脂肪肝的预测效能研究[J]. 包头医学院学报, 2023, 39(7): 51-55. DOI: 10.16833/j.cnki.jbmc.2023.07.010.
45 李东丹, 闫洁, 王美辰, 等. 非酒精性脂肪性肝病肥胖儿童人体成分及其影响因素分析[J]. 中国实用儿科杂志, 2023, 38(7): 525-529. DOI: 10.19538/j.ek2023070610.
46 李洪林, 邓全敏. 肥胖儿童非酒精性脂肪性肝病血清25(OH)D水平变化及临床意义[J]. 肝脏, 2023, 28(7): 810-813. DOI: 10.3969/j.issn.1008-1704.2023.07.018.
47 周新峰, 刘国清, 白建红. 超重肥胖儿童非酒精性脂肪肝与内脏脂肪指数的相关性研究[J]. 中国食品卫生杂志, 2023, 35(2): 254-258. DOI: 10.13590/j.cjfh.2023.02.017.
48 Zhou L, Zhang L, Zhang L, et al. Analysis of risk factors for non-alcoholic fatty liver disease in hospitalized children with obesity before the late puberty stage[J]. Front Endocrinol (Lausanne), 2023, 14: 1224816. PMID: 37720532. PMCID: PMC10501779. DOI: 10.3389/fendo.2023.1224816.
49 黄智航, 罗米扬, 戴文, 等. 全血铜、锌、钙、镁、铁与超重肥胖儿童非酒精性脂肪肝病的关联[J]. 中南大学学报（医学版）, 2024, 49(3): 426-434. PMID: 38970517. PMCID: PMC11208402. DOI: 10.11817/j.issn.1672-7347.2024.230274.
50 刘巧娟, 牟春燕, 康淑红, 等. 肥胖儿童非酒精性脂肪性肝病发病影响因素分析[J]. 临床医学研究与实践, 2024, 9(22): 31-35. DOI: 10.19347/j.cnki.2096-1413.202422008.
51 于琼, 李建英, 曹璞丽, 等. 呼和浩特市超重肥胖儿童非酒精性脂肪肝患病现状及相关因素[J]. 中国学校卫生, 2024, 45(5): 742-745. DOI: 10.16835/j.cnki.1000-9817.2024142.
52 张怡, 崔蕾, 袁伯稳. 单纯性肥胖儿童发生代谢相关脂肪性肝病的危险因素分析[J]. 肝脏, 2024, 29(3): 308-312. DOI: 10.3969/j.issn.1008-1704.2024.03.014.
53 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南[J]. 中华肝脏病杂志, 2006, 14(3): 161-163. DOI: 10.3760/j.issn:1007-3418.2006.03.001.
54 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南[J]. 中国肝脏病杂志（电子版）, 2010, 2(4): 43-48. DOI: 10.3969/j.issn.1674-7380.2010.04.013.
55 European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J]. J Hepatol, 2016, 64(6): 1388-1402. PMID: 27062661. DOI: 10.1016/j.jhep.2015.11.004.
56 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南（2018年更新版）[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.
57 王雨, 杨志然, 陈润花. 中国儿童非酒精性脂肪性肝病患病率的Meta分析[J]. 中国儿童保健杂志, 2022, 30(7): 764-769. DOI: 10.11852/zgetbjzz2021-1338.
58 Jin B, Wu Z, Wang S, et al. Gender differences in non-alcoholic fatty liver disease in obese children and adolescents: a large cross-sectional study[J]. Hepatol Int, 2024, 18(1): 179-187. PMID: 37861942. PMCID: PMC10858100. DOI: 10.1007/s12072-023-10596-9.
59 Raj S V, Ismail M, Chan WK, et al. A systematic review on factors associated with non-alcoholic fatty liver disease (NAFLD) among adolescents[J]. Clin Nutr ESPEN, 2023, 57: 131-137. PMID: 37739647. DOI: 10.1016/j.clnesp.2023.06.014.
60 Huang Y, Jin T, Ni W, et al. Baseline and change in serum lipid and uric acid level over time and incident of nonalcoholic fatty liver disease (NAFLD) in Chinese adults[J]. Sci Rep, 2024, 14(1): 18547. PMID: 39122810. PMCID: PMC11316048. DOI: 10.1038/s41598-024-69411-6.
61 Bril F, Sninsky JJ, Baca AM, et al. Hepatic steatosis and insulin resistance, but not steatohepatitis, promote atherogenic dyslipidemia in NAFLD[J]. J Clin Endocrinol Metab, 2016, 101(2): 644-652. PMID: 26672634. DOI: 10.1210/jc.2015-3111.
62 Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)[J]. Metabolism, 2016, 65(8): 1038-1048. PMID: 26823198. DOI: 10.1016/j.metabol.2015.12.012.
63 Pacifico L, Di Martino M, Anania C, et al. Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease[J]. World J Gastroenterol, 2015, 21(15): 4688-4695. PMID: 25914480. PMCID: PMC4402318. DOI: 10.3748/wjg.v21.i15.4688.
64 Lu Y, Wang Q, Yu L, et al. Revision of serum ALT upper limits of normal facilitates assessment of mild liver injury in obese children with non-alcoholic fatty liver disease[J]. J Clin Lab Anal, 2020, 34(7): e23285. PMID: 32267017. PMCID: PMC7370732. DOI: 10.1002/jcla.23285.
65 Navarro-Jarabo JM, Ubi?a-Aznar E, Tapia-Ceballos L, et al. Hepatic steatosis and severity-related factors in obese children[J]. J Gastroenterol Hepatol, 2013, 28(9): 1532-1538. PMID: 23701491. DOI: 10.1111/jgh.12276.
66 Yuan H, Yu C, Li X, et al. Serum uric acid levels and risk of metabolic syndrome: a dose-response meta-analysis of prospective studies[J]. J Clin Endocrinol Metab, 2015, 100(11): 4198-4207. PMID: 26308292. DOI: 10.1210/jc.2015-2527.
67 Lee TS, Lu TM, Chen CH, et al. Hyperuricemia induces endothelial dysfunction and accelerates atherosclerosis by disturbing the asymmetric dimethylarginine/dimethylarginine dimethylaminotransferase 2 pathway[J]. Redox Biol, 2021, 46: 102108. PMID: 34438260. PMCID: PMC8390558. DOI: 10.1016/j.redox.2021.102108.
68 Sánchez-Lozada LG, Soto V, Tapia E, et al. Role of oxidative stress in the renal abnormalities induced by experimental hyperuricemia[J]. Am J Physiol Renal Physiol, 2008, 295(4): F1134-F1141. PMID: 18701632. PMCID: PMC2576157. DOI: 10.1152/ajprenal.00104.2008.