This study aimed to estimate the prevalence of liver steatosis and fibrosis in the general population and populations with potential risk factors in China, so as to inform policies for the screening and management of fatty liver disease and liver fibrosis in general and high-risk populations. This cross-sectional, population-based, nationwide study was based on the database of the largest health check-up chain in China. Adults from 30 provinces who underwent check-up between 2017 and 2022 were included. Steatosis and fibrosis were assessed and graded by transient elastography (TE). Overall and stratified prevalence was estimated among the general population and various subpopulations with demographic, cardiovascular, and chronic liver disease risk factors. A mixed effect regression model was used to examine predictors independently associated with steatosis and fibrosis. In 5,757,335 participants, the prevalence of steatosis, severe steatosis, advanced fibrosis, and cirrhosis was 44.39%, 10.57%, 2.85%, and 0.87%, respectively. Participants who were male, with obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, elevated alanine aminotransferase or aspartate aminotransferase had a significantly higher prevalence of all grades of steatosis and fibrosis, and those with fatty liver, decreased albumin or platelet count, and hepatitis B virus (HBV) infection also had a significantly higher prevalence of fibrosis than their healthy counterparts. Most cardiovascular and chronic liver disease risk factors were independent predictors for steatosis and fibrosis, except for dyslipidemia for fibrosis. A substantial burden of liver steatosis and fibrosis was found in China. Our study provides evidence for shaping future pathways for screening and risk stratification of liver steatosis and fibrosis in the general population. The findings of this study highlight that fatty liver and liver fibrosis should be included in disease management programs as targets for screening and regular monitoring in high-risk populations, especially in those with diabetes.

Carotid atherosclerosis (CAS), a main cause of ischemic stroke, can begin early in life and remain latent and asymptomatic for long periods before progressing to advanced stages.¹ Early-stage phenotypes of CAS, such as increased carotid intima-media thickness (cIMT), and advanced-stage phenotypes, such as carotid plaque (CP) and carotid stenosis (CS), are indicators of stroke.^2,3 To our knowledge, few studies have investigated the prevalence of various CAS phenotypes in China using nationally representative samples. Therefore, national estimates of CAS prevalence and etiologic studies are of urgent importance for understanding the magnitude of the challenge the country is facing and developing effective strategies for primary prevention, management, and informing stakeholders.

Background China experienced a rapid increase in the prevalence of diabetes. Objectives To assess the prevalence of diabetes among Chinese adults who attend preventive physical examination, and analyzed geographical and gender difference in seasonal variation of fasting blood glucose (FBG). Methods The study used data from 1,390,088 participants attending preventive health examination at 430 health screening centers in 220 cities. Diagnosis of diabetes and prediabetes were based on FBG and hemoglobinA_1c and self-report physician’s diagnosis. We calculated age and sex standardized prevalence of diabetes according to the sixth Chinese population census data in 2010. Geographical distribution of diabetes and prediabetes were displayed on the country map. FBG were analyzed to detect the seasonal variation adjusted for age and gender by geographic location. Results The standardized prevalence of diabetes was 8.70% (95% CI, 8.22%-9.19%), 10.7% in men and 6.61% in women. Among those with diabetes, 43.7% (95% CI, 40.9%-46.5%) were aware of their conditions and 38.5% (95% CI, 36.0%-41.1%) were treated. Only 49.3% (95% CI, 47.0%-51.6%) of treated patients achieved glycemic control. The mean level of FBG was higher in winter than summer and in the northern than the southern. Conclusions The prevalence of diabetes was high whilst the percentages of awareness, treatment and glycemic control were low among adults. Effective measures are needed to prevent and manage diabetes in China. Geographic and seasonal variation of diabetes should be considered for its prevention and control.

Background. Studies suggest an association between H. pylori infection and extragastrointestinal disease. Limited studies provided conflicting results on the association between H. pylori infection and diabetes. The present study was aimed at examining the association between H. pylori infection and diabetes in a large health checkup population in China. Methods. A cross-sectional study was conducted; participants who attended health checkups at Beijing MJ Health Screening Center during 2017-2018 were included. H. pylori infection was diagnosed by ¹³C-urea breath test. Multivariate logistic regression analysis was performed to evaluate the association between H. pylori infection and diabetes. Results. The mean age of 13,397 participants was 43.8±12 years. The prevalence of H. pylori infection and diabetes was 28.2% and 8.1%, respectively. The prevalence of diabetes was higher among H. pylori-positive participants compared with their counterparts (8.9% vs 7.8%, p=0.05). After adjustment of age, sex, family history of diabetes, smoking, education, stroke, coronary heart disease, BMI, SBP, TG, HDL-C, and LDL-C, multivariate logistic regression analysis found no association between H. pylori infection and diabetes (OR 1.02, 95% CI 0.88-1.18). Additionally, subgroup analysis indicated that H. pylori infection was significantly associated with increased risk of diabetes in the female group (OR 1.09, 95% CI 1.08-1.09). Conclusions. No significant association was found between H. pylori infection and diabetes. However, the subgroup analysis suggested that H. pylori infection was possibly associated with increased risk of diabetes among females. Future cohort studies are needed to verify this association in females and to address possible implication in the prevention of diabetes.