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.

Aim: Early-stage phenotypes of carotid atherosclerosis (CAS), such as increased carotid intima-media thickness (cIMT), and advanced-stage phenotypes, such as carotid plaque (CP), are at risk for adverse ischemic stroke events. There is limited evidence regarding the causal association between dietary patterns and the risk of CAS in Chinese adults. We therefore examined multiple dietary patterns associated with the risk of CAS and identified the optimal dietary pattern for preventing CAS. Methods: We analyzed data collected from the prospective MJ Health Check-up Study (2004–2020), including 13,989 participants 18–80 years of age without CAS. The dietary intake was measured using validated food frequency questionnaires, and dietary pattern scores were calculated for four a priori and four a posteriori dietary patterns. The Cox model was used to estimate the adjusted hazard ratios (HRs) relating various dietary pattern scores to the risk of CAS. Results: During 43,903.4 person-years of follow-up, 3732 incidents of increased cIMT and 2861 incident CP events were documented. Overall, the seven dietary patterns, except for the high-protein diet, exhibited significant associations with the risk of increased cIMT and CP. Comparing the highest and lowest quartiles, the a posteriori high-fiber dietary pattern (HFIDP) score demonstrated the strongest inverse associations with the risk of increased cIMT (HR 0.65 [95% confidence interval (CI) 0.59–0.71]) and CP (HR 0.65 [95% CI 0.59–0.73]); conversely, another a posteriori high-fat dietary pattern (HFADP; i.e., incorporating high-fat and processed foods) demonstrated the strongest positive associations with the risk of increased cIMT (HR 1.96 [95% CI 1.75–2.20]) and CP (HR 1.83 [95% CI 1.61–2.08]) (all p for trend < 0.01). Conclusions: Multiple dietary patterns are significantly associated with the risk of early- and advanced-stage phenotypes of CAS. Notably, a high adherence to an HFIDP and low adherence to an HFADP may confer the greatest risk reduction for CAS.

Background: Family-oriented medical decision-making in China is founded on Confucian family-determination. The value and necessity of individual autonomy are marginalized in theory and practice. However, the dilemma in end-of-life (EOL) decision-making caused by the lack of advance care planning (ACP) has been increasingly concerned by the public. This study explores the value and necessity of ACP practice in China from the perspective of healthcare professionals (HCPs). Methods: We conducted semi-structured interviews with five neurological physicians and five neurological nurses from a Grade 3 Class A hospital in Beijing. Results: The results showed that in situations with a poor prognosis, respondents tended to believe that as part of ACP regarding, a patient’s right to refuse invasive treatments should be followed, although all ten interviewees agreed that nasogastric feeding tubes (NGTs) should be maintained. Factors influencing a families’ considerations in EOL decision making included prognosis and age, prior similar experiences, others’ moral judgement, and the advice of HCPs. Four respondents had experienced patients expressing their wishes for EOL treatments and reported some obstacles in considering these wishes. Seven respondents considered creating an ACP themselves, two respondents doubted it would work in practice, and one respondent thought it was unnecessary. Conclusions: The differences in the concept and practice of palliative care may be significantly related to the differences in the idea of ACP between Chinese and Western. The family-oriented decision-making model under Confucian culture cannot replace the ACP practice. Clinical situations and therapeutic measures that reveal the necessity and value of ACP should be the priority exploration to advance ACP practice. The practice of ACP and palliative care should be promoted simultaneously at the national level, and legislation for advance directives (ADs) is necessary for mainland China.

What is already known about this topic? Breast cancer has emerged as the most prevalent cancer among women globally and is increasingly affecting younger populations. However, the relationship between individual socioeconomic status (SES) and breast cancer risk remains incompletely understood. What is added by this report? This population-based cohort study revealed a breast cancer incidence rate of 48.9 per 100,000 person-years. Women with high SES demonstrated a significantly elevated risk of breast cancer compared to those with low SES [hazard ratio (HR)=1.42, 95% confidence interval (CI): 1.05, 1.92]. Self-perceived SES appeared to moderate this association, with an increased breast cancer risk particularly evident among women who had both low objectively assessed and self-perceived SES. What are the implications for public health practice? These findings underscore the need for tailored breast cancer screening programs and targeted health education initiatives that account for differences across SES groups.