Transition frequencies between NAFLD states during follow-up. Values are expressed as times/n (%), row-wise. S1 (healthy state); S2 (NAFLD, BMI < 24 kg/m2); S3 (NAFLD, BMI ≥ 24 kg/m2). NAFLD: non-alcoholic fatty liver disease; BMI: body mass index.
Declarations
Acknowledgments
The authors thank the data management team of the Beijing Physical Examination Center and the medical staff who collected the data.
Author contributions
JT: Conceptualization, Formal analysis, Validation, Writing—original draft, Writing—review & editing. HA: Conceptualization, Data curation, Formal analysis, Software, Writing—original draft. CT, XN, and TC: Data curation, Project administration. YH, SC, and LK: Data curation, Investigation, Resources. XY: Funding acquisition, Conceptualization, Supervision, Writing—review & editing. All authors have read and approved the submitted version.
Conflicts of interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Ethical approval
The study was approved by the Ethics Committee of Capital Medical University (approval number: 2019SY088). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki.
Consent to participate
Written informed consent was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Funding
The project is supported by a grant from the Natural Science Foundation of Beijing Municipality [grant number 7202010]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis.N Engl J Med. 2017;377:2063–72. [DOI] [PubMed]
Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease.Gastroenterology. 2020;158:1851–64. [DOI] [PubMed]
Li Z, Xue J, Chen P, Chen L, Yan S, Liu L. Prevalence of nonalcoholic fatty liver disease in mainland of China: a meta-analysis of published studies.J Gastroenterol Hepatol. 2014;29:42–51. [DOI] [PubMed]
Wang F, Fan J, Zhang Z, Gao B, Wang H. The global burden of liver disease: the major impact of China.Hepatology. 2014;60:2099–108. [DOI] [PubMed] [PMC]
Fan J, Kim S, Wong VW. New trends on obesity and NAFLD in Asia.J Hepatol. 2017;67:862–73. [DOI] [PubMed]
Han E, Lee YH. Non-Alcoholic Fatty Liver Disease: The Emerging Burden in Cardiometabolic and Renal Diseases.Diabetes Metab J. 2017;41:430–7. [DOI] [PubMed] [PMC]
Pisto P, Santaniemi M, Bloigu R, Ukkola O, Kesäniemi YA. Fatty liver predicts the risk for cardiovascular events in middle-aged population: a population-based cohort study.BMJ Open. 2014;4:e004973. [DOI] [PubMed] [PMC]
Park HE, Kwak M, Kim D, Kim M, Cha M, Choi S. Nonalcoholic Fatty Liver Disease Is Associated With Coronary Artery Calcification Development: A Longitudinal Study.J Clin Endocrinol Metab. 2016;101:3134–43. [DOI] [PubMed]
Nseir W, Shalata A, Marmor A, Assy N. Mechanisms linking nonalcoholic fatty liver disease with coronary artery disease.Dig Dis Sci. 2011;56:3439–49. [DOI] [PubMed]
Juanola O, Martínez-López S, Francés R, Gómez-Hurtado I. Non-Alcoholic Fatty Liver Disease: Metabolic, Genetic, Epigenetic and Environmental Risk Factors.Int J Environ Res Public Health. 2021;18:5227. [DOI] [PubMed] [PMC]
Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment.Diabetes Metab. 2021;47:101215. [DOI] [PubMed]
Zheng X, Xiong J, Zhang Y, Xu L, Zhou L, Zhao B, et al. Multistate Markov model application for blood pressure transition among the Chinese elderly population: a quantitative longitudinal study.BMJ Open. 2022;12:e059805. [DOI] [PubMed] [PMC]
Beyersmann J, Wolkewitz M, Allignol A, Grambauer N, Schumacher M. Application of multistate models in hospital epidemiology: advances and challenges.Biom J. 2011;53:332–50. [DOI] [PubMed]
Sun B, Li S, Wang Y, Xiao W, Zhao H, Liu X, et al. Sarcopenia Transitions and Influencing Factors Among Chinese Older Adults With Multistate Markov Model.Innov Aging. 2023;7:igad105. [DOI] [PubMed] [PMC]
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review.Nutr Today. 2015;50:117–28. [DOI] [PubMed] [PMC]
Lin X. A report on the status of nutrition and chronic Diseases among Chinese residents.J Tradit Chin Med Manag. 2015;23:89.
Polyzos SA, Kountouras J, Mantzoros CS. Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics.Metabolism. 2019;92:82–97. [DOI] [PubMed]
Quek J, Chan KE, Wong ZY, Tan C, Tan B, Lim WH, 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.Lancet Gastroenterol Hepatol. 2023;8:20–30. [DOI] [PubMed]
Kong L, Yang Y, Li H, Shan Y, Wang X, Shan X. Prevalence of nonalcoholic fatty liver disease and the related risk factors among healthy adults: A cross-sectional study in Chongqing, China.Front Public Health. 2023;11:1127489. [DOI] [PubMed] [PMC]
Tu B, Li W, Xiao H, Xu X, Zhang Y. Optimizing lifestyle profiles is potential for preventing nonalcoholic fatty liver disease and enhancing its survival.Sci Rep. 2024;14:5516. [DOI] [PubMed] [PMC]
Wong VW, Ekstedt M, Wong GL, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD.J Hepatol. 2023;79:842–52. [DOI] [PubMed]
Gu Y, Guo C, Liu Z, Zhang Y, Han X, Zhang X, et al. The trend in incidence of non-alcoholic fatty liver disease and its impact on cirrhosis and liver cancer: An analysis from Global Burden of Disease 2021.Public Health. 2025;242:79–86. [DOI] [PubMed]
Le MH, Le DM, Baez TC, Wu Y, Ito T, Lee EY, et al. Global incidence of non-alcoholic fatty liver disease: A systematic review and meta-analysis of 63 studies and 1,201,807 persons.J Hepatol. 2023;79:287–95. [DOI] [PubMed]
Koh JH, Wang M, Suzuki H, Muthiah M, Ng CH, Huang DQ. NAFLD and NAFLD-related HCC in Asia: Burden and Surveillance.J Clin Exp Hepatol. 2024;14:101213. [DOI] [PubMed] [PMC]
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021;372:n71. [DOI] [PubMed] [PMC]
National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology; Chinese Medical Association Fatty Liver Expert Committee; Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease: a 2018 update.Infect Dis Inf. 2018;31:393–402.
Li Q, Li X, Kwong JS, Chen H, Sun X, Tian H, et al. Diagnosis and treatment for hyperuricaemia and gout: a protocol for a systematic review of clinical practice guidelines and consensus statements.BMJ Open. 2017;7:e014928. [DOI] [PubMed] [PMC]
Jackson C. Multi-State Models for Panel Data: The msm Package for R.J Stat Softw. 2011;38:1–28. [DOI]
Xiang M, Tian X, Wang H, Gan P, Zhang Q. Inappropriate Diet Exacerbates Metabolic Dysfunction-Associated Steatotic Liver Disease via Abdominal Obesity.Nutrients. 2024;16:4208. [DOI] [PubMed] [PMC]
Yazıcı D, Demir S, Sezer H. Insulin Resistance, Obesity, and Lipotoxicity.Adv Exp Med Biol. 2024;1460:391–430. [DOI] [PubMed]
Tchernof A, Després J. Pathophysiology of human visceral obesity: an update.Physiol Rev. 2013;93:359–404. [DOI] [PubMed]
Kim E, Lee Y, Kwon Y, Lee J. Age at menopause and risk of metabolic dysfunction-associated fatty liver disease: A 14-year cohort study.Dig Liver Dis. 2024;56:1880–6. [DOI] [PubMed]
Li L, Yao Y, Wang Y, Cao J, Jiang Z, Yang Y, et al. G protein-coupled estrogen receptor 1 ameliorates nonalcoholic steatohepatitis through targeting AMPK-dependent signaling.J Biol Chem. 2024;300:105661. [DOI] [PubMed] [PMC]
Fu W, Zhao J, Cheng G, Xu L, Lyu L, Ding Y. Dietary Inflammatory index and its association with fatty liver disease: a study in obese and non-obese populations.BMC Gastroenterol. 2025;25:102. [DOI] [PubMed] [PMC]
Bian L, Tang T, Yu Q, Tong X, Hu S, You Y, et al. Association between the triglyceride to high-density lipoprotein cholesterol ratio and type 2 diabetes mellitus in non-alcoholic fatty liver disease.Sci Rep. 2024;14:31048. [DOI] [PubMed] [PMC]
Sheng G, Lu S, Xie Q, Peng N, Kuang M, Zou Y. The usefulness of obesity and lipid-related indices to predict the presence of Non-alcoholic fatty liver disease.Lipids Health Dis. 2021;20:134. [DOI] [PubMed] [PMC]
Fallatah HI, Akbar HO, Fallatah AM. Fibroscan Compared to FIB-4, APRI, and AST/ALT Ratio for Assessment of Liver Fibrosis in Saudi Patients With Nonalcoholic Fatty Liver Disease.Hepat Mon. 2016;16:e38346. [DOI] [PubMed] [PMC]
Song R, Hu M, Qin X, Qiu L, Wang P, Zhang X, et al. The Roles of Lipid Metabolism in the Pathogenesis of Chronic Diseases in the Elderly.Nutrients. 2023;15:3433. [DOI] [PubMed] [PMC]
Zhao D, Cui H, Shao Z, Cao L. Abdominal obesity, chronic inflammation and the risk of non-alcoholic fatty liver disease.Ann Hepatol. 2023;28:100726. [DOI] [PubMed]
Wong C, Lee MH, Yaow CYL, Chin YH, Goh XL, Ng CH, et al. Glucagon-Like Peptide-1 Receptor Agonists for Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes: A Meta-Analysis.Front Endocrinol (Lausanne). 2021;12:609110. [DOI] [PubMed] [PMC]
Lee HA, Kim HY. Therapeutic Mechanisms and Clinical Effects of Glucagon-like Peptide 1 Receptor Agonists in Nonalcoholic Fatty Liver Disease.Int J Mol Sci. 2023;24:9324. [DOI] [PubMed] [PMC]
