In China, the epidemiological buy MK-1775 census of NAFLD by B ultrasonic started in the 1990s, the prevalence of NAFLD in Chinese adult ranged from 5.2% to 12.9% at that time.[62] This meta-analysis indicates that the prevalence of NAFLD in Chinese people older than 18 years is 20.09% (95% CI: 17.95–22.31%), and the

pooled prevalence estimate has on the rise over time. Possible reasons for this increase in NAFLD prevalence may include economic development, lifestyle changes, urbanization, changes of eating habits, changes in screening and diagnostic instruments, and research methodology. Moreover, there has been an increase in overweight and obese among the population. Given this situation, effective prevention measures BIBW2992 chemical structure focusing on high-risk populations will have a profound impact on public health. Ethnicity may have a significant impact on the prevalence

of NAFLD. The Dallas Heart Study and the Dionysos Study reported that 30% of adults in the United States and 25% in Italy have NAFLD.[63, 64] The baseline survey of a prospective study showed that Hispanics had the highest prevalence of NAFLD (58.3%), then Caucasians (44.4%) and African Americans (35.1%),[65] which of all was higher in China (20%). The neighbor of China (Korea) has 25.8% of adults.[66] This difference in prevalence can be only partially explained by differences in obesity and insulin resistance, especially in African Americans where the prevalence of NAFLD was lower than in Caucasians with similar risk factors. Gender also has a significant impact on the prevalence of NAFLD. This meta-analysis showed that 24.81% of males and 13.16% of females have NAFLD, with almost twice the prevalence of NAFLD in males compared with females. In a study of 99 969 subjects nondrinkers participating in health checkups in Korea, the prevalence of NAFLD by abdominal ultrasound was 40.2% in males and 10.3% in females.[9] Similarly, a population-based study in Israel

demonstrated a 38% prevalence of NAFLD in males compared with 21% in females.[67] The prevalence of NAFLD in the Dallas Heart Study 上海皓元 was 42% in white men compared with only 24% in white women, and this difference was not attributed to differences in body weight or insulin sensitivity.[63] Possible reason is the difference in hormonal regulation between males and females. An animal experiment found estrogen and estrogen receptor to have effects on the regulation of hepatic lipid homeostasis.[68] And, human studies also suggest that NAFLD is more prevalent in postmenopausal and women with polycystic ovary syndrome than those premenopausal ones, which means estrogens may have a protective effect against NAFLD in women.[69] In contrast, dropping hormone levels associated with menopause easily leads to hormone and lipid abnormality and results in obesity, diabetes, and the occurrence of NAFLD.