Epidemiology of metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis and associated cardiometabolic factors in adults in China (2013-2023): A systematic review and meta-analysis

Table 1 Prevalence of metabolically dysfunction-associated steatotic liver disease in different populations in China

Population	MASLD prevalence % (95%CI)
Overall	30.4 (29.4-31.3)
Male	35.4 (34.0-36.7)
Age
< 45 years	27.2 (25.1-29.3)
45-65 years	33.1 (31.8-34.4)
> 65 years	32.1 (29.2-35.0)
Locations
North China	30.7 (29.5-40.1)
South China	30.1 (28.8-31.4)
Regions
Northeast	35.2 (31.8-38.7)
East	30.7 (29.0-32.5)
Southwest	23.9 (20.1-28.1)
North	31.4 (30.0-32.9)
South Central	30.6 (29.1-32.2)
Northwest	28.1 (25.0-31.4)
Study periods
Before 2010	27.6 (25.0-30.2)
2010-2014	28.6 (26.8-30.4)
2015-2019	31.7 (30.0-33.4)
After 2019	36.5 (33.5-39.6)
BMI (kg/m2)
< 18.5	2.7 (1.3-4.5)
18.5-23.9	12.2 (10.5-14.0)
24.0-27.9	42.5 (39.5-45.6)
> 28.0	68.4 (62.3-74.1)

MASLD: Metabolic dysfunction-associated steatotic liver disease; CI: Confidence interval; BMI: Body mass index.

Table 2 Genetic information related to metabolic dysfunction-associated steatotic liver disease in China

Ref.	Gene	Genotype	Relationship with MASLD
Zhao et al[39], 2023	rs1800591 in the MTTP gene	GG, GT, and TT	Genotype frequency compared with χ2 tests (P < 0.001); multivariable logistic regression analysis: MTTP rs1800591 GT + TT serotype (GG serotype as reference) increased the risk of MASLD (OR = 1.643, 95%CI: 1.226-2.203, P = 0.001). Frequencies of allele G and allele T compared with χ2 tests (P < 0.001)
Zhu et al[35], 2023	rs10946398 in the CDK5 regulatory CDKAL1 gene	AA, AC, and CC	The CC genotype of rs10946398 (refer to the AA serotype) are more likely to suffer from MASLD (adjusted OR = 1.509, 95%CI: 1.046-2.178, P = 0.022)
Xu et al[36], 2023	rs641738 in MBOAT7 gene	CC, CT, and TT	There was no association between MBOAT7 rs641738 and MASLD, and an increase in the minor T allele did not increase the risk of developing MASLD. T allele carriage (CT + TT) in MASLD patients was independently associated with advanced fibrosis (OR = 3.024, 95%CI: 1.165-7.848, P = 0.023)
Wu et al[37], 2023	rs1260326 in GCKR gene	CC, CT, and TT	The genotypic frequency of these three SNPs on the GCKR gene significantly differed between lean MASLD and lean non-MASLD individuals (P < 0.05). The frequency of the C allele of rs1260326 in GCKR gene was significantly lower in lean MASLD compared with lean non-MASLD individuals (OR = 0.700, 95%CI: 0.499-0.981, P = 0.038. The frequency of the C allele of rs780093 in GCKR gene was significantly lower in lean MASLD compared with lean non-MASLD individuals (OR = 0.685, 95%CI: 0.488-0.962, P = 0.028). The frequency of the C allele of rs780096 in GCKR gene was significantly lower in lean MASLD compared with lean non-MASLD individuals (OR = 0.698, 95%CI: 0.497-0.980, P = 0.037)
	rs780093 in GCKR gene
	rs780096 in GCKR gene
Li et al[38], 2023	rs1421085 in the FTO gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.032); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.407 with 95%CI: 1.083-1.828
	rs3751812 in the FTO gene	GG, GT, and TT	Genotype frequency compared with χ2 tests (P = 0.015); MASLD compared to non-MASLD for the frequency of allele G: OR = 1.443 with 95%CI: 1.114-1.869
	rs8050136 in the FTO gene	CC, CA, and AA	Genotype frequency compared with χ2 tests (P = 0.024); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.430 with 95%CI: 1.099-1.861
	rs9939609 in the FTO gene	TT, AA, and AT	Genotype frequency compared with χ2 tests (P = 0.019); MASLD compared to non-MASLD for the frequency of allele T: OR = 1.429 with 95%CI: 1.105-1.849
	rs2206277 in the TFAP2B gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.012); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.305 with 95%CI: 1.074-1.586
	rs2279027 in the TBC1D1 gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.232); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.093 with 95%CI: 0.921-1.297
	rs2279026 in the TBC1D1 gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.232); MASLD compared to non-MASLD for the frequency of allele C: OR = 0.879 with 95%CI: 0.741-1.044
	rs2279028 in the TBC1D1 gene	GA, AA, and GG	Genotype frequency compared with χ2 tests (P = 0.256); MASLD compared to non-MASLD for the frequency of allele G: OR = 0.880 with 95%CI: 0.742-1.045
	rs780093 in the GCKR gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.1); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.147 with 95%CI: 0.972-1.353
	rs780094 in the GCKR gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.085); MASLD compared to non-MASLD for the frequency of allele C: OR = 0.873 with 95%CI: 0.74-1.03
	rs1260326 in the GCKR gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.0.023); MASLD compared to non-MASLD for the frequency of allele C: OR = 0.883 with 95%CI: 0.749-1.041
	rs5215 in the potassium in KCNJ11 gene	CC, CT, and TT	Genotype frequency compared with χ2 tests (P = 0.726); MASLD compared to non-MASLD for the frequency of allele C: OR = 1.070 with 95%CI: 0.904-1.265
Zeng et al[40], 2020	rs2273773 in SIRT1 gene	TT, TC, and CC	Genotype frequency compared with χ2 tests for lean people (P = 0.233), non-obese people (P = 0.363), and obese people (P = 0.022)
	rs2070666 in APOC3 gene	TT, TA, and AA	Genotype frequency compared with χ2 tests for lean people (P = 1.000), non-obese people (P = 0.030), and obese people (P = 0.022)
	rs738409 in PNPLA3 gene	CC, CG, and GG	Genotype frequency compared with χ2 tests for lean people (P = 0.370), non-obese people (P = 0.014), and obese people (P = 0.237)
	rs738408 in PNPLA3 gene	CC, CT, and TT	Genotype frequency compared with χ2 tests for lean people (P = 0.370), non-obese people (P = 0.014), and obese people (P = 0.237)
	rs4823173 in PNPLA3 gene	GG, GA, and AA	Genotype frequency compared with χ2 tests for lean people (P = 0.277), non-obese people (P = 0.010), and obese people (P = 0.237)
	rs2072906 in PNPLA3 gene	AA, AG, and GG	Genotype frequency compared with χ2 tests for lean people (P = 0.332), non-obese people (P = 0.014), and obese people (P = 0.202)
	rs5186 in the AGTR1 gene	AA, AC, and CC	Genotype frequency compared with χ2 tests for lean people (P = 0.900), non-obese people (P = 0.801), and obese people (P = 0.024)
	rs440881 in the AGTR1 gene	CC, CA, and AA	Genotype frequency compared with χ2 tests for lean people (P = 0.639), non-obese people (P = 0.319), and obese people (P = 0.054)
Adila et al[41], 2017	rs1801131 in the MTHFR gene	TT, GG, and GT	Genotype frequency compared with χ2 tests (P = 0.440); multivariable logistic regression analysis: GT + GG serotype (TT serotype as reference) increased the risk of MASLD (OR = 1.159, 95%CI: 0.792-1.696, P = 0.447); GT + TT serotype (GG serotype as reference), decrease the risk of MASLD (OR = 0.648, 95%CI: 0.304-1.383, P = 0.262). Frequencies of allele G and allele T compared with χ2 tests (P = 0.785)
	rs1801133 in MTHFR gene	GG, AA, and GA	Genotype frequency compared with χ2 tests (P = 0.261); multivariable logistic regression analysis: GA + AA serotype (GG serotype as reference) increased the risk of MASLD (OR = 1.061 95%CI: 0.723-1.556, P = 0.763); GT + TT serotype (GG serotype as reference), increased the risk of MASLD (OR = 2.023, 95%CI: 1.057-3.872, P = 0.033). Frequencies of allele G and allele A compared with χ2 tests (P = 0.410)
Liang et al[43], 2016	rs738409 in PNPLA3 gene	CC, CG, and GG	Frequency of GG serotype: MASLD vs non-MASLD = 21.5% vs 12.3%, P = 0.003). Multivariable logistic regression analysis: GG serotype (CC serotype as reference) increased the risk of MASLD (adjusted OR = 2.21, 95%CI: 1.32-3.71); CG serotype (CC serotype as reference) increased the risk of MASLD (adjusted OR = 1.35, 95%CI: 0.92-2.00)
Xia et al[42], 2016	rs738409 in PNPLA3 gene	CC, CG, and GG	Multivariable logistic regression analysis: GC + GG serotype (CC serotype as reference) increased the risk of MASLD (adjusted OR=1.356, 95%CI: 1.189 to 1.546)
Ye et al[44], 2014	rs11377 in adiponectin gene	CC, CG, and GG	Genotype frequency compared with χ2 tests (P = 0.649). Frequencies of allele G and allele C compared with χ2 tests (P = 0.595)

MASLD: Metabolic dysfunction-associated steatotic liver disease; MTTP: Microsomal triglyceride transfer protein; OR: Odds ratio; CI: Confidence interval; CDK5: Cyclin-dependent kinase 5; CDKAL1: Cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like 1; MBOAT7: Membrane bound O-acyltransferase domain containing 7; GCKR: Glucokinase regulator; SNPs: Single-nucleotide polymorphisms; TFAP2B: Transcription factor AP-2 beta; TBC1D1: TBC1 domain family member 1; KCNJ11: Wardly rectifying channel subfamily J member 11; SIRT1: Sirtuin 1; APOC3: Apolipoprotein C3; PNPLA3: Patatin-like phospholipase domain-containing protein-3; AGTR1: Angiotensin II receptor type I; MTHFR: Methylenetetrahydrofolate reductase.