Unrecognised rural-urban disparities in epidemiology of metabolic-associated fatty liver disease in the representative area of China.

Background: The unexpectedly increased burden of metabolic-associated fatty liver disease (MAFLD) continues in China, and the differences between rural and urban areas remain unclear. We aimed to clarify the prevalence and risk factors in rural areas of China.

Methods: This cross-sectional study used the most densely populated area with highly unbalanced development differences in China (Guangdong Province) as a representative sample, and multistage stratified random sampling was performed. The participants' demographic, socioeconomic and lifestyle data were collected. Fatty liver and liver stiffness were screened by FibroScan.

Results: A total of 7287 individuals were enrolled (rural: 2684; urban: 4603). The overall MAFLD prevalence was 35.7%, and MAFLD was higher among rural individuals (38.0% vs 34.4%, p<0.001) than urban individuals. Rural individuals had more severe hepatic fibrosis (fibrosis stage 3-4) overall (3.0% vs 1.3%) and among different sexes (male: 4.2% vs 2.0%; female: 1.5% vs 0.5%) (all p<0.05) than urban individuals. For both rural and urban individuals, lifestyle and dietary habits, including midnight snacks, dining out, and overeating salt, red meat and sugar, were associated with an increased risk of MAFLD, and drinking tea and consuming dietary fibres were associated with a decreased risk of MAFLD. However, midnight snacks and overeating red meat were associated with a higher risk of hepatic fibrosis only in urban individuals.

Conclusion: There is a surprisingly high burden of MAFLD in rural Guangdong, China, which implicates a lack of awareness among rural individuals and a warrant the need for disease counteraction strategies.

Trial registration number: ChiCTR2000033376.