IDDF2026-ABS-0345 High prevalence of liver fibrosis and steatotic liver disease among community-dwelling adults in China: results from the prospective liverhealth project in 25,805 participants

Background Chronic liver disease is increasingly driven by metabolic dysfunction worldwide. China, home to the world’s largest population with metabolic disorders, lacks large-scale community-based data on liver fibrosis and steatotic liver disease (SLD). This study aimed to estimate the vibration-controlled transient elastography (VCTE)-based prevalence of liver fibrosis and steatotic liver disease (SLD) among community-dwelling adults in China. Methods The LiverHealth project is a prospective, investigator-initiated, community-based cohort conducted across 18 sites in 13 provinces in China between September 2024 and January 2026. Community-dwelling adults aged ≥18 years were enrolled. SLD was defined using controlled attenuation parameter (CAP) thresholds of ≥248 dB/m (≥S1), ≥268 dB/m (≥S2), and ≥280 dB/m (S3). Participants were further categorized into metabolic dysfunction–associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), and alcohol-related liver disease (ALD). Significant fibrosis, compensated advanced chronic liver disease (cACLD), and advanced fibrosis were defined as liver stiffness measurement (LSM) ≥8 kPa, ≥10 kPa, and ≥12 kPa, respectively. The potential aetiologies of liver fibrosis were classified using a hierarchical framework with priority given to viral hepatitis, followed by alcohol-related liver fibrosis, metabolic-related liver fibrosis, and other causes. Results A total of 25,805 community-dwelling adults were enrolled (median age 51.0 years; 44.8% men). The prevalence of steatosis was 43.7% for ≥S1, 30.7% for ≥S2, and 24.3% for S3. MASLD, MetALD, and ALD were present in 39.4%, 2.0%, and 1.6% of participants, respectively. Significant fibrosis, cACLD, and advanced fibrosis were identified in 4.4%, 1.6%, and 0.8% of individuals, respectively (IDDF2026-ABS-0345 Figure 1). In multivariable analyses, male sex, older age, higher body mass index, larger waist circumference, heavy alcohol consumption, diabetes, hypertension, and dyslipidaemia were independently associated with both steatosis and liver fibrosis (IDDF2026-ABS-0345 Table 1). Metabolic-related liver fibrosis accounted for most fibrosis cases across disease stages (78.7% of significant fibrosis, 73.2% of cACLD, and 68.8% of advanced fibrosis) (IDDF2026-ABS-0345 Figure 2). Conclusions Liver fibrosis and SLD are highly prevalent in the Chinese community. These estimates correspond to nearly 49 million adults with significant fibrosis in China, with metabolic dysfunction accounting for most of the fibrosis burden. These findings indicate CLD as a major public health problem in China.