{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:05:02Z","timestamp":1793642702743,"version":"4.5.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2022,2,5]],"date-time":"2022-02-05T00:00:00Z","timestamp":1644019200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>\n                    The prevalence of liver disease, and especially of advanced liver fibrosis, in the German population is poorly defined. The aim of the study was to explore liver enzymes and surrogate scores of hepatic steatosis and advanced hepatic fibrosis in a population\u2010based cohort study in Germany. In the cross\u2010sectional population\u2010based Gutenberg Health study, data of 14,950 participants enrolled between 2007 and 2012 were captured and analyzed. The distribution of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma\u2010glutamyltransferase (GGT), fatty liver index (FLI), and Fibrosis\u20104 (FIB\u20104) score, as well as the underlying risk factors, were assessed by regression models. Elevated liver enzymes in this population\u2010based sample were seen in 19.9% for ALT, 12.8% for AST, and 14% for GGT. Risk factors for liver disease included alcohol use and the presence of the metabolic syndrome, which were both risk factors associated with increased liver enzymes. The FLI suggested that 37.5% of the population exhibited hepatic steatosis and 1.1% of patients exhibited a FIB\u20104 above the upper cutoff, while 19.2% were in the intermediate range. Interestingly, advanced fibrosis was significantly more frequent in men compared with women (FIB\u20104: 1.5% vs. 0.6% [\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.0001]; NFS: 3.6% vs. 1.9% [\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.0001]). In addition, age was a relevant risk factor for exhibiting a noninvasive surrogate score suggestive of advanced fibrosis in the current study population.\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    Elevated liver enzymes were seen in almost a fifth of the German population. At the population\u2010based level, the prevalence of advanced fibrosis was estimated at 1% in Germany.\n                  <\/jats:p>","DOI":"10.1002\/hep4.1899","type":"journal-article","created":{"date-parts":[[2022,2,5]],"date-time":"2022-02-05T03:39:56Z","timestamp":1644032396000},"page":"1457-1466","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":44,"title":["Prevalence and Risk Factors of Advanced Liver Fibrosis in a Population\u2010Based Study in Germany"],"prefix":"10.1097","volume":"6","author":[{"given":"Yvonne","family":"Huber","sequence":"first","affiliation":[{"name":"Department of Medicine I,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schulz","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine,Department of Cardiology,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Schmidtmann","sequence":"additional","affiliation":[{"name":"Institute of Medical Biostatistics, Epidemiology and Informatics,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Beutel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Center for Cardiology \u2010 Cardiology I,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"},{"name":"German Center for Cardiovascular Research,Partner Site Rhine\u2010Main,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R.","family":"Galle","sequence":"additional","affiliation":[{"name":"Department of Medicine I,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp S.","family":"Wild","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine,Department of Cardiology,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"},{"name":"German Center for Cardiovascular Research,Partner Site Rhine\u2010Main,Mainz,Germany"},{"name":"Center for Thrombosis and Hemostasis,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl J.","family":"Lackner","sequence":"additional","affiliation":[{"name":"Institute for Clinical Chemistry and Laboratory Medicine,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Department of Medicine I,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"},{"name":"Metabolic Liver Research Program,Department of Medicine I,University Medical Center of the Johannes Gutenberg University Mainz,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,2,5]]},"reference":[{"key":"hep41899-bib-0001-20251121","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1002\/hep.31173","article-title":"Changes in the global burden of chronic liver diseases from 2012 to 2017: the growing impact of NAFLD","volume":"72","year":"2020","journal-title":"Hepatology"},{"key":"hep41899-bib-0002-20251121","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1080\/17474124.2021.1974295","article-title":"Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real\u2010world practice: a targeted literature review","volume":"15","year":"2021","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"hep41899-bib-0003-20251121","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1111\/j.1572-0241.2003.07486.x","article-title":"The prevalence and etiology of elevated aminotransferase levels in the United States","volume":"98","year":"2003","journal-title":"Am J Gastroenterol"},{"key":"hep41899-bib-0004-20251121","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1572-0241.2005.00341.x","article-title":"The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999\u20102002","volume":"101","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"hep41899-bib-0005-20251121","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1111\/j.1572-0241.2008.02022.x","article-title":"Risk factors for chronic liver disease in Blacks, Mexican Americans, and Whites in the United States: results from NHANES IV, 1999\u20132004","volume":"103","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"hep41899-bib-0006-20251121","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1053\/j.gastro.2007.10.024","article-title":"Impact of fatty liver disease on health care utilization and costs in a general population: a 5\u2010year observation","volume":"134","year":"2008","journal-title":"Gastroenterology"},{"key":"hep41899-bib-0007-20251121","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0168-8278(01)00151-9","article-title":"The spectrum of liver disease in the general population: lesson from the Dionysos study","volume":"35","year":"2001","journal-title":"J Hepatol"},{"key":"hep41899-bib-0008-20251121","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.2337\/dc19-S004","article-title":"4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes\u20102019","volume":"42","year":"2019","journal-title":"Diabetes Care"},{"key":"hep41899-bib-0009-20251121","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jhep.2018.05.036","article-title":"Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016\u20102030","volume":"69","year":"2018","journal-title":"J Hepatol"},{"key":"hep41899-bib-0010-20251121","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1111\/liv.14825","article-title":"Disease burden and economic impact of diagnosed non\u2010alcoholic steatohepatitis in five European countries in 2018: a cost\u2010of\u2010illness analysis","volume":"41","year":"2021","journal-title":"Liver Int"},{"key":"hep41899-bib-0011-20251121","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2337\/dc07-1463","article-title":"Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects","volume":"31","year":"2008","journal-title":"Diabetes Care"},{"key":"hep41899-bib-0012-20251121","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1038\/s41575-020-0315-7","article-title":"NAFLD\u2014sounding the alarm on a silent epidemic","volume":"17","year":"2020","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"hep41899-bib-0013-20251121","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s41575-021-00477-7","article-title":"Defining comprehensive models of care for NAFLD","volume":"18","year":"2021","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"hep41899-bib-0014-20251121","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jhep.2021.02.034","article-title":"Prospective evaluation of the prevalence of non\u2010alcoholic fatty liver disease and steatohepatitis in a large middle\u2010aged US cohort","volume":"75","year":"2021","journal-title":"J Hepatol"},{"key":"hep41899-bib-0015-20251121","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1053\/j.gastro.2020.01.043","article-title":"Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta\u2010analysis","volume":"158","year":"2020","journal-title":"Gastroenterology"},{"key":"hep41899-bib-0016-20251121","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s00103-012-1502-7","article-title":"Die Gutenberg Gesundheitsstudie","volume":"55","year":"2012","journal-title":"Bundesgesundheitsblatt \u2010 Gesundheitsforschung \u2010 Gesundheitsschutz"},{"key":"hep41899-bib-0017-20251121","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","year":"2009","journal-title":"Circulation"},{"key":"hep41899-bib-0018-20251121","first-page":"39","article-title":"Health risk drinking and problematic consumption of alcohol in Pomerania: comparative analysis of the Study of Health in Pomerania (SHIP) compared with the Federal German Health and Examination Survey in 1998","volume":"67","year":"2005","journal-title":"Gesundheitswesen"},{"key":"hep41899-bib-0019-20251121","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ypmed.2003.11.011","article-title":"Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption","volume":"39","year":"2004","journal-title":"Prev Med"},{"key":"hep41899-bib-0020-20251121","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1471-230X-6-33","article-title":"The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population","volume":"6","year":"2006","journal-title":"BMC Gastroenterol"},{"key":"hep41899-bib-0021-20251121","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/apt.14976","article-title":"Predictors of advanced fibrosis in non\u2010cirrhotic non\u2010alcoholic fatty liver disease in Germany","volume":"48","year":"2018","journal-title":"Aliment Pharmacol Ther"},{"key":"hep41899-bib-0022-20251121","first-page":"1233","article-title":"Liver\u2010specific diagnostic for non\u2010alcoholic fatty liver disease (NAFLD)\u2014time to replace liver biopsy?","volume":"58","year":"2020","journal-title":"Z Gastroenterol"},{"key":"hep41899-bib-0023-20251121","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1055\/s-0030-1247406","article-title":"Pr\u00e4valenz des Metabolischen Syndroms in Deutschland: Ergebnisse der Study of Health in Pomerania (SHIP)","volume":"5","year":"2010","journal-title":"Diabetologie Und Stoffwechsel \u2010 DIABETOL STOFFWECHS"},{"key":"hep41899-bib-0024-20251121","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/apt.14327","article-title":"Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross\u2010sectional analysis of 2011\u20102014 National Health and Nutrition Examination Survey","volume":"46","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"hep41899-bib-0025-20251121","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MEG.0000000000000233","article-title":"A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes","volume":"27","year":"2015","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"hep41899-bib-0026-20251121","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1053\/j.gastro.2008.10.052","article-title":"Elevated serum alanine aminotransferase and gamma\u2010glutamyltransferase and mortality in the United States population","volume":"136","year":"2009","journal-title":"Gastroenterology"},{"key":"hep41899-bib-0027-20251121","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease\u2014meta\u2010analytic assessment of prevalence, incidence, and outcomes","volume":"64","year":"2016","journal-title":"Hepatology"},{"key":"hep41899-bib-0028-20251121","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1002\/hep.23135","article-title":"Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma\u2010glutamyl transpeptidase levels","volume":"50","year":"2009","journal-title":"Hepatology"},{"key":"hep41899-bib-0029-20251121","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1002\/hep4.1428","article-title":"Cardiovascular risk categories in patients with nonalcoholic fatty liver disease and the role of low\u2010density lipoprotein cholesterol","volume":"3","year":"2019","journal-title":"Hepatol Commun"},{"key":"hep41899-bib-0030-20251121","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12876-021-01601-2","article-title":"Factors associated with elevated alanine aminotransferase in employees of a German chemical company: results of a large cross\u2010sectional study","volume":"21","year":"2021","journal-title":"BMC Gastroenterol"},{"key":"hep41899-bib-0031-20251121","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1007\/s00535-018-1474-y","article-title":"The novel cutoff points for the FIB4 index categorized by age increase the diagnostic accuracy in NAFLD: a multi\u2010center study","volume":"53","year":"2018","journal-title":"J Gastroenterol"},{"key":"hep41899-bib-0032-20251121","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1038\/ajg.2016.453","article-title":"Age as a confounding factor for the accurate non\u2010invasive diagnosis of advanced NAFLD fibrosis","volume":"112","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"hep41899-bib-0033-20251121","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.jhep.2008.06.018","article-title":"Increased overall mortality and liver\u2010related mortality in non\u2010alcoholic fatty liver disease","volume":"49","year":"2008","journal-title":"J Hepatol"},{"key":"hep41899-bib-0034-20251121","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1365-2036.2008.03896.x","article-title":"Metabolic and histological features of non\u2010alcoholic fatty liver disease patients with different serum alanine aminotransferase levels","volume":"29","year":"2009","journal-title":"Aliment Pharmacol Ther"},{"key":"hep41899-bib-0035-20251121","first-page":"185","article-title":"Pr\u00e4valenztrend lebensstilabh\u00e4ngiger Risikofaktoren. Dtsch Arztebl","volume":"112","year":"2015","journal-title":"Int"},{"key":"hep41899-bib-0036-20251121","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4093\/dmj.2019.0011","article-title":"Nonalcoholic fatty liver disease in diabetes. Part I: Epidemiology and Diagnosis","volume":"43","year":"2019","journal-title":"Diabetes Metab J"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep4.1899","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep4.1899","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.1899","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T15:00:33Z","timestamp":1763737233000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.1899"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,5]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1002\/hep4.1899","relation":{},"ISSN":["2471-254X","2471-254X"],"issn-type":[{"value":"2471-254X","type":"print"},{"value":"2471-254X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,5]]},"assertion":[{"value":"2021-09-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}