{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:16Z","timestamp":1787028676381,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T00:00:00Z","timestamp":1597276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004085","name":"Ministry of Education, Science and Technology","doi-asserted-by":"publisher","award":["2017030666"],"award-info":[{"award-number":["2017030666"]}],"id":[{"id":"10.13039\/501100004085","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Non-alcoholic fatty liver disease (NAFLD) is a serious health concern as it can progress to liver cirrhosis and hepatoma. We investigated past trends in the prevalence of NAFLD and related factors among Korean men and women from 1998 to 2017 and predicted their future prevalence among Korean men. We used data from the Korea National Health and Nutrition Examination Survey I\u2013VII (KNHANES). NAFLD was defined as a hepatic steatosis index of &gt;36. Subjects with viral hepatitis, liver cirrhosis, cancer, pregnancy, and a habit of drinking \u226530 g alcohol per occasion were excluded. We evaluated the prevalence trends of NAFLD, obesity, abdominal obesity, high fat intake, and low physical activity in each KNHANES wave. For future prevalence predictions, average annual percentage changes (AAPCs) were estimated from the joinpoint model. In men, NAFLD prevalence has increased by approximately 11 percentage points in the past 19 years, reaching 30.7% in wave VII. Prevalence of obesity, abdominal obesity, high fat intake, and low physical activity also increased. The AAPC of NAFLD prevalence was 2.3% per year, and the estimated NAFLD prevalence in 2030 and 2035 was 39.1% and 43.8%, respectively. The forecasted prevalence of obesity, abdominal obesity, and high fat intake among Korean men in 2035 was 65.0%, 52.2%, and 23.5%, respectively. The estimated future prevalence of NAFLD and related factors was considerably high in the younger age group (19\u201345 year). In women, NAFLD prevalence has increased by approximately three percentage points in the past 19 years; however, this increase was not significant in the multivariate analysis. Public strategies to manage obesity, abdominal obesity, and unhealthy lifestyles are needed to prevent NAFLD.<\/jats:p>","DOI":"10.3390\/jcm9082626","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T09:23:44Z","timestamp":1597310624000},"page":"2626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Trends in the Prevalence of Non-Alcoholic Fatty Liver Disease and Its Future Predictions in Korean Men, 1998\u20132035"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7177-7816","authenticated-orcid":false,"given":"Seo Young","family":"Kang","sequence":"first","affiliation":[{"name":"International Healthcare Center, Asan Medical Center, Seoul 05505, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3307-2970","authenticated-orcid":false,"given":"Ye-Jee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul 05505, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9514-2401","authenticated-orcid":false,"given":"Hye Soon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul 05505, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/cld.579","article-title":"Natural history of nonalcoholic steatohepatitis\/nonalcoholic fatty liver disease-hepatocellular carcinoma: Magnitude of the problem from a hepatology clinic perspective","volume":"8","author":"Labgaa","year":"2016","journal-title":"Clin. Liver Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1440-1746.2005.04086.x","article-title":"Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults","volume":"21","author":"Park","year":"2006","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.3350\/cmh.2013.19.3.266","article-title":"Regional prevalence of non-alcoholic fatty liver disease in Seoul and Gyeonggi-do, Korea","volume":"19","author":"Jeong","year":"2013","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jhep.2007.02.007","article-title":"Prevalence and risk factors of non-alcoholic fatty liver disease in potential living liver donors in Korea: A review of 589 consecutive liver biopsies in a single center","volume":"42","author":"Lee","year":"2007","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15532","DOI":"10.3748\/wjg.v20.i42.15532","article-title":"Liver transplantation and non-alcoholic fatty liver disease","volume":"20","author":"Zezos","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1053\/j.gastro.2011.06.061","article-title":"Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States","volume":"141","author":"Charlton","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.cgh.2013.09.023","article-title":"Outcomes of liver transplantation for nonalcoholic steatohepatitis: A systematic review and meta-analysis","volume":"12","author":"Wang","year":"2014","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1002\/hep.30626","article-title":"Sex differences in nonalcoholic fatty liver disease: State of art and identification of research gaps","volume":"70","author":"Lonardo","year":"2019","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1053\/j.gastro.2018.04.034","article-title":"Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease: A multi-national cohort study","volume":"155","author":"Wong","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.cgh.2011.01.023","article-title":"Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma","volume":"9","author":"Yasui","year":"2011","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1055\/s-0028-1091978","article-title":"The epidemiology of nonalcoholic fatty liver disease: A global perspective","volume":"28","author":"Lazo","year":"2008","journal-title":"Semin. Liver Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.3748\/wjg.v21.i5.1650","article-title":"Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index","volume":"21","author":"Pang","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.dsx.2018.03.016","article-title":"Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors","volume":"12","author":"Rayyan","year":"2018","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/ije\/dyt228","article-title":"Data resource profile: The Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"43","author":"Kweon","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_16","unstructured":"IPAQ Research Committee (2019, July 15). Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ)\u2013Short Form. Available online: http:\/\/www.institutferran.org\/documentos\/scoring_short_ipaq_april04.pdf."},{"key":"ref_17","unstructured":"World Health Organization (2019, July 15). Global Physical Activity Questionnaire (GPAQ) Analysis Guide. Available online: https:\/\/www.who.int\/ncds\/surveillance\/steps\/resources\/GPAQ_Analysis_Guide.pdf."},{"key":"ref_18","unstructured":"World Health Organization (2000). Regional Office for the Western Pacific. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment, Health Communications Australia."},{"key":"ref_19","unstructured":"Korean Society for the Study of Obesity (2018). Guideline for the Management of Obesity 2018, Korean Society for the Study of Obesity."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dld.2009.08.002","article-title":"Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig. Liver Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/hep.30226","article-title":"Effect of alcohol consumption on survival in nonalcoholic fatty liver disease: A national prospective cohort study","volume":"70","author":"Hajifathalian","year":"2019","journal-title":"Hepatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s12986-017-0213-3","article-title":"Serum metabolites in non-alcoholic fatty-liver disease development or reversion; a targeted metabolomic approach within the PREDIMED trial","volume":"14","author":"Papandreou","year":"2017","journal-title":"Nutr. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1002\/sim.3733","article-title":"Estimating average annual per cent change in trend analysis","volume":"28","author":"Clegg","year":"2009","journal-title":"Stat. Med."},{"key":"ref_25","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\u20132030","volume":"69","author":"Estes","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_26","unstructured":"Korean Society for the Study of Obesity (2019, September 10). 2016 Obesity Fact Sheet. Available online: http:\/\/www.kosso.or.kr\/file\/factsheet_1006new6_web.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1253\/circj.CJ-14-0850","article-title":"Global trend in overweight and obesity and its association with cardiovascular disease incidence","volume":"78","author":"Yatsuya","year":"2014","journal-title":"Circ. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1053\/j.gastro.2012.04.001","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology","volume":"142","author":"Chalasani","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1002\/hep.23280","article-title":"Obesity and nonalcoholic fatty liver disease: Biochemical, metabolic, and clinical implications","volume":"51","author":"Fabbrini","year":"2010","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.amepre.2011.10.026","article-title":"Obesity and severe obesity forecasts through 2030","volume":"42","author":"Finkelstein","year":"2012","journal-title":"Am. J. Prev. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/ijo.2016.165","article-title":"Modelling obesity trends in Australia: Unravelling the past and predicting the future","volume":"41","author":"Hayes","year":"2017","journal-title":"Int. J. Obes."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jhep.2017.06.003","article-title":"New trends on obesity and NAFLD in Asia","volume":"67","author":"Fan","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/apt.14112","article-title":"Systematic review with meta-analysis: Risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients","volume":"46","author":"Sookoian","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/apt.14401","article-title":"Systematic review with meta-analysis: The significance of histological disease severity in lean patients with nonalcoholic fatty liver disease","volume":"47","author":"Sookoian","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3727\/105221617X15093707969658","article-title":"Updates on dietary models of nonalcoholic fatty liver disease: Current studies and insights","volume":"18","author":"Stephenson","year":"2018","journal-title":"Gene Expr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1111\/apt.12038","article-title":"Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: A population-based study","volume":"36","author":"Gerber","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.jhep.2015.07.010","article-title":"Relationship of sitting time and physical activity with non-alcoholic fatty liver disease","volume":"63","author":"Ryu","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jhep.2017.05.016","article-title":"Treatment of NAFLD with diet, physical activity and exercise","volume":"67","author":"Trenell","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/j.1365-2036.2011.04724.x","article-title":"Systematic review: The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/hep.29466","article-title":"Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease","volume":"67","author":"Estes","year":"2018","journal-title":"Hepatology"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Hu, X., Huang, Y., Bao, Z., Wang, Y.Q., Shi, D.M., Liu, F., Gao, Z.J., and Yu, X.F. (2012). Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai work-units. BMC Gastroenterol., 12.","DOI":"10.1186\/1471-230X-12-123"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.hepres.2005.09.007","article-title":"The characteristics and natural history of Japanese patients with nonalcoholic fatty liver disease","volume":"33","author":"Hashimoto","year":"2005","journal-title":"Hepatol. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S1665-2681(19)31922-2","article-title":"Prevalence of non-alcoholic fatty liver disease: Population based study","volume":"6","author":"Amarapurkar","year":"2007","journal-title":"Ann. Hepatol."},{"key":"ref_44","unstructured":"Korea Centers for Disease Control and Prevention (2019, September 20). Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2), Available online: https:\/\/knhanes.cdc.go.kr\/knhanes\/sub04\/sub04_03.do?classType=7."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Nam, G.E., Han, B., Joo, C.L., Kang, S.Y., Lim, J., Kim, Y.-H., and Park, H.S. (2019). Poor control of blood glucose, lifestyle, and cardiometabolic parameters in younger adult patients with type 2 diabetes mellitus. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091405"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1210\/jc.2003-031327","article-title":"Estrogen controls lipolysis by up-regulating alpha2A-adrenergic receptors directly in human adipose tissue through the estrogen receptor alpha. Implications for the female fat distribution","volume":"89","author":"Pedersen","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Park, Y.M., Pereira, R.I., Erickson, C.B., Swibas, T.A., Cox-York, K.A., and Van Pelt, R.E. (2017). Estradiol-mediated improvements in adipose tissue insulin sensitivity are related to the balance of adipose tissue estrogen receptor alpha and beta in postmenopausal women. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176446"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1126\/science.1140485","article-title":"Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 protection","volume":"317","author":"Naugler","year":"2007","journal-title":"Science"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/hep.21669","article-title":"FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest","volume":"46","author":"Mallet","year":"2007","journal-title":"Hepatology"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Jang, D.K., Lee, J.S., Lee, J.K., and Kim, Y.H. (2019). Independent association of physical activity with nonalcoholic fatty liver disease and alanine aminotransferase levels. J. Clin. Med., 8.","DOI":"10.3390\/jcm8071013"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jhep.2015.02.051","article-title":"Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008\u20132011)","volume":"63","author":"Lee","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"15145","DOI":"10.1038\/s41598-018-32245-0","article-title":"Male-specific association between subclinical hypothyroidism and the risk of non-alcoholic fatty liver disease estimated by hepatic steatosis index: Korea National Health and Nutrition Examination Survey 2013 to 2015","volume":"8","author":"Lee","year":"2018","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/8\/2626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:00:06Z","timestamp":1760176806000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/8\/2626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,13]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["jcm9082626"],"URL":"https:\/\/doi.org\/10.3390\/jcm9082626","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,13]]}}}