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3 "Yun Liu"
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Metabolic Risk/Epidemiology
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Healthy Lifestyle and the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease: A Large Prospective Cohort Study
Qing Chang, Yixiao Zhang, Tingjing Zhang, Zuyun Liu, Limin Cao, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Yang Ding, Yuhong Zhao, Kaijun Niu, Yang Xia
Received April 27, 2023  Accepted November 30, 2023  Published online March 19, 2024  
DOI:    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD.
A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors.
The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle.
Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.


Citations to this article as recorded by  
  • Diagnostic indicators and lifestyle interventions of metabolic-associated fatty liver disease
    Tianzhu Chen, Xiang Qin, Jianping Jiang, Beihui He
    Frontiers in Nutrition.2024;[Epub]     CrossRef
Metabolic Risk/Epidemiology
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Serum Retinol-Binding Protein Levels Are Associated with Nonalcoholic Fatty Liver Disease in Chinese Patients with Type 2 Diabetes Mellitus: A Real-World Study
Zhi-Hui Zhang, Jiang-Feng Ke, Jun-Xi Lu, Yun Liu, Ai-Ping Wang, Lian-Xi Li
Diabetes Metab J. 2022;46(1):129-139.   Published online August 10, 2021
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  • 188 Download
  • 9 Web of Science
  • 9 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReader   ePub   
The association of serum retinol-binding protein (RBP) levels with nonalcoholic fatty liver disease (NAFLD) remains controversial. Furthermore, few studies have investigated their relationship in type 2 diabetes mellitus (T2DM) patients. Therefore, the aim of the present study was to explore the association between serum RBP levels and NAFLD in Chinese inpatients with T2DM.
This cross-sectional, real-world study included 2,263 Chinese T2DM inpatients. NAFLD was diagnosed by abdominal ultrasonography. The subjects were divided into four groups based on RBP quartiles, and clinical characteristics were compared among the four groups. The associations of both RBP levels and quartiles with the presence of NAFLD were also analyzed.
After adjustment for sex, age, and diabetes duration, there was a significant increase in the prevalence of NAFLD from the lowest to the highest RBP quartiles (30.4%, 40.0%, 42.4%, and 44.7% for the first, second, third, and fourth quartiles, respectively, P<0.001 for trend). Fully adjusted multiple logistic regression analysis revealed that both increased RBP levels (odds ratio, 1.155; 95% confidence interval, 1.012 to 1.318; P=0.033) and quartiles (P=0.014 for trend) were independently associated with the presence of NAFLD in T2DM patients.
Increased serum RBP levels were independently associated with the presence of NAFLD in Chinese T2DM inpatients. Serum RBP levels may be used as one of the indicators to assess the risk of NAFLD in T2DM patients.


Citations to this article as recorded by  
  • The relationship between NAFLD and retinol-binding protein 4 - an updated systematic review and meta-analysis
    Rui Hu, Xiaoyue Yang, Xiaoyu He, Guangyao Song
    Lipids in Health and Disease.2023;[Epub]     CrossRef
  • Blood lactate levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: a real-world study
    Yi-Lin Ma, Jiang-Feng Ke, Jun-Wei Wang, Yu-Jie Wang, Man-Rong Xu, Lian-Xi Li
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • High‐normal unconjugated bilirubin is associated with decreased risk of chronic kidney disease in type 2 diabetes: A real‐world study
    Man‐Rong Xu, Chun‐Hua Jin, Jun‐Xi Lu, Mei‐Fang Li, Lian‐Xi Li
    Diabetes/Metabolism Research and Reviews.2023;[Epub]     CrossRef
  • Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis
    Elina En Li Cho, Chong Zhe Ang, Jingxuan Quek, Clarissa Elysia Fu, Lincoln Kai En Lim, Zane En Qi Heng, Darren Jun Hao Tan, Wen Hui Lim, Jie Ning Yong, Rebecca Zeng, Douglas Chee, Benjamin Nah, Cosmas Rinaldi Adithya Lesmana, Aung Hlaing Bwa, Khin Maung W
    Gut.2023; 72(11): 2138.     CrossRef
  • Serum iron is closely associated with metabolic dysfunction-associated fatty liver disease in type 2 diabetes: A real-world study
    Jun-Wei Wang, Chun-Hua Jin, Jiang-Feng Ke, Yi-Lin Ma, Yu-Jie Wang, Jun-Xi Lu, Mei-Fang Li, Lian-Xi Li
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Low-normal serum unconjugated bilirubin levels are associated with late but not early carotid atherosclerotic lesions in T2DM subjects
    Chun-Hua Jin, Jun-Wei Wang, Jiang-Feng Ke, Jing-Bo Li, Mei-Fang Li, Lian-Xi Li
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Waist-to-height ratio is a simple and practical alternative to waist circumference to diagnose metabolic syndrome in type 2 diabetes
    Yi-Lin Ma, Chun-Hua Jin, Cui-Chun Zhao, Jiang-Feng Ke, Jun-Wei Wang, Yu-Jie Wang, Jun-Xi Lu, Gao-Zhong Huang, Lian-Xi Li
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • GA/HbA1c ratio is a simple and practical indicator to evaluate the risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: an observational study
    Jun-Wei Wang, Chun-Hua Jin, Jiang-Feng Ke, Yi-Lin Ma, Yu-Jie Wang, Jun-Xi Lu, Mei-Fang Li, Lian-Xi Li
    Diabetology & Metabolic Syndrome.2022;[Epub]     CrossRef
  • Decreased Serum Osteocalcin is an Independent Risk Factor for Metabolic Dysfunction-Associated Fatty Liver Disease in Type 2 Diabetes
    Yu-Jie Wang, Chun-Hua Jin, Jiang-Feng Ke, Jun-Wei Wang, Yi-Lin Ma, Jun-Xi Lu, Mei-Fang Li, Lian-Xi Li
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 3717.     CrossRef
Association of Bisphenol A and Its Substitutes, Bisphenol F and Bisphenol S, with Obesity in United States Children and Adolescents
Buyun Liu, Hans-Joachim Lehmler, Yangbo Sun, Guifeng Xu, Qi Sun, Linda G. Snetselaar, Robert B. Wallace, Wei Bao
Diabetes Metab J. 2019;43(1):59-75.   Published online February 19, 2019
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  • 160 Download
  • 94 Web of Science
  • 97 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   

Bisphenol F (BPF) and bisphenol S (BPS) are increasingly used as substitutes for bisphenol A (BPA), an environmental obesogen. However, health effects of BPF and BPS remain unclear. In this study, we evaluated the associations of BPA, BPF, and BPS with obesity in children and adolescents.


We used data from the U.S. National Health and Nutrition Examination Survey 2013 to 2014, a nationally representative study. We included 745 participants aged 6 to 17 years old. General obesity was defined based on the 2000 Centers for Disease Control and Prevention body mass index-for-age growth charts for the United States. Abdominal obesity was defined as waist-to-height ratio ≥0.5.


After adjustment for demographic, socioeconomic and lifestyle factors, and urinary creatinine levels, the odds ratio of general obesity comparing the highest with lowest quartile of urinary bisphenol levels was 1.74 (95% confidence interval [CI], 0.92 to 3.31) for BPA, 1.54 (95% CI, 1.02 to 2.32) for BPF, and 1.36 (95% CI, 0.53 to 3.51) for BPS. Moreover, the associations were stronger in boys than in girls for BPA and BPF. Similar results were observed for abdominal obesity.


This study for the first time showed that exposure to BPF, a commonly used substitute for BPA, was positively associated with higher risk of obesity in children and adolescents. The association of BPA and BPF with general and abdominal obesity was primarily observed in boys, suggesting a possible sex difference. Further investigations on the underlying mechanisms are needed.


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    Mei Li, Tenglong Li, Juan Yin, Chunfeng Xie, Jianyun Zhu
    Toxicology.2023; 484: 153408.     CrossRef
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    Katherine J. Xu, Neruja Loganathan, Denise D. Belsham
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    Ophélie Téteau, Philippe Liere, Antoine Pianos, Alice Desmarchais, Olivier Lasserre, Pascal Papillier, Claire Vignault, Marie-Emilie Lebachelier de la Riviere, Virginie Maillard, Aurélien Binet, Svetlana Uzbekova, Marie Saint-Dizier, Sebastien Elis
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
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    Yun Jeong Lee, Youn-Hee Lim, Choong Ho Shin, Bung-Nyun Kim, Johanna Inhyang Kim, Yun-Chul Hong, Yong Min Cho, Young Ah Lee, Pasquale Avino
    PLOS ONE.2022; 17(6): e0268503.     CrossRef
  • Associations of bisphenol exposure with thyroid hormones in pregnant women: a prospective birth cohort study in China
    Huishen Huang, Jun Liang, Peng Tang, Chuanxiang Yu, Haoran Fan, Qian Liao, Jinghua Long, Dongxiang Pan, Xiaoyun Zeng, Shun Liu, Dongping Huang, Xiaoqiang Qiu
    Environmental Science and Pollution Research.2022; 29(58): 87170.     CrossRef
  • Association between urinary concentrations of bisphenol A substitutes and diabetes in adults
    Rafael Moreno-Gómez-Toledano, Esperanza Vélez-Vélez, María I Arenas, Marta Saura, Ricardo J Bosch
    World Journal of Diabetes.2022; 13(7): 521.     CrossRef
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    Chen Huang, Yuqin Wang, Xiao Lin, Ting Fung Chan, Keng Po Lai, Rong Li
    Ecotoxicology and Environmental Safety.2022; 242: 113897.     CrossRef
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    Rafael Moreno-Gómez-Toledano
    Environmental Pollution.2022; 313: 120106.     CrossRef
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    Malcolm J. Gander
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    Niyazi Emre Kurşunoğlu, Banu Pinar Sarer Yurekli
    World Journal of Clinical Cases.2022; 10(31): 11226.     CrossRef
  • Exposure to Bisphenol A Substitutes, Bisphenol S and Bisphenol F, and Its Association with Developing Obesity and Diabetes Mellitus: A Narrative Review
    Hend F. Alharbi, Raya Algonaiman, Rana Alduwayghiri, Thamer Aljutaily, Reham M. Algheshairy, Abdulkarim S. Almutairi, Razan M. Alharbi, Leena A. Alfurayh, Amjad A. Alshahwan, Amjad F. Alsadun, Hassan Barakat
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