# Prevalence, risk factors and association with gallstone disease of non-alcoholic fatty liver disease among rural indigenous communities: A cross-sectional study in Sarawak, Malaysia

## TL;DR

This study found a high prevalence of non-alcoholic fatty liver disease in rural Dayak communities in Malaysia, linked to obesity and metabolic factors.

## Contribution

The study provides new insights into NAFLD prevalence and risk factors in an underexplored indigenous population.

## Key findings

- The prevalence of NAFLD was 58% among Dayak participants in Sarawak.
- Central obesity and higher BMI were significant risk factors for NAFLD.
- Gallstone disease was not significantly associated with NAFLD in this population.

## Abstract

This study aimed to evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) among Dayak communities in Malaysia, shedding light on an underexplored population.

A cross-sectional study was undertaken among Dayak villagers in Sarawak aged 18 years and above using an interview-based questionnaire, followed by an anthropometric measurement, a blood test and an abdominal ultrasound.

A total of 324 participants met the inclusion criteria. Among them, 42.9% were men, and the mean age was 49.85±14.9 years. The prevalence of NAFLD was substantially high at 58%, with 43.1% of the participants having mild fatty liver (grade 1). NAFLD was closely associated with waist circumference and body mass index (BMI) (P<0.001). Central obesity, as indicated by waist circumference and BMI, emerged as a potent risk factor, with higher values correlating with an increased likelihood of NAFLD. A higher prevalence of NAFLD was observed in the participants with an advancing age, an elevated triglyceride level (66.7%) and a lower high-density lipoprotein cholesterol level (81.6%). However, these associations did not remain significant in the multivariate analysis. Gallstones, which share common risk factors with NAFLD, were not significantly associated with NAFLD in this population (P=0.853).

This study defines the prevalence and association of NAFLD with sociodemographic characteristics, health profiles and gallstone disease among indigenous villages in Dayak communities. A high BMI and central obesity are found to be independent risk factors of NAFLD.