In this retrospective study, subjects who received voluntary routine health checkups at Boramae Health Care Center between 2010 and 2020 were consecutively enrolled. Most of them had no symptoms and voluntarily underwent heath examinations. In the case of subjects who underwent twice or more exams, results of the primary test were used. Initially, a total of 26,914 adults aged ≥ 20 years were enrolled. Among them, 1802 subjects with no hepatic ultrasonography data and 4505 subjects with no body composition analysis were excluded. We also excluded subjects who had potential cause of chronic liver disease, including 806 who were positive for the hepatitis B virus or positive for the hepatitis C virus, 2258 who had a significant alcohol intake (> 210 g/week for males and > 140 g/week for females)15 (link), and three who had liver cancer. Finally, 17,540 subjects were included for the analysis (Fig. 1).

Flow chart.

This study was approved by the Institutional Review Board (IRB) of Boramae Medical Center (No. 30-2022-93). The requirement for written informed consent was waived by IRB of Boramae Medical Center due to the retrospective nature of this study. This study was conducted in accordance with the Declaration of Helsinki.
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