Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) is increasingly common in the adult population. In the United States, the overall burden of NAFLD is unknown due to challenges with population-level NAFLD detection. The purpose of this study was to estimate prevalence of NAFLD and significant NAFLD fibrosis and identify factors associated with them in the U.S.MethodsData came from the 2017–2018 cycle of National Health and Nutrition Examination Survey. We defined NAFLD by controlled attenuation parameter (CAP) scores of ≥248 dB/m in absence of excessive alcohol use and viral hepatitis. We defined significant fibrosis as Vibration controlled transient elastography (VCTE) liver stiffness measurements (LSM) value ≥7.9 kPa. We calculated the adjusted odds ratio (OR) and 95% confidential intervals (CI) for associations with NAFLD and significant NAFLD fibrosis using multivariable logistic regression.ResultsOverall, among 4,024 individuals aged ≥20 years included in the analysis, 56.7% had NAFLD by CAP. In comparison, when defined by elevated liver enzymes, NAFLD prevalence was 12.4%. The prevalence of significant NAFLD fibrosis by VCTE LSM was 14.5%. NAFLD prevalence increased with age, was higher among men than women and among Hispanics compared with non-Hispanic whites. Individuals who were obese, had metabolic syndrome (MetS) and type 2 diabetes were more likely to have NAFLD compared to those that who were not obese or without MetS/diabetes. Inadequate physical activity (OR = 1.57, 95% CI: 1.18–2.08) was also a factor associated with NAFLD. MetS, high waist circumstance, diabetes and hypertension were independently associated with significant NAFLD fibrosis.ConclusionsNAFLD and significant NAFLD fibrosis are highly prevalent in U.S. general population.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the U.S [1], and anticipated to become the leading indication for liver transplantation [2]
Non-alcoholic fatty liver disease (NAFLD) and significant NAFLD fibrosis are highly prevalent in U.S general population
While most individuals with NAFLD are likely to have a good prognosis [5], up to 25% of NAFLD patients develop nonalcoholic steatohepatitis (NASH) [6] and 20% of NASH patients develop significant fibrosis (Metavir stage 2) [7], which is strongly associated with risk of adverse liver related complications, including hepatocellular carcinoma (HCC) [8]
Summary
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the U.S [1], and anticipated to become the leading indication for liver transplantation [2]. While most individuals with NAFLD are likely to have a good prognosis [5], up to 25% of NAFLD patients develop nonalcoholic steatohepatitis (NASH) [6] and 20% of NASH patients develop significant fibrosis (Metavir stage 2) [7], which is strongly associated with risk of adverse liver related complications, including hepatocellular carcinoma (HCC) [8]. Most population-based prevalence studies have relied on liver enzymes or ultrasonography for identifying and quantifying the burden of NAFLD; both methods potentially underestimate the true population prevalence of NAFLD [9, 10]. Vibration controlled transient elastography (VCTE) can estimate liver fibrosis by measuring liver stiffness; simultaneously it can quantify liver fat using the controlled attenuation parameter (CAP) with a sensitivity of 87% and specificity of 91% for detecting hepatic steatosis [13]. The purpose of this study was to estimate prevalence of NAFLD and significant NAFLD fibrosis and identify factors associated with them in the U.S
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