Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States' adolescent population.

Abstract

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children and adolescents.AIMTo determine the prevalence and risk factors of steatosis and advanced fibrosis using transient elastography (TE) in the United States’ adolescent population.METHODSUsing the National Health and Nutrition Examination Survey 2017-2018, adolescent participants aged 13 to 17 years who underwent TE and controlled attenuation parameter (CAP) were included in this study. Forty-one factors associated with liver steatosis and fibrosis were collected. Univariate and multivariate linear regression analysis were used to identify statistically significant predictors.RESULTSSeven hundred and forty participants met inclusion criteria. Steatosis (S1-S3), based on CAP, and advanced fibrosis (F3-F4), based on TE, were present in 27% and 2.84% of the study population, respectively. Independent predictors of steatosis grade included log of alanine aminotransferase, insulin resistance, waist-to-height ratio, and body mass index. Independent predictors of fibrosis grade included steatosis grade, non-Hispanic black race, smoking history, and systolic blood pressure.CONCLUSIONThis study demonstrated a high prevalence of steatosis in the United States’ adolescent population. Almost 3% of United States’ adolescents had advanced fibrosis. These findings are concerning because a younger age of onset of NAFLD can lead to an earlier development of severe disease, including steatohepatitis, cirrhosis, and liver decompensation.