Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States.

Michael H Le,Ramsey C Cheung,Helen S Te,Dae Won Jun,Nghiem B Ha,Pardha Devaki,Mindie H Nguyen,Ming-Lung Yu

doi:10.1371/journal.pone.0173499

Abstract

In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 1988–1994. Our goal was to determine the NAFLD prevalence in the recent 1999–2012 NHANES, risk factors for advanced fibrosis (stage 3–4) and mortality. NAFLD was defined as having a United States Fatty Liver Index (USFLI) > 30 in the absence of heavy alcohol use and other known liver diseases. The probability of low/high risk of having advanced fibrosis was determined by the NAFLD Fibrosis Score (NFS). In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.93–5.08, p<0.001). In conclusion, in this most recent NHANES, NAFLD prevalence remains at 30% with 10.3% of these having advanced fibrosis. NAFLD per se was not a risk factor for increased mortality, but NAFLD with advanced fibrosis was. Mexican American ethnicity was a significant risk factor for NAFLD but not for advanced fibrosis or increased mortality.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of liver disease in Western countries and includes nonalcoholic steatohepatitis (NASH) which could progress to cirrhosis and is associated with liver cancer[1,2]
In multivariate model that is inclusive of sex, ethnicity, education level, smoking status, cardiovascular disease, cancer, and chronic obstructive pulmonary disease (COPD), high risk for advanced fibrosis was a significant independent predictor of increased all-cause mortality, with high-risk patients having over three folds higher likelihood of dying than those without NAFLD (HR = 3.13, 95% CI 1.93–5.08, p
Our study examined the prevalence of NAFLD, advanced fibrosis and mortality using the recent National Health and Nutrition Examination Survey (NHANES) 1999–2012 cycles

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of liver disease in Western countries and includes nonalcoholic steatohepatitis (NASH) which could progress to cirrhosis and is associated with liver cancer[1,2]. NAFLD, fibrosis, and mortality in the U.S. Ramsey Cheung - Grant/Research Support: Gilead Sciences, AbbVie. Mindie H. Nguyen - Advisory Committees/ Review Panels: Bristol-Myers Squibb, Gilead, Intercept, Anylam; Grant/Research Support: Gilead Sciences, Inc., Bristol-Myers Squibb, Janssen Pharmaceuticals, National Cancer Institute. The following authors have nothing to disclose: Michael H. This does not alter our adherence to PLOS ONE policies on sharing data and materials

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