Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data
- 1 April 2017
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Gastroenterology
- Vol. 112 (4), 581-587
- https://doi.org/10.1038/ajg.2017.5
Abstract
Nonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of manifestations ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), fibrosis and eventually cirrhosis. The prevalence of NAFLD has been shown to be increasing over time; however, the prevalence of NASH cirrhosis and advanced fibrosis over time has not been well studied. Estimate the changes in prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis among adults in the United States. National Health and Nutrition Examination Survey (NHANES) data obtained during the periods from 1999-2002 and 2009-2012 were analyzed to estimate the prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis in subjects aged ≥18 years at the time of enrollment. We excluded patients with viral hepatitis, excessive alcohol consumption, aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >500 and patients who were pregnant. Cirrhosis was defined by AST to platelet ratio index (APRI) >2 and abnormal liver function tests. NASH cirrhosis was defined as cirrhosis that presented with at least one of the following: obesity, diabetes, insulin resistance (HOMA-IR≥3), and metabolic syndrome. Advanced fibrosis was defined by using well-established cutoff values for APRI, fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS). Population weighted prevalence was calculated separately for two groups to account for complex sampling method of NHANES. A total of 7034 NHANES participants from 1999-2002 and 2009-2012 group were included with mean age of 46.2±0.59 and 47.3±0.51 years, respectively, at the time of screening. The prevalence of NASH cirrhosis was significantly higher in 2009-2012 group (0.178% with an estimated 417,524 American adults with NASH-associated cirrhosis) compared to 1999-2002 group (0.072%); P value<0.05. The prevalence of NAFLD with advanced fibrosis also increased from 0.84 to 1.75% during the same time period (P value<0.001) corresponding to 4,104,871 American adults. During these time periods, there were also significant increases in obesity (29.8 vs. 36.6%), diabetes (8.3 vs. 11.9%), and insulin resistance (34.7 vs. 42.1%); P value <0.005 for all of them. There has been a 2.5-fold and 2-fold increases in the prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis, respectively, in 2009-2012 compared to 1999-2002. Extrapolation of NHANES data suggests that in 2010, 417,524 in the US had NASH cirrhosis, and 4,104,871 had NAFLD-associated advanced fibrosis. This represents a major disease burden and suggests the need for widespread programs to identify and treat those affected, and public health efforts aimed at controlling the burden of NAFLD and its complications.Keywords
This publication has 27 references indexed in Scilit:
- Noninvasive Evaluation of Nonalcoholic Fatty Liver DiseaseSeminars in Liver Disease, 2015
- Fibrosis stage is the strongest predictor for disease‐specific mortality in NAFLD after up to 33 years of follow‐upJournal of Hepatology, 2014
- Prevalence of Nonalcoholic Fatty Liver Disease in the United States: The Third National Health and Nutrition Examination Survey, 1988–1994American Journal of Epidemiology, 2013
- Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States, 1976-2010.2013
- Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008Clinical Gastroenterology and Hepatology, 2011
- The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitisJournal of Hepatology, 2010
- Comparison of blood tests for liver fibrosis specific or not to NAFLDJournal of Hepatology, 2009
- The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLDJournal of Hepatology, 2007
- Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfectionJournal of Hepatology, 2006
- A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis CJournal of Hepatology, 2003