Prevalence of nonalcoholic steatohepatitis-associated cirrhosis in the United States: an analysis of national health and nutrition examination survey data
MN Kabbany, PKC Selvakumar, K Watt… - Official journal of the …, 2017 - journals.lww.com
Official journal of the American College of Gastroenterology| ACG, 2017•journals.lww.com
Objectives: 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. Methods: National …
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. Methods: National …
Abstract
Objectives:
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.
Methods:
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.
Results:
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%); Pvalue< 0.05. The prevalence of NAFLD with advanced fibrosis also increased from 0.84 to 1.75% during the same time period (Pvalue< 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%); Pvalue< 0.005 for all of them.
Conclusions:
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