title: Increasing Burden of Chronic Liver Disease Among Adolescents and Young Adults in the USA: A Silent Epidemic.
abstract: Chronic liver disease (CLD) starts or becomes established in the adolescent and young adult (AYA) age group. This study aimed to estimate trends in CLD prevalence among US AYAs and to assess factors associated with CLD.
  
  
  
  Cross-sectional data from 14,547 AYAs (population-weighted N = 68,274,386) aged 15-39 years enrolled in the National Health and Nutrition Examination Survey from 1988 to 2012 were used. Nonalcoholic fatty liver disease (NAFLD) was defined as elevated alanine aminotransferase (>19 U/L for females and >30 U/L for males) in subjects with BMI ≥ 25 kg/m2; alcoholic liver disease (ALD) as excessive alcohol use (≥3 drinks/day for men and ≥2 drinks/day for women) and elevated aminotransferases after excluding alternative etiologies. Participants were considered hepatitis C virus (HCV) positive if antibody to HCV and HCV-RNA was positive.
  
  
  
  There was a sharp increase in the prevalence of CLD from 12.9% in 1988-1994 to 28.5% in 1999-2004 that remained stable after that (27.7%). NAFLD was the most common etiology accounting for 22% of all CLD in the later period. The prevalence of ALD has been steadily increasing throughout the years, while HCV has been decreasing. On multivariate analysis, being overweight/obese, Mexican-American ethnicity, later study period, older age, and male gender, were associated with higher odds of having CLD.
  
  
  
  More than one quarter of US AYAs might be affected by CLD. CLD prevalence in this age group has more than doubled over the past three decades mainly due to rise in NAFLD prevalence.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University, Sofia, Bulgaria.
authors.forename: Iliana
authors.initials: I
authors.lastname: Doycheva
authors.affiliation: Gastroenterology and Hepatology Department, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kymberly D
authors.initials: KD
authors.lastname: Watt
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ghassoub
authors.initials: G
authors.lastname: Rifai
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Abou Mrad
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Zein
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Carey
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. alkhoun@ccf.org.|Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, A-111, Cleveland, OH, 44195, USA. alkhoun@ccf.org.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
mesh_terms: D000293:Adolescent; D000328:Adult; D058625:End Stage Liver Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Alcoholic liver disease; Hepatitis C; Nonalcoholic fatty liver disease; Obesity; Young population