title: Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States.
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.
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States of America.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Le
authors.affiliation: Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, United States of America.
authors.forename: Pardha
authors.initials: P
authors.lastname: Devaki
authors.affiliation: School of Medicine, University of California Davis, Sacramento, CA, United States of America.|Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States of America.
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.affiliation: Department of Gastroenterology, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Jun
authors.affiliation: Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL, United States of America.
authors.forename: Helen S
authors.initials: HS
authors.lastname: Te
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States of America.|Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America.
authors.forename: Ramsey C
authors.initials: RC
authors.lastname: Cheung
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States of America.
authors.forename: Mindie H
authors.identifier: http://orcid.org/0000-0002-6275-4989
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology