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Race/ethnicity-based temporal changes in prevalence of NAFLD-related advanced fibrosis in the United States, 2005–2016

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Abstract

Background and aim

Advanced fibrosis associated with nonalcoholic fatty liver disease (NAFLD) has been reported to have a higher risk of hepatic and non-hepatic mortality. We aim to study the recent trends in the prevalence of NAFLD-related advanced fibrosis in a large population sample.

Methods

Cross-sectional data from 28,739 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016 were utilized. NAFLD was defined using the hepatic steatosis index (HSI) and the US fatty liver index (USFLI) in the absence of other causes of chronic liver disease. The presence and absence of advanced fibrosis in NAFLD was determined by the NAFLD fibrosis score, FIB-4 score, and aspartate aminotransferase-to-platelet ratio index.

Results

The prevalence of NAFLD-related advanced fibrosis increased from 2.6% [95% confidence interval (CI) 2.1–3.1] in 2005–2008 and 4.4% (95% CI 3.7–5.1) in 2009–2012, to 5.0% (95% CI 4.2–5.9) in 2013–2016 using HSI as the NAFLD prediction model; and from 3.3% (95% CI 2.5–4.5) in 2005–2008 and 6.4% (95% CI 3.7–5.1) in 2009–2012, to 6.8% (95% 5.3–8.7) in 2013–2016 using USFLI (p < 0.01). A similar trend was observed in entire NHANES cohort regardless of NAFLD status. While the prevalence of advanced fibrosis increased steadily in non-Hispanic whites through the duration of the study, it leveled off during 2013–2016 in non-Hispanic blacks.

Conclusions

Prevalence of advanced fibrosis associated with NAFLD increased steadily from 2005 to 2016. More importantly, race/ethnicity-based temporal differences were noted in the prevalence of NAFLD-related advanced fibrosis during the study.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NFS:

NAFLD fibrosis score

APRI:

Aspartate aminotransferase-to-platelet ratio index

NHANES:

National Health and Nutrition Examination Survey

BMI:

Body mass index

HSI:

Hepatic steatosis index

USFLI:

US fatty liver index

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CI:

Confidence interval

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

    Donghee Kim

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea

    Won Kim

  3. Department of Medicine, North Shore Medical Center, Salem, MA, USA

    Adeyinka C. Adejumo

  4. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA

    George Cholankeril, Sean P. Tighe & Aijaz Ahmed

  5. Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA

    Robert J. Wong

  6. Baylor Simmons Transplant Institute, Fort Worth, TX, USA

    Stevan A. Gonzalez

  7. Radcliffe Department of Medicine, University of Oxford, Oxford, UK

    Stephen A. Harrison

  8. Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA

    Zobair M. Younossi

Authors
  1. Donghee Kim
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  2. Won Kim
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  4. George Cholankeril
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  9. Zobair M. Younossi
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  10. Aijaz Ahmed
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Contributions

DK was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript. WK, ACA, GC, SPT, RJW, SAG, SAH and ZMY were involved in interpretation of data and critical revision of the manuscript for important intellectual content. AA was involved in study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision.

Corresponding author

Correspondence to Aijaz Ahmed.

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Conflict of interest

Donghee Kim, Won Kim, Adeyinka C. Adejumo, George Cholankeril, Sean P. Tighe, Robert J. Wong, Stevan A. Gonzalez, Stephen A. Harrison, Zobair M. Younossi and Aijaz Ahmed declare that they have no conflict of interest.

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Kim, D., Kim, W., Adejumo, A.C. et al. Race/ethnicity-based temporal changes in prevalence of NAFLD-related advanced fibrosis in the United States, 2005–2016. Hepatol Int 13, 205–213 (2019). https://doi.org/10.1007/s12072-018-09926-z

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  • DOI: https://doi.org/10.1007/s12072-018-09926-z

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