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Increasing Burden of Chronic Liver Disease Among Adolescents and Young Adults in the USA: A Silent Epidemic

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Abstract

Background and Aims

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

ALD:

Alcoholic liver disease

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AYA:

Adolescent and young adult

BMI:

Body mass index

CI:

Confidence interval

CLD:

Chronic liver disease

HCV:

Hepatitis C virus

IDU:

Injection drug user

NAFLD:

Nonalcoholic fatty liver disease

NHANES:

National Health and Nutrition Examination Survey

OR:

Odds ratio

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Author’s contributions

ID involved in interpretation of data. RL performed statistical analysis. NA involved in study concept and design, data analysis and interpretation. ID, NA drafting of the manuscript. KW, GR, RAM, NNZ, WC, RL, NA performed critical revision of the manuscript. ID, KW, GR, RAM, NNZ, WC, RL, NA approved final submission.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical University, Sofia, Bulgaria

    Iliana Doycheva

  2. Gastroenterology and Hepatology Department, Mayo Clinic, Rochester, MN, USA

    Kymberly D. Watt

  3. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    Ghassoub Rifai, Rachel Abou Mrad, Nizar N. Zein, William D. Carey & Naim Alkhouri

  4. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Rocio Lopez

  5. Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, A-111, Cleveland, OH, 44195, USA

    Naim Alkhouri

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  1. Iliana Doycheva
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  3. Ghassoub Rifai
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Correspondence to Naim Alkhouri.

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Doycheva, I., Watt, K.D., Rifai, G. et al. Increasing Burden of Chronic Liver Disease Among Adolescents and Young Adults in the USA: A Silent Epidemic. Dig Dis Sci 62, 1373–1380 (2017). https://doi.org/10.1007/s10620-017-4492-3

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  • DOI: https://doi.org/10.1007/s10620-017-4492-3

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