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

  • Donghee Kim
  • Won Kim
  • Adeyinka C. Adejumo
  • George Cholankeril
  • Sean P. Tighe
  • Robert J. Wong
  • Stevan A. Gonzalez
  • Stephen A. Harrison
  • Zobair M. Younossi
  • Aijaz AhmedEmail author
Original Article


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.


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.


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.


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.


Hepatic steatosis National Health and Nutrition Examination Survey Nonalcoholic steatohepatitis 



Nonalcoholic fatty liver disease


NAFLD fibrosis score


Aspartate aminotransferase-to-platelet ratio index


National Health and Nutrition Examination Survey


Body mass index


Hepatic steatosis index


US fatty liver index


Alanine aminotransferase


Aspartate aminotransferase


Confidence interval


Authors’ 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.


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

Compliance with ethical standards

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.

Supplementary material

12072_2018_9926_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  • Donghee Kim
    • 1
  • Won Kim
    • 2
  • Adeyinka C. Adejumo
    • 3
  • George Cholankeril
    • 4
  • Sean P. Tighe
    • 4
  • Robert J. Wong
    • 5
  • Stevan A. Gonzalez
    • 6
  • Stephen A. Harrison
    • 7
  • Zobair M. Younossi
    • 8
  • Aijaz Ahmed
    • 4
    Email author
  1. 1.Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of Internal MedicineSeoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical CenterSeoulSouth Korea
  3. 3.Department of MedicineNorth Shore Medical CenterSalemUSA
  4. 4.Division of Gastroenterology and HepatologyStanford University School of MedicinePalo AltoUSA
  5. 5.Division of Gastroenterology and HepatologyAlameda Health System, Highland HospitalOaklandUSA
  6. 6.Baylor Simmons Transplant InstituteFort WorthUSA
  7. 7.Radcliffe Department of MedicineUniversity of OxfordOxfordUK
  8. 8.Department of Medicine, Center for Liver DiseasesInova Fairfax HospitalFalls ChurchUSA

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