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