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Awareness of Nonalcoholic Fatty Liver Disease Is Increasing but Remains Very Low in a Representative US Cohort

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in the USA. Interestingly, most patients with NAFLD are unaware of having any liver disease (LD). We aimed to assess the awareness of suspected NAFLD and factors associated with being aware of LD.

Methods

Adult subjects with suspected NAFLD (BMI > 25) with elevated ALT in the absence of secondary causes of LD who participated in the continuous national health and nutrition examination survey (NHANES) during 2001–2016 were identified and analyzed. Trends of NAFLD awareness were then assessed in periods of 4 years each. Multivariable logistic regression analysis was performed to assess factors associated with LD awareness.

Results

A total of 7033 subjects were included in the final analysis (1731, 1757, 1711, and 1834 subjects for the periods of 2001–2004, 2005–2008, 2009–2012, and 2013–2016, respectively). Over the study duration, an increase in BMI, waist circumference, diabetes, and HbA1c; and a decrease in the number of smokers, platelets count, bilirubin, total cholesterol, and LDL level were noticed (p < 0.001). Awareness of having LD across study periods has increased over time from 1.5% in the 2001–2004 periods to 3.1% in the 2013–2016 periods. Multivariable logistic regression analysis showed that older age, ethnicity (non-black), having fewer drinks/week, metabolic syndrome, higher ALT, ALP, and GGT were associated with being aware of having LD.

Conclusions

Awareness of having LD among subjects with suspected NAFLD has increased over the last two decades, but more than 95% of these patients are still unaware of having LD. Educational programs to increase awareness of LD and risk factors for NAFLD should be implemented on a large scale.

Clinical Trial Registration Number

Not required, as we used de-identified NHANES data.

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Abbreviations

AF:

Advanced fibrosis

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

APRI:

AST to platelet ration index

BMI:

Body mass index

CDC:

Centers for disease control and prevention

ESLD:

End-stage liver disease

FIB-4:

Fibrosis-4

GGT:

γ-Glutamyl transpeptidase

HSI:

Hepatic steatosis index

HDL:

High-density lipoprotein

HbA1c:

Hemoglobin A1c

IDF:

International diabetes federation

LDL:

Low-density lipoprotein

LD:

Liver disease

MCQ:

“Medical conditions” questionnaire

MetS:

Metabolic syndrome

NHANES:

National health and nutrition examination survey

NAFLD:

Nonalcoholic fatty liver disease

NFS:

NAFLD fibrosis score

NASH:

Nonalcoholic steatohepatitis

NCHS:

National center for health statistics

ULN:

Upper limit of normal

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, A5 Annex, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Amandeep Singh

  2. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Amandeep Singh, William Carey & Arthur McCullough

  3. University of Nebraska Medical Center, Omaha, NE, USA

    Amaninder S. Dhaliwal & Shailainder Singh

  4. Department of Gastroenterology and Hepatology, Stony Brook University, New York, USA

    Atul Kumar

  5. Center for Populations Health Sciences and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA

    Rocio Lopez

  6. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA

    Mohit Gupta

  7. Cedar-Sinai Medical Center, Los Angeles, CA, USA

    Mazen Noureddin

  8. Texas Liver Institute, University of Texas (UT) Health, San Antonio, TX, USA

    Naim Alkhouri

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  1. Amandeep Singh
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  2. Amaninder S. Dhaliwal
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  8. William Carey
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Contributions

AS, ASD, MG, and NA helped in study concept and design; AS contributed to acquisition of data; all authors helped in analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content, and administrative, technical, or material support; RL, AS, and NA contributed to statistical analysis; ASD, SS, AK, AK, MN, WC, AM, and NA contributed to study supervision.

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Correspondence to Amandeep Singh.

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Singh, A., Dhaliwal, A.S., Singh, S. et al. Awareness of Nonalcoholic Fatty Liver Disease Is Increasing but Remains Very Low in a Representative US Cohort. Dig Dis Sci 65, 978–986 (2020). https://doi.org/10.1007/s10620-019-05700-9

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  • DOI: https://doi.org/10.1007/s10620-019-05700-9

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