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. 2017 Mar 27;12(3):e0173499.
doi: 10.1371/journal.pone.0173499. eCollection 2017.

Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States

Michael H Le  1 , Pardha Devaki  2 , Nghiem B Ha  3   4 , Dae Won Jun  5 , Helen S Te  6 , Ramsey C Cheung  4   7 , Mindie H Nguyen  4
Affiliations

Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States

Michael H Le et al. PLoS One. .

Abstract

In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 1988-1994. Our goal was to determine the NAFLD prevalence in the recent 1999-2012 NHANES, risk factors for advanced fibrosis (stage 3-4) and mortality. NAFLD was defined as having a United States Fatty Liver Index (USFLI) > 30 in the absence of heavy alcohol use and other known liver diseases. The probability of low/high risk of having advanced fibrosis was determined by the NAFLD Fibrosis Score (NFS). In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.93-5.08, p<0.001). In conclusion, in this most recent NHANES, NAFLD prevalence remains at 30% with 10.3% of these having advanced fibrosis. NAFLD per se was not a risk factor for increased mortality, but NAFLD with advanced fibrosis was. Mexican American ethnicity was a significant risk factor for NAFLD but not for advanced fibrosis or increased mortality.

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Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Helen S. Te - Advisory Committees or Review Panels: Intercept; Grant/Research Support: Abbvie, Gilead, Conatus. Ramsey Cheung - Grant/Research Support: Gilead Sciences, AbbVie. Mindie H. Nguyen - Advisory Committees/ Review Panels: Bristol-Myers Squibb, Gilead, Intercept, Anylam; Grant/Research Support: Gilead Sciences, Inc., Bristol-Myers Squibb, Janssen Pharmaceuticals, National Cancer Institute. The following authors have nothing to disclose: Michael H. Le, Pardha Devaki, Nghiem B. Ha, Dae Won Jun. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Weighted survival by NAFLD and fibrosis status based on NFS cutoffs in the National Health and Nutrition Examination Survey, 1999–2010.
NFS cutoffs for advanced fibrosis: low risk <-1.455, indeterminate risk -1.455–0.676, high risk >0.676.No NAFLD vs. NAFLD low risk: p = 0.015| No NAFLD vs. NAFLD indeterminate risk: p<0.001. No NAFLD vs. NAFLD high risk: p<0.001 |NAFLD low risk of advanced fibrosis vs NAFLD high risk of advanced fibrosis: p<0.001|
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