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. 2020;9(3):244.
Epub 2020 Dec 30.

Prevalence and Predictors of Nonalcoholic Steatohepatitis Using Multiple Non-Invasive Methods: Data from NHANES III

Magda Shaheen  1 , Katrina M Schrode  1 , Dulcie Kermah  1 , Deyu Pan  1 , Vishwajeet Puri  2 , Ali Zarrinpar  3 , David Elisha  1 , Sonia Michael Najjar  2 , Theodore C Friedman  1
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Prevalence and Predictors of Nonalcoholic Steatohepatitis Using Multiple Non-Invasive Methods: Data from NHANES III

Magda Shaheen et al. J Liver. 2020.

Abstract

Objective: Patients with nonalcoholic steatohepatitis (NASH) are at risk for developing cirrhosis and hepatic cancer. Currently, the definitive gold-standard method of diagnosing NASH is a liver biopsy, an invasive and costly method. Our objective was to compare three non-invasive methods of identifying NASH by using data on 10,007 subjects from NHANES III (1988-1994) to determine the prevalence and variables associated with NASH, as defined by each non-invasive method.

Methods: We used ultrasound data to identify subjects with moderate-to-severe hepatic steatosis, of whom we identified the NASH population using either the HAIR score, the NASH liver fat score, or the Gholam score, each of which had been validated with liver biopsy. We performed multinomial logistic regression to compare each NASH population to the normal population (those with no-to-mild hepatic steatosis).

Results: We identified 1136 (9.5%) subjects as having NASH by at least one method and 219 (1.8%) were identified by all 3 methods. Independent of the non-invasive method used, Mexican-Americans (MA) had the highest prevalence of NASH. All three methods identified significant risk factors for NASH (p<0.05), including: elevated waist-to-hip ratio, elevated levels of C-peptide, total cholesterol, or C-reactive protein (CRP).

Conclusion: We conclude that the combined non-invasive methods can help identify candidates with a high likelihood of being diagnosed with NASH. Health care providers can screen people with the combined non-invasive methods for the risk factors and identify candidates for interventions, including exercise and/or referral to biopsy.

Keywords: NHANES III; Non-alcoholic fatty liver; Non-invasive methods; Nonalcoholic steatohepatitis; Obesity.

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Figures

Figure 1:
Figure 1:
Flow diagram for the study sample from NHANES III used for analysis.
See this image and copyright information in PMC

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References

    1. McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015;62(5):1148–1155. - PubMed
    1. Angulo P Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221–1231. - PubMed
    1. Zarrinpar A, Faltermeier CM, Agopian VG, Naini BV, Harlander‐Locke MP, Kaldas FM, et al. Metabolic factors affecting hepatocellular carcinoma in steatohepatitis. Liver Int. 2019;39(3):531–539. - PMC - PubMed
    1. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91–100 - PubMed
    1. Pan JJ, Fallon MB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol. 2014;6(5):274. - PMC - PubMed