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. 2024 Aug;79(2):229-237.
doi: 10.1002/jpn3.12230. Epub 2024 May 1.

Fibrosis and steatotic liver disease in US adolescents according to the new nomenclature

Ning Ma  1 , Meena Bansal  1 , Jaime Chu  2 , Andrea D Branch  1
Affiliations

Fibrosis and steatotic liver disease in US adolescents according to the new nomenclature

Ning Ma et al. J Pediatr Gastroenterol Nutr. 2024 Aug.

Abstract

Objective: To apply the new nomenclature for steatotic liver diseases (SLD), replacing nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD), in adolescents using National Health and Nutrition Examination Survey (NHANES) data.

Methods: Among 1410 adolescents (12-19 years) in NHANES (2017-March, 2020), the controlled attenuation parameter (CAP) of transient elastography (TE) was used to define steatosis and fibrosis (TE ≥ 7.4 kPa). Obesity and alanine aminotransferase (ALT) ≥ 80 U/L were used to identify adolescents qualifying for hepatology referral according to practice guidelines. NAFLD was defined as liver steatosis without a specific exposure; it has no cardiometabolic risk factor requirement, unlike MASLD.

Results: Steatosis (yes/no) is the first decision point in the new diagnostic protocol; however, criteria for steatosis are undefined. At the supplier (EchoSens)-recommended CAP threshold of 240 dB/m, 30.5% (95% confidence interval [CI]: 27.1%-34.0%) of adolescents had SLD and about 85% of adolescents with NAFLD met criteria for MASLD. The other 15% would receive an ambiguous diagnosis of either cryptogenic SLD or possible MASLD. At higher CAP thresholds, MASLD/NAFLD concordance increased and approached 100%. Among adolescents with MASLD-fibrosis, only 8.8% (95% CI: 0%-19.3%) had overweight/obese and ALT ≥ 80 U/L.

Conclusions: The new nomenclature highlights the high prevalence of liver steatosis. At the CAP threshold of 240 dB/m, however, approximately 15% of adolescents would receive an ambiguous diagnosis, which could lead to confusion and worry. Fewer than 10% of adolescents with MASLD-fibrosis had overweight/obese and ALT ≥ 80 U/L. Revised guidelines are needed to ensure that the other 90% receive appropriate referral and liver disease care.

Keywords: MASLD; NHANES; VCTE; cardiometabolic risk factors; cryptogenic SLD.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Mount Sinai receives support for Dr. Andrea D. Branch’s research from Gilead and Pfizer. Dr. Andrea D. Branch advised the Center for Disease Analysis Foundation. Dr. Jaime Chu has done ad hoc consulting for Albireo Pharma in the last 1 year. Dr. Meena Bansal has done consulting/Ad boards in Kinetix, Madrigal, Pfizer, Theratechnologies, Fibronostics, and NOVO Nordisk; and Mount Sinai receives support for Dr. Bansal’s research. Dr. Ning Ma had nothing to report.

Figures

FIGURE 1
FIGURE 1
The new nomenclature’s diagnostic scheme applied to adolescents in the United States. The flowcharts show 1410 adolescents (age 12–19 years old) categorized (A) according to new nomenclature; and (B) according to NAFLD criteria. The graph shows MASLD/NAFLD concordance with different CAP thresholds of steatotic liver disease. CAP, controlled attenuation parameter; MASLD, Metabolic dysfunction-associated steatotic liver disease; MetALD, Metabolic dysfunction-associated alcohol-associated liver disease; NAFLD, nonalcoholic fatty liver disease; NHANES, National Health and Nutrition Evaluation Survey.
FIGURE 2
FIGURE 2
The age-standardized-weighted percentage of SLD using different VCTE-CAP thresholds to define SLD, with stratification by race/ethnicity. The age-standardized-weighted prevalence of SLD based on different thresholds of VCTE-CAP were determined for the total cohort (black), non-Hispanic White (NHW, blue), non-Hispanic Black (NHB, red), Mexican American (MA, gray) and other (O, light gray) racial/ethnic groups. Differences between groups were tested by univariate t statistic. Statistical significance was a two-sided p < 0.05. *p < 0.05, **p < 0.001. CAP, controlled attenuation parameter; SE, standard error; SLD, steatotic liver diseases; VCTE, vibration controlled transient elastography.
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