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Younossi Z. Abstract 96. Presented at: Digestive Disease Week; 21.-24. May 2021 (virtual meeting).
Disclosure:
Younossi does not report any relevant financial information.
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The prevalence of fatty liver in the US increased significantly between 1999 and 2016, with high and medium risk groups also increasing, according to a presentation at Digestive Disease Week.
“This is an important study to educate policy makers about what we will be looking at in the future in fatty liver disease. Hence, we are looking at treatment strategies and algorithms to identify these patients in the general population and connect and link them to appropriate care, ” Zobair Younossi, MD, said Healio. “In 2016, approximately 38% of patients with fatty liver disease, which is around 30 to 35 million adults in the United States, have clinically significant fibrosis. Approximately 2.5 million adults actually have what is known as advanced fibrosis, as estimated by FIB4. “
Younossi and colleagues used data from the National Health and Nutrition Examination Survey (NHANES), which examined adults 20 to 20 years old from 1999 to 2016, and NHANES III, which examined adults from 1988 to 1994. They defined NAFLD by a US Fat Liver Index (US FLI) of 30 or more, excluding other causes of liver disease. They rated the fibrosis using the Fibrosis-4 (FIB-4) score.
With data for 11,532 participants in NHANES III, the NAFLD prevalence on ultrasound was 19.4% (95% CI, 17.7-21.3). Of those with NAFLD, the researchers stratified according to the risk of liver fibrosis: 80% at low risk; 18.6% with moderate risk; and 1.4% for high risk.
Patients with moderate or severe fibrosis also had the highest rates of cardiovascular disease (50.8%), diabetes (33.5%), cancer (32%), hypertension (26.3%) and hyperlipidemia (21, 1%).
Using US FLI, the researchers found a prevalence of NAFLD in this cohort of 23.6% (95 CI, 21.7-25.5), with 77.5% at low risk of liver fibrosis, 20.8% at medium risk and 1.65% occurred at high risk.
There were 17,216 participants in the latter NHANES group, and the prevalence of NAFLD based on US FLI increased from 29.5% (25.6-33.4) to 40.3% (36.6-44) in one annual percentage change of 2% (P = 0.013)).
“NAFLD increases over time, and the highest increases in the NAFLD population are seen in what is known as high-risk NAFLD, followed by medium-risk NAFLD,” said Younossi.
The moderate risk in NAFLD increased from 6.26% (1.1-14.17) to 14.17 (12.06-16.28) with an annual percentage change of 5.59% (P = <0.001). The severe risk increased from 0.49% (0.17-0.81) to 1.15% (0.45-1.85) with an annual percentage change of 8.75% (P = 0.004). The low risk hasn't changed.
These increases in prevalence and risk did not differ by gender, but Younossi said they occur predominantly in patients 40 years of age and older, the group with the highest risk of NASH, and more commonly in patients who are considered Mexican-American or non-Hispanic are classified as white.
“If you do the multivariate analysis of the real driver of this surge, the main driver was type 2 diabetes,” he said. “Type 2 diabetes was the main predictor of the increase in these patients, what I term high-risk NAFLD, or high-risk advanced fibrosis. … If you look at patients with fatty liver disease and advanced fibrosis – especially in the age group of 40 years or older, who are considered to be the peak of their productivity – the main reason the increase in this group is the high rate of diabetes. “
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