Prevalence and risk factors of nonalcoholic fatty liver disease, high-risk nonalcoholic steatohepatitis, and fibrosis among lean United States adults: NHANES 2017-2020

Markos Kalligeros; Stephanos Vassilopoulos; Athanasios Vassilopoulos; Fadi Shehadeh; Ingrid Lazaridou; Eleftherios Mylonakis; Kittichai Promrat; Jack R Wands

doi:10.20524/aog.2023.0840

Prevalence and risk factors of nonalcoholic fatty liver disease, high-risk nonalcoholic steatohepatitis, and fibrosis among lean United States adults: NHANES 2017-2020

Ann Gastroenterol. 2023 Nov-Dec;36(6):670-677. doi: 10.20524/aog.2023.0840. Epub 2023 Nov 3.

Authors

Markos Kalligeros¹, Stephanos Vassilopoulos¹, Athanasios Vassilopoulos¹, Fadi Shehadeh^{1

2}, Ingrid Lazaridou¹, Eleftherios Mylonakis³, Kittichai Promrat⁴, Jack R Wands⁵

Affiliations

¹ Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA (Markos Kalligeros, Stephanos Vassilopoulos, Athanasios Vassilopoulos, Fadi Shehadeh, Ingrid Lazaridou).
² Department of Electrical and Computer Engineering, National Technical University of Athens, Greece (Fadi Shehadeh).
³ Department of Medicine, Houston Methodist Hospital, Houston, TX, USA (Eleftherios Mylonakis).
⁴ Division of Gastroenterology and Hepatology, Providence VA Medical Center, Providence, RI, USA (Kittichai Promrat).
⁵ Liver Research Center, The Warren Alpert Medical School of Brown University, Providence, RI, USA (Jack R. Wands).

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is a growing public health concern worldwide. Early detection and management of modifiable risk factors are critical to mitigating its impact. This study aimed to investigate the prevalence and risk factors of NAFLD, nonalcoholic steatohepatitis (NASH), and fibrosis among lean adults in the United States (US), using the latest National Health and Nutrition Examination Survey (NHANES) dataset from 2017-2020.

Methods: Using controlled attenuation parameter scores of ≥285 dB/m, we assessed the age-adjusted prevalence of lean NAFLD. To determine the age-adjusted prevalence of high-risk NASH and significant fibrosis, we used the FibroScan-aspartate aminotransferase (FAST) score (cutoffs 0.35 and 0.67) and vibration-controlled transient elastography (liver stiffness measurement ≥8 kPa). Multivariate logistic regression was used to identify potential risk factors.

Results: We found the age-adjusted prevalence of lean NAFLD to be 6.30%. Among lean US adults, the age-adjusted prevalence of high-risk NASH and significant fibrosis was 1.29% and 4.35%, respectively. Older age and metabolic comorbidities, such as hypertension, diabetes, and dyslipidemia were associated with NAFLD and its complications.

Conclusion: These findings suggest that the prevalence of NAFLD is of concern among lean individuals, particularly those aged 40 and older with metabolic comorbidities, while a targeted approach to screening and risk stratification for hepatic fibrosis upon lean NAFLD diagnosis is warranted.

Keywords: NHANES; Nonalcoholic fatty liver disease; fibrosis; nonalcoholic steatohepatitis.