Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994.

Previous estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)²), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

[1]  J. Everhart,et al.  Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. , 2003, Gastroenterology.

[2]  B. Neuschwander‐Tetri,et al.  Nonalcoholic steatohepatitis: Summary of an AASLD Single Topic Conference , 2003, Hepatology.

[3]  K. Flegal,et al.  Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991 , 1994 .

[4]  Rocio Lopez,et al.  The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis , 2010, Hepatology.

[5]  S. Caldwell,et al.  Epidemiology and natural history of non-alcoholic steatohepatitis. , 2009, Clinics in liver disease.

[6]  F. Schaffner,et al.  Nonalcoholic fatty liver disease. , 1986, Progress in liver diseases.

[7]  I. Sartori Increasing Prevalence of Overweight Among US Adults , 1996 .

[8]  Eliseo Guallar,et al.  Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta‐analysis , 2011, Hepatology.

[9]  J. Deddens,et al.  A comparison of two methods for estimating prevalence ratios , 2008, BMC medical research methodology.

[10]  T. Sørensen,et al.  Prediction of risk of liver disease by alcohol intake, sex, and age: A prospective population study , 1996, Hepatology.

[11]  W. Kim,et al.  Burden of liver disease in the United States: Summary of a workshop , 2002, Hepatology.

[12]  S. Caldwell,et al.  Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying disease , 1999, Hepatology.

[13]  A. Sanyal,et al.  Population-based risk factors and resource utilization for HCC: US perspective , 2010, Current medical research and opinion.

[14]  J. Heimbach,et al.  Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. , 2011, Gastroenterology.

[15]  K. Reynolds,et al.  Association between inflammation and insulin resistance in U.S. nondiabetic adults: results from the Third National Health and Nutrition Examination Survey. , 2004, Diabetes care.

[16]  Philippe Giral,et al.  Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial. , 2008, Gastroenterology.

[17]  M. Lazo,et al.  Brief Communication: Clinical Implications of Short-Term Variability in Liver Function Test Results , 2008, Annals of Internal Medicine.

[18]  Sang-hun Park Expanding the Natural History of Nonalcoholic Steatohepatitis: from Cryptogenic Cirrhosis to Hepatocellular Carcinoma , 2003 .

[19]  Joel Z Stengel,et al.  Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. , 2011, Gastroenterology.

[20]  E. Jackvony,et al.  Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis , 2010, Hepatology.

[21]  D. Reboussin,et al.  Effect of a 12-Month Intensive Lifestyle Intervention on Hepatic Steatosis in Adults With Type 2 Diabetes , 2010, Diabetes Care.

[22]  Heidi M. Blanck,et al.  Vital signs: state-specific obesity prevalence among adults --- United States, 2009. , 2010, MMWR. Morbidity and mortality weekly report.

[23]  Z. Younossi,et al.  Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. , 1999, Gastroenterology.

[24]  G. Brandi,et al.  Drinking habits as cofactors of risk for alcohol induced liver damage , 1997, Gut.

[25]  N. Chalasani,et al.  Unexplained Elevations in Alanine Aminotransferase in Individuals with the Metabolic Syndrome: Results from the Third National Health and Nutrition Survey (NHANES III) , 2005, The American journal of the medical sciences.

[26]  Vincent Wai-Sun Wong,et al.  Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years , 2010, Gut.

[27]  Jeanne M Clark,et al.  The epidemiology of nonalcoholic fatty liver disease: a global perspective. , 2008, Seminars in liver disease.

[28]  D. Houlihan,et al.  Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. , 2010, The New England journal of medicine.

[29]  J. Rankin,et al.  Risk of fatty infiltration or cirrhosis of the liver in relation to ethanol consumption: a case-control study. , 1986, Clinical and investigative medicine. Medecine clinique et experimentale.

[30]  E. Boyko,et al.  The Prevalence and Predictors of Elevated Serum Aminotransferase Activity in the United States in 1999–2002 , 2006, The American Journal of Gastroenterology.

[31]  P. Hayashi,et al.  The natural history of nonalcoholic fatty liver disease: a clinical histopathological study , 2003, American Journal of Gastroenterology.

[32]  Chris Day,et al.  A position statement on NAFLD/NASH based on the EASL 2009 special conference. , 2010, Journal of hepatology.

[33]  E. Gunter,et al.  Laboratory procedures used for the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 , 1996 .

[34]  Jonathan C. Cohen,et al.  Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity , 2004, Hepatology.

[35]  B. Neuschwander‐Tetri,et al.  Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease , 2010, Hepatology.

[36]  Jiaquan Xu,et al.  Deaths: preliminary data for 2011. , 2012 .

[37]  R. Fisher,et al.  Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values , 2003, Hepatology.

[38]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[39]  Ronald W. Wilson National Center for Health Statistics -- 1976-78 -- Correspondence, Miscellaneous -- letter, 1976-07-21 , 1976 .

[40]  A. Sanyal,et al.  AGA technical review on nonalcoholic fatty liver disease. , 2002, Gastroenterology.

[41]  F. Brancati,et al.  The prevalence and etiology of elevated aminotransferase levels in the United States , 2003, American Journal of Gastroenterology.