Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data

  title={Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data},
  author={Mohammad Nasser Kabbany and Praveen Kumar Conjeevaram Selvakumar and Kymberly D. Watt and Rocio Lopez and Zade Akras and Nizar N. Zein and William D. H. Carey and Naim Alkhouri},
  journal={The American Journal of Gastroenterology},
Objectives:Nonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of manifestations ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), fibrosis and eventually cirrhosis. The prevalence of NAFLD has been shown to be increasing over time; however, the prevalence of NASH cirrhosis and advanced fibrosis over time has not been well studied. Estimate the changes in prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis among adults in the… 

Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: Implications for Liver Transplantation.

It is recommended that individuals who present with features of metabolic syndrome in the presence of elevated liver enzymes should be screened for NAFLD and, more importantly, nonalcoholic steatohepatitis (NASH).

Race/ethnicity-based temporal changes in prevalence of NAFLD-related advanced fibrosis in the United States, 2005–2016

While the prevalence of advanced fibrosis increased steadily in non-Hispanic whites through the duration of the study, it leveled off during 2013–2016 innon-Hispanic blacks, a similar trend was observed in entire NHANES cohort regardless of NAFLD status.

Peculiarities of Cirrhosis due to Nonalcoholic Steatohepatitis (NASH).

This review outlines how NASH cirrhosis differs from other etiologies of Cirrhosis including natural history, noninvasive assessment, and the challenges in the management of the complications of cirrhotic disease including hepatic encephalopathy and hepatocellular carcinoma.

The Global Burden of Non-alcoholic Steatohepatitis

NASH, its pathophysiological, patients reported and economic outcomes as well as potential therapeutic targets are discussed, which are increasingly linked to HCC in the United States.

Burden of nonalcoholic fatty liver disease in Canada, 2019-2030: a modelling study.

Increasing rates of obesity translate into increasing NAFLD-related cases of cirrhosis and hepatocellular carcinoma and related mortality and prevention efforts should be aimed at reducing the incidence ofNAFLD and slowing fibrosis progression among those already affected.

Disease Severity Is Associated With Higher Healthcare Utilization in Nonalcoholic Steatohepatitis Medicare Patients.

The results confirm the substantial impact of NASH, particularly more severe disease, on HCRU and costs and identify patients who may benefit from interventions to prevent progression and subsequently reduce HCRu and costs.

Increasing metabolic co-morbidities are associated with higher risk of advanced fibrosis in nonalcoholic steatohepatitis

Prevalence ofNASH with advanced fibrosis among U.S. adults was as high as 6.90% and prevalence of NASH with cirrhosis was ashigh as 3.67%, representing 5.18 million and 2.75 million, respectively, when using an estimate of 75 million U.s. adults with NAFLD.



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

The results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease, which is more common in men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States

After a median follow‐up of 14.5 years, NAFLD was not associated with higher mortality, but advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.

Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.

Prevalence of nonalcoholic fatty liver disease and NASH is higher than estimated previously and Hispanics and patients with diabetes are at greatest risk for both NAFLD and NASh.

The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis

Alcohol consumption, a modifiable risk factor, appears to be the most significant factor associated with risk of HCC development in patients with NASH‐cirrhosis in this study population.

APRI: a simple bedside marker for advanced fibrosis that can avoid liver biopsy in patients with NAFLD/NASH.

Aspartate aminotransferase-to-platelet ratio index compared favourably to NFS and was superior to AST/ALT for the prediction of advanced fibrosis, and is proposed in a new algorithm for the detection ofAdvanced fibrosis.

Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.

Noninvasive Evaluation of Nonalcoholic Fatty Liver Disease.

Transient elastography, as well as FIB-4 and NAFLD fibrosis scores are the best methods to rule out severe fibrosis and cirrhosis, and could be used in clinical practice as first-line tools to screen patients withNAFLD to help determine those who may still require a liver biopsy.

Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease.

NAFLD fibrosis score appears to be the best indicator of patients at risk, based on HRs, for liver-related complications or death in patients with nonalcoholic fatty liver disease.

Fibrosis stage is the strongest predictor for disease‐specific mortality in NAFLD after up to 33 years of follow‐up

NAFLD patients have increased risk of death, with a high risk ofdeath from cardiovascular disease and liver‐related disease, and the NAS was not able to predict overall mortality, whereas fibrosis stage predicted both overall and disease‐specific mortality.