Dataset Information

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans.

ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States. However, few data are available on recent trends in the incidence and prevalence of NAFLD in the U.S.We analyzed the national Veterans Administration databases from 2003 to 2011 and calculated the age-adjusted prevalence and incidence of NAFLD for the overall sample of patients and by demographic subgroups. We used a previously validated algorithm to define NAFLD, which was based on persistent increases in levels of liver enzymes in the absence of positive results from tests for hepatitis C or hepatitis B or evidence of excessive alcohol use.Of the 9,784,541 patients with at least 1 visit to the Veterans Administration between 2003 and 2011, 1,330,600 patients (13.6%) had NAFLD. The annual incidence rates of NAFLD remained stable (from 2.2% to 3.2%) during the study duration. The prevalence of NAFLD increased from 6.3% in 2003 (95% confidence interval, 6.26%-6.3%) to 17.6% in 2011 (95% confidence interval, 17.58%-17.65%), a 2.8-fold increase. The incidence and prevalence increased at significantly greater rates in patients younger than 45 years vs older patients.In a U.S. population, the annual incidence of NAFLD ranges from 2% to 3%. The prevalence of NAFLD more than doubled from 2003 through 2011; it is likely to continue to increase because of a steady overall incidence coupled with a rising incidence in younger individuals.

SUBMITTER: Kanwal F

PROVIDER: S-EPMC4918764 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans.

Kanwal Fasiha F Kramer Jennifer R JR Duan Zhigang Z Yu Xiaoying X White Donna D El-Serag Hashem B HB

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20150817 2

<h4>Background & aims</h4>Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States. However, few data are available on recent trends in the incidence and prevalence of NAFLD in the U.S.<h4>Methods</h4>We analyzed the national Veterans Administration databases from 2003 to 2011 and calculated the age-adjusted prevalence and incidence of NAFLD for the overall sample of patients and by demographic subgroups. We used a previously validated algorithm ...[more]

PMID: 26291667

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Project description:The US prevalence of nonalcoholic fatty liver disease (NAFLD) is 30.6% and increasing. NAFLD shares some risk factors with periodontitis and dental caries. We explored the association between NAFLD and several oral conditions among US adults, using data from the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES), 1988 to 1994. NAFLD was assessed with ultrasonography (USON), the screening gold standard not available in the more recent NHANES, and the noninvasive Fibrosis Score (FS), Fatty Liver Index (FLI), and US Fatty Liver Index (US-FLI) as other screening alternatives. There were 5,421 eligible dentate adults aged 21 to 74 y with complete relevant data, with transferrin levels ?50%, without hepatitis B or C, who were not heavy drinkers. Multivariable models were developed to examine the independent effects of moderate-severe periodontitis, untreated dental caries, caries experience, and tooth loss (<20 teeth) on NAFLD while controlling for clinical, biological, and sociodemographic factors. Weighted estimates for odds ratios (ORs) and 95% CIs were calculated with logistic regression. Between 17% and 24% of adults had NAFLD depending on the classification criteria. In adjusted models, as compared with those with better oral health, adults with <20 teeth were more likely to have NAFLD depending on the measure (USON: OR = 1.50, 95% CI = 1.11 to 2.02; FS: OR = 4.36, 95% CI = 3.47 to 5.49; FLI: OR = 1.99, 95% CI = 1.52 to 2.59; US-FLI: OR = 2.32, 95% CI = 1.79 to 3.01). People with moderate-severe periodontitis were more likely to have NAFLD (USON: OR = 1.54, 95% CI = 1.06 to 2.24; FS: OR = 3.10, 95% CI = 2.31 to 4.17; FLI: OR = 1.61, 95% CI = 1.13 to 2.28; US-FLI: OR = 2.21, 95% CI = 1.64 to 2.98). People with any untreated caries were more likely to have NAFLD (USON: OR = 1.51, 95% CI = 1.20 to 1.90; FLI: OR = 1.80, 95% CI = 1.33 to 2.44). NAFLD was associated with tooth loss, periodontitis, and, for some NAFLD measures, untreated dental caries but not overall caries experience after controlling for several key sociodemographic and behavioral factors. Results suggest that further evaluation is needed to better understand this health-oral health interrelationship and potential opportunities for medical-dental integration.

Project description:Population-level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple-cause mortality data (2007-2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause-specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non-liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD-10 codes. Trends were evaluated by average annual percentage change (AAPC) in age-standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non-Hispanic whites, 32,868 non-Hispanic blacks, 46,530 Hispanics, 5,025 non-Hispanic American Indian or Alaska Natives [AIANs], 7,023 non-Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; P < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; P = 0.003), non-Hispanic whites (AAPC, 2.48%), non-Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non-Hispanic blacks and non-Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non-liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD-related deaths. For cause-specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non-liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). Conclusion: NAFLD-related deaths in U.S. adults are increasing. Cirrhosis is the top cause-specific death, followed by CVD. Women, non-Hispanic whites, and non-Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.

Project description:BACKGROUND:Prevalence of nonalcoholic fatty liver disease (NAFLD) and rate of advanced fibrosis among individuals with metabolic syndrome (MetS) and its individual metabolic abnormalities needs better understanding in the United States population. We aim to study these by using a large United States population database, the Third National Health and Nutrition Examination Survey (NHANES III). METHODS:A total of 11,674 individuals were included in our study cohort. NAFLD was defined as presence of moderate to severe hepatic steatosis on liver ultrasound in absence of viral hepatitis, significant alcohol use, elevated transferrin level, and medication use leading to hepatic steatosis. Advanced fibrosis among those with NAFLD was determined using noninvasive method, the NAFLD fibrosis score. MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III definition. RESULTS:The prevalence of NAFLD among included study cohort was 18.2% (95% confidence interval, 16.5-19.9). Individuals with metabolic abnormalities demonstrated higher prevalence (MetS, 43.2%; increased waist circumference, 31.2%; impaired fasting glucose/diabetes, 41.2%; high triglyceride level, 34.7%; low high-density lipoprotein, 27.8%; high blood pressure, 29.2%). The individuals with MetS had significantly higher NAFLD prevalence compared with controls (adjusted odds ratio, 11.5; 95% confidence interval, 8.9-14.7). The severity of hepatic steatosis was also noted to increase with higher number of metabolic abnormalities. Among individual metabolic abnormalities, increased waist circumference, impaired fasting glucose/diabetes, high triglyceride, and low high-density lipoprotein levels were found to be independently associated with NAFLD. Individuals with impaired fasting glucose/diabetes and those with 5 metabolic abnormalities had higher rate of advanced fibrosis (18.6% and 30.3%, respectively). Prevalence of NAFLD among individuals without any metabolic abnormality was 6.1%. CONCLUSION:Prevalence of NAFLD and rate of advanced fibrosis are significantly high among individuals with metabolic abnormalities.

Dataset Information

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans.

Publications

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans.

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