Background & Aims

Metabolic-associated fatty liver disease (MAFLD) is common among adolescents, but the prevalence of significant fibrosis in this age group is not known. We aimed to estimate the prevalence of MAFLD and significant (≥F2) fibrosis by transient elastography (TE) in adolescents in the United States.

Methods

We analyzed TE data from participants 12–18 years old included in the National Health and Nutrition Examination Survey 2017–2018 (data available from 867 adolescents). Steatosis was evaluated by the median controlled attenuation parameter (CAP) and fibrosis by median liver stiffness measurement.

Results

Two-hundred forty participants (24.16%; 95% CI, 21.07–27.24) had any degree of steatosis (CAP≥248 dBm), 123 participants (11.6%; 95% CI, 9.19–14.06) had S3 steatosis (CAP≥280 dBm), and 51 participants (4.4%; 95% CI, 2.51–6.33) had significant fibrosis (liver stiffness ≥7.4 kPa). Multivariate analyses revealed that body mass index (odds ratio [OR] per unit increase, 1.2; 95% CI, 1.2–1.4), sex (OR female vs male participants , 0.5; 95% CI, 0.4–0.7), ethnicity (OR, Hispanic vs non-Hispanic white, 4.5; 95% CI, 1.7–11.8), and hypertension (OR, 3.5; 95% CI, 1.3–9.9) were associated with S3 steatosis, whereas body mass index (OR, 1.1 per unit increase; 95% CI, 1.0–1.2) and ethnicity (OR, non-Hispanic black vs non-Hispanic white, 3.9; 95% CI, 1.2–13.2) were associated with significant fibrosis. High proportions of participants with fibrosis were in the normal weight category (35%) and had normal levels of alanine aminotransferase (78%).

Conclusions

Prevalence of MAFLD and significant fibrosis are alarmingly high in adolescents in the National Health and Nutrition Examination Survey 2017–2018. Levels of alanine aminotransferase and blood biomarkers do not correctly identify adolescents with more advanced disease. Effective noninvasive strategies to differentiate simple steatosis from progressive forms are urgently needed.

中文翻译：

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2017-2018 年全国健康和营养检查调查中瞬态弹性成像检测青少年肝脂肪变性和纤维化的患病率。

背景与目标

代谢相关性脂肪肝 (MAFLD) 在青少年中很常见，但该年龄段显着纤维化的患病率尚不清楚。我们旨在通过瞬时弹性成像 (TE) 估计美国青少年 MAFLD 和显着 (≥F2) 纤维化的患病率。

方法

我们分析了 2017-2018 年国家健康和营养检查调查中 12-18 岁参与者的 TE 数据（数据来自 867 名青少年）。通过中值受控衰减参数 (CAP) 评估脂肪变性，通过中值肝脏硬度测量评估纤维化。

结果

240 名参与者（24.16%；95% CI，21.07–27.24）有任何程度的脂肪变性（CAP≥248 dBm），123 名参与者（11.6%；95% CI，9.19–14.06）有 S3 脂肪变性（CAP≥280） dBm），并且 51 名参与者（4.4%；95% CI，2.51–6.33）有明显的纤维化（肝脏硬度≥7.4 kPa）。多变量分析显示体重指数（每单位增加的比值比 [OR]，1.2；95% CI，1.2-1.4）、性别（OR 女性与男性参与者，0.5；95% CI，0.4-0.7）、种族（OR ，西班牙裔与非西班牙裔白人，4.5；95% CI，1.7–11.8）和高血压（OR，3.5；95% CI，1.3–9.9）与 S3 脂肪变性相关，而体重指数（OR，1.1/单位）增加；95% CI，1.0–1.2）和种族（OR，非西班牙裔黑人与非西班牙裔白人，3.9；95% CI，1.2–13.2）与显着的纤维化相关。

结论

在 2017-2018 年国家健康和营养检查调查中，青少年 MAFLD 和显着纤维化的患病率高得惊人。丙氨酸氨基转移酶和血液生物标志物的水平不能正确识别患有更晚期疾病的青少年。迫切需要有效的非侵入性策略来区分简单脂肪变性和进行性脂肪变性。