Objective Given significant advances in treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of liver diseases in the USA may be changing. Our aim was to assess the shift in the prevalence of different liver disease aetiologies in the USA over the past three decades. Design National Health and Nutrition Examination Surveys (NHANES; cross-sectional 1988–1994 and 1999–2016) were used. Results A total of 58 731 adults from NHANES (1988–2016) were included. Over the study period, the prevalence of chronic hepatitis B and alcoholic liver disease remained stable: 0.3%–0.4% and 0.8%–1.0%, respectively (p>0.05). The prevalence of chronic hepatitis C decreased nearly twofold: 1.6% in 1988–1994 to 0.9% in 2013–2016 (p=0.03). In contrast, the prevalence of non-alcoholic fatty liver disease (NAFLD; by US-Fatty Liver Index) increased from 20.0% (1988–1994) to 28.3% (1999–2004) to 33.2% (2009–2012) and 31.9% (2013–2016) (p<0.0001). Furthermore, steady increases were observed in the rates of obesity (22.2% in 1988–1994 to 31.0% in 1999–2004 to 38.9% in 2013–2016), type 2 diabetes mellitus (T2DM) (from 7.2% to 8.2% to 13.5% same years), insulin resistance and hypertension (all p<0.0001). Yearly trend analyses showed that the only LD with consistently increasing prevalence was NAFLD (trend p=0.01). Multivariable regression analysis showed that obesity (OR 10.4; 95% CI 9.5 to 11.3) and T2DM (OR 3.7; 95% CI 3.2 to 4.2) were the major independent predictors of NAFLD. Conclusions Over the past 30 years in the USA, NAFLD is the only liver disease with growing prevalence, synchronous with the increasing rates of obesity and T2DM.

中文翻译：

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美国近三年慢性肝病流行病学

目的 鉴于病毒性肝炎治疗的重大进展和肥胖症的日益流行，美国不同类型肝病的负担可能正在发生变化。我们的目的是评估过去三十年美国不同肝病病因流行率的变化。使用了设计国家健康和营养检查调查（NHANES；横断面 1988-1994 和 1999-2016）。结果共纳入了来自 NHANES（1988-2016 年）的 58 731 名成年人。在研究期间，慢性乙型肝炎和酒精性肝病的患病率保持稳定：分别为 0.3%–0.4% 和 0.8%–1.0%（p>0.05）。慢性丙型肝炎的患病率下降了近两倍：1988-1994 年的 1.6% 到 2013-2016 年的 0.9%（p=0.03）。相比之下，非酒精性脂肪性肝病（NAFLD；按美国脂肪肝指数）从 20.0%（1988-1994）增加到 28.3%（1999-2004）到 33.2%（2009-2012）和 31.9%（2013-2016）（p<0.0001）。此外，肥胖率（从 1988-1994 年的 22.2% 到 1999-2004 年的 31.0% 到 2013-2016 年的 38.9%）、2 型糖尿病（T2DM）（从 7.2% 到 8.2% 到 13. %同年）、胰岛素抵抗和高血压（所有 p<0.0001）。年度趋势分析表明，唯一一个患病率持续增加的 LD 是 NAFLD（趋势 p=0.01）。多变量回归分析显示肥胖（OR 10.4；95% CI 9.5 至 11.3）和 T2DM（OR 3.7；95% CI 3.2 至 4.2）是 NAFLD 的主要独立预测因素。结论 在美国过去 30 年中，NAFLD 是唯一一种患病率不断增加的肝脏疾病，与肥胖和 T2DM 的发病率同步增加。