Original Article
Pancreas, Biliary Tract, and Liver
Prevalence of Liver Steatosis and Fibrosis Detected by Transient Elastography in Adolescents in the 2017–2018 National Health and Nutrition Examination Survey

https://doi.org/10.1016/j.cgh.2020.06.048Get rights and content

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.

Section snippets

Study Design and Population

The present study represents an analysis of data from the 2017–2018 cycles of NHANES, which is conducted in the United States by the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention. NHANES is a cross-sectional survey program that uses a stratified, multistage, clustered probability sampling design to include individuals representative of the general, noninstitutionalized population ≥2 months of age. Full methodology of data collection is

Results

Clinical and metabolic features of the 867 study participants are shown in Table 1. Mean age was 15.1 years, 52% were male, about one-fifth were obese, and 4.3% had elevated blood pressure. Any degree of steatosis was present in 240 individuals (weighted prevalence 24.16%; 95% confidence interval [CI], 21.07%–27.24%), and 123 had S3 steatosis (weighted prevalence 11.63%; 95% CI, 9.19%–14.06%). No participant tested positive for either hepatitis C antibodies or hepatitis B surface antigen, and

Discussion

This is to our knowledge the first study reporting estimates on the prevalence of MAFLD and significant fibrosis in adolescents from the general U.S. population by means of transient elastography. We found that approximately 1 in 10 adolescents had a CAP ≥280 dB/m (indicative of S3 steatosis), and almost 1 in 20 had evidence of increased liver stiffness, suggestive of significant fibrosis. Our results align with previous data on adolescents from the 1999–2004 NHANES cycles, which showed a

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    Conflicts of interest The authors disclose no conflicts.

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