Background: Recently, the face of liver disease (LD) in the U.S. may be changing. The aim was to assess the prevalence of LDs in the U.S. over 3 decades.

Methods: Clinical data from NHANES were used to establish the diagnoses of chronic hepatitis C (CHC), B (CHB) alcoholic LD (ALD), and nonalcoholic fatty LD (NAFLD).

Results: 58,731 adults with LD were included. During the study, prevalence of CHB and ALD remained stable (0.3%-0.4% and 0.8%-1.0%, trend p>0.05); while the prevalence of CHC decreased nearly 2 fold [from 1.6% to 0.9% (p=0.03)]. In contrast, prevalence of NAFLD increased from 20.0% to 28.3% to 33.2% (p<0.0001). At the same time, increases were observed in the rates of obesity (22.2% to 31.0% to 38.9%) and type 2 diabetes (7.2% to 8.2% to 13.5% same years). Yearly trend analyses showed that the only liver disease with consistently increasing prevalence was NAFLD (Kendall tau=0.64, P=0.01). Multivariate regression analysis showed that after adjustment for age, gender, and ethnicity, obesity 10.4 (9.5-11.3), diabetes 3.7 (3.2-4.2), hypertension 2.3 (2.1-2.5) and hyperlipidemia 1.8 (1.6-2.1)) were the major independent predictors of NAFLD.

Conclusions: Over the past 30 years in the U.S., NAFLD is the only liver disease with increasing prevalence. The increasing prevalence of NAFLD is primarily driven by diabetes and obesity.


Z.M. Younossi: Consultant; Self; Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S. Research Support; Self; Bristol-Myers Squibb Company. M. Stepanova: None. Y. Younossi: None. P. Golabi: None. A. Mishra: None. N. Rafiq: None.

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