Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2021; 13(7): 790-803
Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.790
Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States’ adolescent population
Amporn Atsawarungruangkit, Yousef Elfanagely, Jason Pan, Kelsey Anderson, James Scharfen, Kittichai Promrat
Amporn Atsawarungruangkit, Jason Pan, Kittichai Promrat, Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Yousef Elfanagely, Kelsey Anderson, James Scharfen, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Author contributions: Atsawarungruangkit A, Pan J, and Promrat K contributed to the study concept and design; Atsawarungruangkit A contributed to the data acquisition and analysis; Atsawarungruangkit A, Elfanagely Y, Pan J, Anderson K, Scharfen J and Promrat K contributed to the result interpretation, drafting manuscript, and critically revising it.
Institutional review board statement: NHANES protocol was approved by the NCHS Research Ethics Review Board.
Conflict-of-interest statement: The authors declare that there are no any conflicts of interest.
Data sharing statement: NHANES is a program of studies designed to assess the health and nutritional status of adults and children in the United States, conducted by the National Center for Health Statistics (NCHS). The survey collected multiple data sets, including demographic, interviews, physical examinations, and laboratory testing of biologic samples. It is available to the public.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yousef Elfanagely, MD, Doctor, Department of Internal Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, United States. yelfanagely@gmail.com
Received: May 4, 2021
Peer-review started: May 4, 2021
First decision: June 4, 2021
Revised: June 10, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: July 27, 2021
Abstract
BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children and adolescents.

AIM

To determine the prevalence and risk factors of steatosis and advanced fibrosis using transient elastography (TE) in the United States’ adolescent population.

METHODS

Using the National Health and Nutrition Examination Survey 2017-2018, adolescent participants aged 13 to 17 years who underwent TE and controlled attenuation parameter (CAP) were included in this study. Forty-one factors associated with liver steatosis and fibrosis were collected. Univariate and multivariate linear regression analysis were used to identify statistically significant predictors.

RESULTS

Seven hundred and forty participants met inclusion criteria. Steatosis (S1-S3), based on CAP, and advanced fibrosis (F3-F4), based on TE, were present in 27% and 2.84% of the study population, respectively. Independent predictors of steatosis grade included log of alanine aminotransferase, insulin resistance, waist-to-height ratio, and body mass index. Independent predictors of fibrosis grade included steatosis grade, non-Hispanic black race, smoking history, and systolic blood pressure.

CONCLUSION

This study demonstrated a high prevalence of steatosis in the United States’ adolescent population. Almost 3% of United States’ adolescents had advanced fibrosis. These findings are concerning because a younger age of onset of NAFLD can lead to an earlier development of severe disease, including steatohepatitis, cirrhosis, and liver decompensation.

Keywords: Non-alcoholic fatty liver disease, Fatty liver, Metabolic syndrome, Cirrhosis, national health and nutrition examination survey, Pediatric, Adolescents

Core Tip: Adolescents in the United States were found to have a high prevalence of non-alcoholic fatty liver disease, which was estimated to be 27%. Nearly 3% were found to have advanced fibrosis diagnosed by transient elastography. The severity of steatosis was associated with alanine aminotransferase, insulin resistance, waist-to-height ratio, and body mass index. Risk factors of fibrosis included steatosis grade, non-Hispanic black race, smoking history, and systolic blood pressure.