Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States
Open accessAbstract
In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 1988-1994. Our goal was to determine the NAFLD prevalence in the recent 1999-2012 NHANES, risk factors for advanced fibrosis (stage 3-4) and mortality. NAFLD was defined as having a United States Fatty Liver Index (USFLI) > 30 in the absence of heavy alcohol use and other known liver diseases. The probability of low/high risk of having advanced fibrosis was determined by the NAFLD Fibrosis Score (NFS). In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.93-5.08, p<0.001). In conclusion, in this most recent NHANES, NAFLD prevalence remains at 30% with 10.3% of these having advanced fibrosis. NAFLD per se was not a risk factor for increased mortality, but NAFLD with advanced fibrosis was. Mexican American ethnicity was a significant risk factor for NAFLD but not for advanced fibrosis or increased mortality.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Age (>50 years), insulin resistance and multiple cardiometabolic risk factors all increase the probability of MASH, severe fibrosis/cirrhosis and both overall and liver-related mortality.
“Age ( > 50 years), insulin resistance and multiple cardiometabolic risk factors all increase the probability of MASH, severe fi brosis/cirrhosis and both overall and liver-related mortality. 36”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [36]
The Results (Demographic and laboratory characteristics; page unavailable) associate older age, higher insulin resistance, and several cardiometabolic conditions with advanced-fibrosis risk in people with NAFLD. The Results (Mortality in NAFLD subjects and by risks for advanced fibrosis; page unavailable) link high fibrosis risk to increased all-cause mortality, but do not establish the stated >50-year cutoff or show that those factors increase the probability of MASH or liver-related mortality. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)
Grundy, S. M., Becker, D. M., Clark, L. T., Cooper, R., Denke, M. A., Howard, J. L., Hunninghake, D. B., Illingworth, D. R., Luepker, R. V., McBride, P. E., et al. (2002) · Civil War Book Review · Cited by 12,198 · see citing works
Use and Abuse of HOMA Modeling
Wallace, T. M., Levy, J. C., & Matthews, D. R. (2004) · Diabetes Care · doi:10.2337/diacare.27.6.1487 · Cited by 5,114 · see citing works
Chalasani, N., Younossi, Z. M., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K. J., Charlton, M., & Sanyal, A. J. (2012) · Hepatology · doi:10.1002/hep.25762 · Cited by 3,798 · see citing works
Prevalence of Hepatic Steatosis in An Urban Population in the United States: Impact of Ethnicity
Browning, J. D., Szczepaniak, L. S., Dobbins, R., Nuremberg, P., Horton, J. D., Cohen, J. C., Grundy, S. M., & Hobbs, H. H. (2004) · Hepatology · doi:10.1002/hep.20466 · Cited by 3,664 · see citing works
Angulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., Enders, F., Saksena, S., Burt, A. D., Bida, J. P., et al. (2007) · Hepatology · doi:10.1002/hep.21496 · Cited by 3,198 · see citing works
Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006) · BMC Gastroenterology · doi:10.1186/1471-230x-6-33 · Cited by 3,054 · see citing works
The Natural History of Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study
Adams, L. A., Lymp, J. F., St. Sauver, J., Sanderson, S. O., Lindor, K. D., Feldstein, A., & Angulo, P. (2005) · Gastroenterology · doi:10.1053/j.gastro.2005.04.014 · Cited by 2,890 · see citing works
Nonalcoholic Fatty Liver Disease: From Steatosis to Cirrhosis
Farrell, G. C., & Larter, C. Z. (2006) · Hepatology · doi:10.1002/hep.20973 · Cited by 2,413 · see citing works
Williams, C. D., Stengel, J. Z., Asike, M., Torres, D. M., Shaw, J. C., Contreras, M., Landt, C. L., & Harrison, S. A. (2010) · Gastroenterology · doi:10.1053/j.gastro.2010.09.038 · Cited by 2,146 · see citing works
National health and nutrition examination survey: analytic guidelines, 1999-2010.
Cl, J., Paulose‐Ram, R., Ogden, C. L., Carroll, Kruszon‐Moran, D., Dohrmann, S. M., & Curtin, L. R. (2013) · PubMed · Cited by 1,522 · see citing works
Musso, G., Gambino, R., Cassader, M., & Pagano, G. (2010) · Annals of Medicine · doi:10.3109/07853890.2010.518623 · Cited by 1,285 · see citing works
National health and nutrition examination survey: plan and operations, 1999-2010.
Zipf, G., Chiappa, M. M., Porter, K. S., Ostchega, Y., Lewis, B. G., & Dostal, J. (2013) · PubMed · Cited by 1,182 · see citing works
A position statement on NAFLD/NASH based on the EASL 2009 special conference
Ratziu, V., Bellentani, S., Cortez‐Pinto, H., Day, C., & Marchesini, G. (2010) · Journal of Hepatology · doi:10.1016/j.jhep.2010.04.008 · Cited by 1,059 · see citing works
Epidemiology of Non-Alcoholic Fatty Liver Disease
Bellentani, S., Scaglioni, F., Marino, M., & Bedogni, G. (2010) · Digestive Diseases · doi:10.1159/000282080 · Cited by 1,026 · see citing works
Lazo, M., Hernáez, R., Eberhardt, M. S., Bonekamp, S., Kamel, I. R., Güallar, E., Koteish, A. A., Brancati, F. L., & Clark, J. M. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kws448 · Cited by 796 · see citing works
Kim, D., Kim, R. W., Kim, H. J., & Therneau, T. M. (2013) · Hepatology · doi:10.1002/hep.26156 · Cited by 772 · see citing works
Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease
Ong, J. P., Pitts, A., & Younossi, Z. M. (2008) · Journal of Hepatology · doi:10.1016/j.jhep.2008.06.018 · Cited by 636 · see citing works
Non alcoholic fatty liver disease and metabolic syndrome.
Paschos, P., & Paletas, K. (2009) · PubMed Central · Cited by 539 · see citing works
Clinical, Laboratory and Histological Associations in Adults with Nonalcoholic Fatty Liver Disease†
Neuschwander‐Tetri, B. A., Clark, J. M., Bass, N. M., Natta, M. L. V., Ünalp–Arida, A., Tonascia, J. A., Zein, C. O., Brunt, E. M., Kleiner, D. E., McCullough, A. J., et al. (2010) · Hepatology · doi:10.1002/hep.23784 · Cited by 463 · see citing works
Ruhl, C. E., & Everhart, J. E. (2014) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13012 · Cited by 455 · see citing works
Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal
Machado, M. V., & Cortez‐Pinto, H. (2012) · Journal of Hepatology · doi:10.1016/j.jhep.2012.11.021 · Cited by 411 · see citing works
Non-alcoholic fatty liver disease: The diagnosis and management
El-Kader, S. M. A. (2015) · World Journal of Hepatology · doi:10.4254/wjh.v7.i6.846 · Cited by 381 · see citing works
Non-Alcoholic Fatty Liver Disease and the Metabolic Syndrome
Najjar, S. M. (2010) · Springer eBooks · doi:10.1007/978-1-4419-1607-5_12 · Cited by 354 · see citing works
Koehler, E. M., Schouten, J. N. L., Hansen, B. E., Albert Hofman, D., Stricker, B. H. C., & Janssen, H. L. A. (2013) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2012.12.031 · Cited by 340 · see citing works
Nonalcoholic fatty liver disease: A manifestation of the metabolic syndrome
Kim, C. H., & Younossi, Z. M. (2008) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.75.10.721 · Cited by 339 · see citing works
Chitturi, S., Farrell, G. C., Hashimoto, E., Saibara, T., Lau, G. K. K., Sollano, J. D., & NAFLD, T. A. W. P. O. (2007) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2007.05001.x · Cited by 311 · see citing works
Noninvasive evaluation of NAFLD
Castéra, L., Vilgrain, V., & Angulo, P. (2013) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2013.175 · Cited by 272 · see citing works
Smoking and severity of hepatic fibrosis in nonalcoholic fatty liver disease
Zein, C. O., Ünalp, A., Colvin, R., Liu, Y.-C., & McCullough, A. J. (2010) · Journal of Hepatology · doi:10.1016/j.jhep.2010.07.040 · Cited by 226 · see citing works
Huang, X., Xu, M., Chen, Y., Peng, K., Huang, Y. F., Wang, P., Ding, L., Lin, L., Xu, Y., Chen, Y., et al. (2015) · Medicine · doi:10.1097/md.0000000000001682 · Cited by 192 · see citing works
Hepatitis C Infection in African Americans: Its Natural History and Histological Progression
Wiley, T. E., Brown, J. L., & Chan, J. (2002) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2002.05555.x · Cited by 168 · see citing works
Cuthbertson, D. J., Weickert, M. O., Lythgoe, D. T., Sprung, V. S., Dobson, R., Shoajee-Moradie, F., Umpleby, A. M., Pfeiffer, A. F. H., Thomas, E. L., Bell, J. D., et al. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0112 · Cited by 164 · see citing works
Yang, B.-L., Wu, W.-C., Fang, K., Wang, Y., Huo, T., Huang, Y., Yang, H., Su, C., Lin, H.-C., Lee, F., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0120443 · Cited by 158 · see citing works
Lee, Y., Bang, H., Park, Y. M., Bae, J. C., Lee, B., Kang, E. S., Soo, B., Lee, H. C., Balkau, B., Lee, W., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0107584 · Cited by 153 · see citing works
Meffert, P. J., Baumeister, S. E., Lerch, M. M., Mayerle, J. V., Kratzer, W., & Völzke, H. (2014) · The American Journal of Gastroenterology · doi:10.1038/ajg.2014.155 · Cited by 128 · see citing works
Noninvasive fatty liver markers predict liver disease mortality in the U.S. population
Ünalp–Arida, A., & Ruhl, C. E. (2015) · Hepatology · doi:10.1002/hep.28390 · Cited by 96 · see citing works
Stata survival analysis and epidemiological tables reference manual
StataCorp (2011) · Stata Press/StataCorp eBooks · Cited by 79 · see citing works
Ditah, I. C., Saeian, K., Ngwa, T. N., et al. (2016) · Gastroenterology · doi:10.1016/s0016-5085(16)33561-2 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Rinella, M. E., Neuschwander-Tetri, B. A., Siddiqui, M. S., Abdelmalek, M. F., Caldwell, S., Barb, D., Kleiner, D. E., & Loomba, R. (2023) · Hepatology · doi:10.1097/hep.0000000000000323 · Cited by 2,667 · see citing works
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease
Sanyal, A. J., Van Natta, M. L., Clark, J., Neuschwander-Tetri, B. A., Diehl, A., Dasarathy, S., Loomba, R., Chalasani, N., Kowdley, K., Hameed, B., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2029349 · Cited by 1,146 · see citing works
2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis
Le, M. H., Yeo, Y. H., Li, X., Li, J., Zou, B., Wu, Y., Ye, Q., Huang, D. Q., Zhao, C., Zhang, J., et al. (2022) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.12.002 · Cited by 711 · see citing works
Self-citationMicroRNA-378 promotes hepatic inflammation and fibrosis via modulation of the NF-κB-TNFα pathway
Zhang, T., Hu, J., Wang, X., Zhao, X., Li, Z., Niu, J., Steer, C. J., Zheng, G., & Song, G. (2019) · Journal of Hepatology · doi:10.1016/j.jhep.2018.08.026 · Cited by 196 · see citing works
Hagström, H., Talbäck, M., Andreasson, A., Walldius, G., & Hammar, N. (2020) · Gastroenterology · doi:10.1053/j.gastro.2019.09.008 · Cited by 182 · see citing works
Chehrehgosha, H., Sohrabi, M. R., Ismail-Beigi, F., Malek, M., Reza Babaei, M., Zamani, F., Ajdarkosh, H., Khoonsari, M., Fallah, A. E., & Khamseh, M. E. (2021) · Diabetes Therapy · doi:10.1007/s13300-021-01011-3 · Cited by 173 · see citing works
Hagström, H., Nasr, P., Ekstedt, M., Stål, P., Hultcrantz, R., & Kechagias, S. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2018.11.030 · Cited by 132 · see citing works
Younossi, Z. M., Anstee, Q. M., Wai-Sun Wong, V., Trauner, M., Lawitz, E. J., Harrison, S. A., Camargo, M., Kersey, K., Subramanian, G. M., Myers, R. P., et al. (2021) · Gastroenterology · doi:10.1053/j.gastro.2020.12.003 · Cited by 118 · see citing works
Wong, Y. J., Nguyen, V. H., Yang, H.-I., Li, J., Le, M. H., Wu, W.-J., Han, N. X., Fong, K. Y., Chen, E., Wong, C., et al. (2023) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2023.0004 · Cited by 77 · see citing works
Self-citationGolabi, P., Stepanova, M., Pham, H. T., Cable, R., Rafiq, N., Bush, H., Gogoll, T., & Younossi, Z. M. (2018) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2018-000198 · Cited by 32 · see citing works
Curci, R., Bianco, A., Franco, I., Bonfiglio, C., Campanella, A., Mirizzi, A., Giannuzzi, V., Cozzolongo, R., Veronese, N., & Osella, A. R. (2023) · Nutrients · doi:10.3390/nu15163520 · Cited by 11 · see citing works
- Authors
- Le, M. H., Devaki, P., Ha, N. B., Jun, D. W., Te, H. S., Cheung, R. C., & Nguyen, M. H.
- Affiliations
- Stanford Medicine (US)
- Cleveland Clinic (US)
- Hanyang University Medical Center (KR)
- University of Chicago (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Nguyen, Mindie H.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-03-27
- Volume
- 12
- Issue
- 3
- Pages
- e0173499
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5367688
- OpenAlex
- W2599153295
- Cited by
- 287
- References
- 38
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 37 · 2023: 25 · 2022: 37 · 2021: 41 · 2020: 45 · 2019: 29 · 2018: 35 · 2017: 5
- FWCI
- 24.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- The Royal Society of Chemistry’s Journals, Books and Databases (The Royal Society of Chemistry) (submittedVersion, cc-by)
- Funders
- Bristol-Myers Squibb
- Gilead Sciences
- National Cancer Institute
- Janssen Pharmaceuticals
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, prevalence, advanced liver fibrosis, mortality, risk factors, NAFLD fibrosis score
- MeSH terms
- Adult, Aged, Female, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Nutrition Surveys, Risk Factors, Severity of Illness Index, United States, Prevalence, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
