Atsawarungruangkit A, Elfanagely Y, Pan J, Anderson K, Scharfen J, Promrat K. Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States’ adolescent population. World J Hepatol 2021; 13(7): 790-803 [PMID: 34367500 DOI: 10.4254/wjh.v13.i7.790]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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 Processing time: 79 Days and 16.6 Hours
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.
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.
