Ethnic influence on nonalcoholic fatty liver disease prevalence and lack of disease awareness in the United States, 2011–2016

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is a rising global disease associated with clinical and economic burdens. Objectives We aimed to quantify NAFLD prevalence and awareness to provide stakeholders necessary information to combat NAFLD burden. Methods This study utilizes data from the National Health and Nutrition Examination Survey 2011–2016 and included 4538 adult participants who did not have heavy drinking or viral hepatitis history. The US fatty liver index defined NAFLD and NAFLD fibrosis score defined fibrosis. NAFLD awareness was captured by questionnaire. Results Amongst the study population of 4538 persons, NAFLD prevalence was 32.5%, lowest in non‐Hispanic Blacks (18.0%) and Asians (18.1%), highest amongst Mexican Americans (48.4%). Within the NAFLD group, advanced fibrosis was highest in non‐Hispanic Blacks (28.5%) and lowest amongst non‐Hispanic Asians (2.7%). Of the 1473 (97.5%) NAFLD participants who answered NAFLD awareness question, 90% visited a healthcare centre at least once in the past year, but only 5.1% were aware of having NAFLD. On weighted population estimates, 77.33 million persons had NAFLD, 17.63 million had advanced fibrosis, and 73.39 million NAFLD participants were not aware of having NAFLD. Conclusions Of 77.33 million people in the United States have NAFLD with 17.63 million having advanced fibrosis, with lowest prevalence in non‐Hispanic Asians and highest in Mexican Americans. A conundrum exists amongst non‐Hispanic Blacks who have low NAFLD prevalence but highest prevalence of advanced fibrosis. Awareness of NAFLD was low across all ethnicities. Effort is needed to improve disease awareness whilst addressing NAFLD clinical burden across ethnicities.

Chronic Kidney Disease Awareness and Longitudinal Health Outcomes: Results from the REasons for Geographic And Racial Differences in Stroke Study

“…Although our findings show that some of the highest risk persons with CKD are being informed of their kidney disease, overall CKD awareness remains extremely low. Lack of symptoms contributes to low CKD awareness; similarly, awareness of nonalcoholic fatty liver disease, another asymptomatic condition, is only about 5% [22]. In contrast, the majority of persons with hypertension and diabetes are aware of their disease, indicating that a high level of awareness can be achieved for asymptomatic conditions [23,24].…”

Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

“…Limited patient awareness of MAFLD may also lead to poor linkage to care at both the primary care and referral care levels. (14) Limitations of this study include its retrospective nature; in particular, it is not possible to reliably determine indications for imaging procedures and why surveillance was or was not performed. Also, biopsy was not performed in the majority of patients, so we could not distinguish between simple steatosis and nonalcoholic steatohepatitis, which may be especially relevant in patients without cirrhosis.…”

“…Limited patient awareness of MAFLD may also lead to poor linkage to care at both the primary care and referral care levels. ( 14 )…”

“…In addition, disease awareness of MAFLD among affected persons is extremely poor, estimated to be about 5% based on data from a nationally representative sample of Americans from 2011 to 2016. (14) Disease recognition is low even among patients with MAFLD-related cirrhosis, and this lack of awareness is associated with presentation with advanced-stage HCC. (15) Similar to chronic hepatitis B and unlike most other causes of liver disease, MAFLD-related HCC can arise in the absence of cirrhosis.…”

Letter: substantial under‐diagnosis of NAFLD – more efforts are needed globally

“…While sobering, this low diagnosis rate of NAFLD is in line with findings from a recent population-based study from the US, where only about 5% of persons with NAFLD were aware of having a liver disease. 4,5 In that study, NAFLD participants (diagnosed via the fatty liver index) were asked "Has a doctor or other health professional ever told you that you had any kind of liver condition? "; participants answered yes or no.…”