Prevalence of steatosis and fibrosis in young adults in the UK: a population-based study

Abstract

Background The estimated worldwide prevalence of non-alcoholic fatty liver disease (NAFLD) in adults is 25%; however, prevalence in young adults remains unclear. We aimed to identify the prevalence of steatosis and fibrosis in young adults in a sample of participants recruited through the Avon Longitudinal Study of Parents and Children (ALSPAC), based on transient elastography and controlled attenuation parameter (CAP) score. MethodsIn this population-based study, we invited active participants of the ALSPAC cohort to our Focus@24+ clinic at the University of Bristol (Bristol, UK) between June 5, 2015, and Oct 31, 2017, for assessment by transient elastography with FibroScan, to determine the prevalence of steatosis and fibrosis. FibroScan data were collected on histologically equivalent fibrosis stage (F0-F4) and steatosis grade (S0-S3); results with an IQR to median ratio of 30% or greater were excluded for median fibrosis results greater than 7•1 kPa, and CAP scores for steatosis were excluded if less than ten valid readings could be obtained. Results were collated with data on serology (including alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transferase) and exposures of interest: alcohol consumption (via the Alcohol Use Disorder Identification Test for Consumption [AUDIT-C] and the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for alcohol use disorder), body-mass index (BMI), waist-to-height ratio, socioeconomic status (based on predefined ALSPAC markers), and sex. We used logistic regression models to calculate odds ratios (ORs) for the effect of exposures of interest on risk of steatosis and fibrosis, after dichotomising the prevalences of fibrosis and steatosis and adjusting for covariates (excessive alcohol intake [hazardous drinking, AUDIT-C score ≥5; or harmful drinking, evidence of alcohol use disorder], social class, smoking, and BMI). Findings 10 018 active ALSPAC participants were invited to our Focus@24+ clinic, and 4021 attended (1507 men and 2514 women), with a mean age of 24•0 years (IQR 23•0-25•0). 3768 CAP scores were eligible for analysis. 780 (20•7% [95% CI 19•4-22•0]) participants had suspected steatosis (S1-S3; ≥248 dB/m), with 377 (10•0%) presenting with S3 (severe) steatosis (≥280 dB/m). A BMI in the overweight or obese range was positively associated with steatosis when adjusted for excessive alcohol consumption, social class, and smoking (overweight BMI: OR 5•17 [95% CI 4•11-6•50], p<0•0001; obese BMI: 27•27 [20•54-36•19], p<0•0001). 3600 participants had valid transient elastography results for fibrosis analysis. 96 participants (2•7% [95% CI 2•2-3•2]) had transient elastography values equivalent to suspected fibrosis (F2-F4; ≥7•9 kPa), nine of whom had values equivalent to F4 fibrosis (≥11•7 kPa). Individuals with alcohol use disorder and steatosis had an increased risk of fibrosis when adjusted for smoking and social class (4•02 [1•24-13•02]; p=0•02).Interpretation One in five young people had steatosis and one in 40 had fibrosis around the...

ALT Trends through Childhood and Adolescence Associated with Hepatic Steatosis at 24 Years: A Population-Based UK Cohort Study

“…We found no meaningful changes to our results. Similar to Abeysekera, et al, we also found no evidence of an association between hazardous alcohol consumption and hepatic steatosis [ 34 ]. Future studies should focus on the impact of high alcohol consumption in this population on hepatic steatosis, fibrosis, and other health outcomes.…”

“…At 24 years, 10.4% of the ALSPAC sample had severe and 11.9% had mild or moderate hepatic steatosis. Abeysekera, et al, using the same cohort, also found a similar 20.7% prevalence of steatosis [ 34 ]. This represents a large increase from a NAFLD prevalence of 2.5% (defined as moderate or severe steatosis) in the cohort as measured by ultrasound at the age of 17–18 years [ 34 , 35 ].…”

“…While we did not exclude participants with other liver conditions, a previous report from this population reported that no participants had viral hepatitis or were taking nucleos(t)ide analogues or direct-acting antivirals and very few were taking medications for autoimmune hepatitis [ 34 ]. Therefore, we are confident that there was little, if any, confounding by other liver disease.…”

Case-finding strategies in non-alcoholic fatty liver disease

“…As the length of exposure to the cause is a key factor in the development of advanced liver disease, one can suppose that the picture of chronic liver disease will change with increased cases of advanced liver disease in young adults in the near future. In this context, a very recent population-based study in young adults aged 22-26 years has found a 2.7% prevalence of elevated liver stiffness ≥7.9 kPa [25]. NAFLD patients have an increased risk of cardiovascular disease and recent data support pathophysiological processes linking NASH and liver fibrosis with cardiometabolic disease [37,38].…”

“…However, these tests have been developed and therefore their coefficients for age have been calibrated in cohorts of patients aged around 45-50 years [48][49][50]52]. Consequently, they are less sensitive in younger people [56], which could become a matter of importance with the expected increase in cases of advanced liver fibrosis in young adults due to the dramatic increase in prevalence of obesity and insulin resistance in children [25]. On the other side, it has been well described that NFS and FIB4 provide higher rates of false positive results in aged populations.…”