Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans

Abstract

Background & Aims Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States (US). However, few data are available on recent trends in the incidence and prevalence of NAFLD in the US. Methods We analyzed the national Veterans Administration (VA) databases from 2003 to 2011 and calculated the age-adjusted prevalence and incidence of NAFLD for the overall sample of patients and by demographic subgroups. We used a previously validated algorithm to define NAFLD, based on persistent increases in levels of liver enzymes in the absence of positive results from tests for hepatitis C or hepatitis B, or evidence of excessive alcohol use. Results Of the 9,784,541 patients with at least 1 visit to the VA between 2003 and 2011, 1,330,600 patients (13.6%) had NAFLD. The annual incidence rates of NAFLD remained stable (from 2.2% to 3.2%) over the study duration. The prevalence of NAFLD increased from 6.3% in 2003 (95% confidence interval, 6.26%–6.3%) to 17.6% in 2011 (95% confidence interval, 17.58%–17.65%)—a 2.8-fold increase. The incidence and prevalence increased at significantly greater rates in patients younger than 45 years old vs older patients. Conclusions In a US population, the annual incidence of NAFLD ranges from 2% to 3%. The prevalence of NAFLD more than doubled from 2003 through 2011; it is likely to continue to increase, due to a steady overall incidence coupled with a rising incidence in younger individuals.

Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030

“…Another notable result is the rapid projected increase in individuals with cirrhosis, especially decompensated cirrhosis that is cost and resource-intensive [53][54][55]. Increased incidence of decompensated cirrhosis would be expected to have a proportionate impact on healthcare resources and costs associated with advanced liver disease [55,56], and magnify the negative consequences of increasing disease burden.…”

Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

“…As a result, there are no true population based incidence data reported for NAFLD. However, Kanwal and colleagues 10 have suggested that the annual incidence of NAFLD based on liver enzyme levels in veterans from the USA who were younger than 45 years old increased from 2.32% to 4.26% (P <0.001). Furthermore, NAFLD is known to be highly associated with several meta bolic conditions (T2DM, obesity, the metabolic syn drome, hypertension and hyperlipid aemia) 22,23 .…”

Current and upcoming pharmacotherapy for non-alcoholic fatty liver disease

“…Non-alcoholic fatty liver disease (NAFLD), defined as excess accumulation of fat in the liver, has become the most common cause for chronic liver disease in the Western world and is estimated to impact at least 30% of Americans1 2 or Chinese3 with the prevalence appearing to rise in recent years 4 5. Non-alcoholic steatohepatitis (NASH) is a subset of NAFLD, estimated to affect 2–5% of Americans, in which increased liver fat is accompanied by cellular injury, inflammatory infiltrate and, subsequently, liver fibrosis, which can progress to cirrhosis with its associated complications 6.…”