NAFLD is lion’s share of liver diseases

Nonalcoholic fatty liver disease may soon become the most important cause of chronic liver disease in the United States, “with a substantial clinical and economic impact.”

In what they described as the first population-based study to assess changes in the prevalence of chronic liver diseases over the past 20 years, found that the prevalence is steadily rising in only one major category: nonalcoholic fatty liver virus, hepatitis C virus, and alcohol use have remained stable.

The rise in NAFLD correlates with the well-known increases in obesity and type 2 diabetes, and the study findings suggest that liver disease “will remain among the major causes of mortality and morbidity in the US and will be responsible for substantial medical resource utilization.”

“This issue becomes especially important as we face a potential decline in the availability of resources dedicated to the care of patients with chronic disease, as well as the expected shortage of individuals trained in hepatology who are available to care for these patients,” the executive director of the Center  for Liver Diseases at Inova Fairfax (Va.) Hospital said.

The investigators used data from the National Health and Nutrition Examination Survey (NHANES), the CDC’s assessments of health and nutrition in nationally representative samples of the adult population, to track trends in chronic liver disease during three periods: 1988-1994 (15,855 subjects), 1999-2004 (13,970 subjects), and 2005-2008 (9,670 subjects).

The prevalence of the four types of chronic liver disease combined increased during this 20-year interval, from 12% to 15%. However, that was driven entirely by the increasing prevalence of NAFLD, which rose from 5.5% in 1988-1994, to 9.8% in 999-2004 to 11.0% in 2005-2008.

In contrast, the prevalence of chronic liver disease related to hepatitis B remained stable (0.4%, 00.3%, respectively), as did that related to hepatitis C (2%,2% and 2%, respectively. The prevalence of alcohol-related chronic liver disease also remained stable over the three time periods, at 1.4%, 2% and 2%, respectively.