Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
J Pediatr Gastroenterol Nutr. 2024 Jul;79(1):110-118. doi: 10.1002/jpn3.12219. Epub 2024 Apr 16.
We investigated the current prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and fibrosis/cirrhosis and identified at-risk populations for MASLD and MASLD-related fibrosis among US adolescents and young adults in the United States.
Utilizing the National Health and Nutrition Examination Survey 2017-2020, the prevalence of MASLD and fibrosis/cirrhosis was assessed via controlled attenuation parameter (CAP) score and liver stiffness measurements by transient elastography in participants aged 12-29 years with at least one cardiometabolic criteria and absence of other chronic liver disease. Multivariable logistic regression was performed to determine predictors of MASLD and MASLD-related fibrosis.
The overall prevalence of MASLD was 23.9% (95% confidence interval [CI]: 21.3-26.5 for CAP ≥ 263 dB/m) and 17.3% (95% CI: 14.7-20.0 for ≥285 dB/m), respectively. The prevalence of fibrosis and cirrhosis in MASLD was 11.0% and 3.1%, respectively. When categorized by age, the prevalence of MASLD varied from 16.8% (of which 6.2% [fibrosis], 1.8% [cirrhosis]) in early and middle adolescents (12-17 years), to 25.5% (11.8% [fibrosis], 4.8% [cirrhosis]) in late adolescents and young adults (18-24 years), and to 30.4% (of which 13.2% [fibrosis] and 2.1% [cirrhosis]) in older young adults (25-29 years). The independent predictors for MASLD included male sex, Hispanic, non-Hispanic Asian, body mass index, and low HDL-cholesterol. In contrast, diabetes and body mass index were associated with an increased risk of fibrosis in individuals with MASLD.
The prevalence of MASLD and related fibrosis in adolescents and young adults in the United States has reached a significant level, with a substantial proportion of cirrhosis.
本研究旨在调查代谢相关脂肪性肝病（MAFLD）及其纤维化/肝硬化在美国青少年和年轻人群中的流行情况，并确定此类患者的高危人群。
本研究利用 2017-2020 年美国国家健康和营养调查（NHANES）数据，纳入至少存在 1 项心血管代谢危险因素且无其他慢性肝病的 12-29 岁参与者，通过受控衰减参数（CAP）评分和瞬时弹性成像检测肝硬度值评估 MAFLD 和纤维化/肝硬化的流行情况。采用多变量逻辑回归分析确定 MAFLD 和 MAFLD 相关纤维化的预测因素。
总体而言，MAFLD 的流行率为 23.9%（95%置信区间[CI]：CAP≥263dB/m 为 21.3%-26.5%；CAP≥285dB/m 为 17.3%-20.0%）。MAFLD 患者的纤维化和肝硬化的流行率分别为 11.0%和 3.1%。按年龄分层，MAFLD 的流行率分别为：青少年早期（12-17 岁）16.8%（其中 6.2%存在纤维化，1.8%存在肝硬化）；青少年晚期和年轻成人（18-24 岁）25.5%（11.8%存在纤维化，4.8%存在肝硬化）；成年晚期年轻成人（25-29 岁）30.4%（其中 13.2%存在纤维化，2.1%存在肝硬化）。MAFLD 的独立预测因素包括男性、西班牙裔、非西班牙裔亚裔、体质指数和低高密度脂蛋白胆固醇。相比之下，糖尿病和体质指数与 MAFLD 患者的纤维化风险增加相关。
美国青少年和年轻成人 MAFLD 及其相关纤维化的流行率已达到较高水平，其中肝硬化的比例较大。
