PREVALENCE AND SCREENING OF HIGH LIVER STIFFNESS AND ALCOHOL ASSOCIATED FATTY LIVER DISEASE: A NATIONALLY REPRESENTATIVE ANALYSIS AND STRATEGY

Abstract

Chronic liver disease (CLD) is a major healthcare burden for the United States, responsible for 60,000 deaths annually and recently surpassing heart failure hospitalization rates. We analyzed 4,510 adults sampled by the National Health and Nutrition Examination Survey (NHANES) in the cycle of 2017-2018 who underwent non- invasive vibration-controlled transient elastography (VCTE). Participants are enrolled using a stratified multistage probability with an oversampling design that allows a weighted and simplified representation of the civilian US population. In the first paper, we intended to examine the national estimated prevalence of increased liver stiffness (LSM) measured by VCTE among these participants to characterize the at-risk population. Once the proportion and phenotype were identified, we constructed a screening score based on the variables associated with increased liver stiffness and advanced cirrhosis. The score was validated by calculating C- statistics and compared to the recommended screening FIB-4 score. VCTE data from the same cohort provided controlled attenuation parameter (CAP), which measures hepatic steatosis. Alcohol-associated liver disease (ALD) is responsible for rising rates of cirrhosis and liver-related mortality in the US. It is also one of the most common causes of fatty liver disease (FLD), which is the major contributor of CLD. Considering the lack of evidence on the mechanism and the quantity of alcohol that contributes to fatty liver disease progression, we performed multiple regression models in the second paper using dietary recall to identify the associations between the multiple consumption dimensions and the type of alcohol consumed with hepatic steatosis.