The prevalence of alcoholic fatty liver disease (AFLD) among adults in the United States remained relatively stable from 2001 to 2016, but AFLD with fibrosis stage 2 or greater increased significantly, according to research published in JAMA.

Investigators used the 2001-2016 National Health and Nutrition Examination Survey data set to assess the national prevalence of AFLD in adults. AFLD was identified on the basis of alcohol use (>28 g/d for women and >42 g/d for men in the last 12 months) and elevated liver enzyme levels (aspartate aminotransferase or alanine aminotransferase >25 U/L in women and >35 U/L in men) in the absence of elevated bilirubin.

Of the 34,423 individuals included in the data analysis, 4.3% had a diagnosis of AFLD (60.6% men; average age, 40.2 years). The prevalence of AFLD from 2001-2002 to 2015-2016 remained stable, ranging from 4.3% to 4.7%, whereas the prevalence of AFLD with fibrosis stage 2 or greater increased from 0.6% to 1.5%, and AFLD with fibrosis stage 3 or greater increased from 0.1% to 0.2%. These increases did not differ by sex, age, or race.

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“This is a particularly concerning observation given that developing fibrosis is the strongest predictor of progression to cirrhosis, liver cancer, and death,” the authors wrote.

“The increasing prevalence of US adults with AFLD with stage 2 or greater fibrosis and AFLD with stage 3 or greater fibrosis is concerning and emphasizes the need for greater awareness of unhealthy alcohol use and need for early prevention and intervention efforts,” concluded the investigators.

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Reference Wong T, Dang K, Ladhani S, Singal AK, Wong RJ. Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016 [published online May 7, 2019]. JAMA. doi:10.1001/jama.2019.2276