Fibrosis and Steatotic Liver Disease in US Adolescents According to the New Nomenclature

Details

• Personal Author:
  Bansal M ; Branch AD ; Chu J ; Ma N
• Description:
  Objective: To apply the new nomenclature for steatotic liver diseases (SLD), replacing nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD), in adolescents using National Health and Nutrition Examination Survey (NHANES) data. Methods: Among 1410 adolescents (12-19 years) in NHANES (2017-March, 2020), the controlled attenuation parameter (CAP) of transient elastography (TE) was used to define steatosis and fibrosis (TE ≥ 7.4 kPa). Obesity and alanine aminotransferase (ALT) ≥ 80 U/L were used to identify adolescents qualifying for hepatology referral according to practice guidelines. NAFLD was defined as liver steatosis without a specific exposure; it has no cardiometabolic risk factor requirement, unlike MASLD. Results: Steatosis (yes/no) is the first decision point in the new diagnostic protocol; however, criteria for steatosis are undefined. At the supplier (EchoSens)-recommended CAP threshold of 240 dB/m, 30.5% (95% confidence interval [CI]: 27.1%-34.0%) of adolescents had SLD and about 85% of adolescents with NAFLD met criteria for MASLD. The other 15% would receive an ambiguous diagnosis of either cryptogenic SLD or possible MASLD. At higher CAP thresholds, MASLD/NAFLD concordance increased and approached 100%. Among adolescents with MASLD-fibrosis, only 8.8% (95% CI: 0%-19.3%) had overweight/obese and ALT ≥ 80 U/L. Conclusions: The new nomenclature highlights the high prevalence of liver steatosis. At the CAP threshold of 240 dB/m, however, approximately 15% of adolescents would receive an ambiguous diagnosis, which could lead to confusion and worry. Fewer than 10% of adolescents with MASLD-fibrosis had overweight/obese and ALT ≥ 80 U/L. Revised guidelines are needed to ensure that the other 90% receive appropriate referral and liver disease care. [Description provided by NIOSH]
• Subjects:
  Adolescent Diagnosis Fibrosis Occupational Health Safety
• Keywords:
  Adolescents Author Keywords: MASLD Cardiometabolic Risk Factors Cryptogenic SLD Diagnostic Techniques Guidelines Liver Disease Metabolic Disorders NHANES Obesity VCTE

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• ISSN:
  0277-2116
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  229-237
• Volume:
  79
• Issue:
  2
• NIOSHTIC Number:
  nn:20069663
• Citation:
  J Pediatr Gastroenterol Nutr 2024 Aug; 79(2):229-237
• Contact Point Address:
  Andrea D. Branch, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, Box 1123, New York, NY 10029, USA
• Email:
  andrea.branch@mssm.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Start Date:
  20170701
• Source Full Name:
  Journal of Pediatric Gastroenterology and Nutrition
• End Date:
  20240630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f9867b252dec9cadc6934fe0f953d6a6cad016101f6a6989cc5ea7d35cdfcbd2efb1b3065a3340cfbc9996cfffa18c4816a8ddbb3162fb021f47f5cf83c0c953
• Download URL:
  https://stacks.cdc.gov/view/cdc/208046/cdc_208046_DS1.pdf
• File Type:
  [PDF - 1.21 MB ]