Fibrosis and steatotic liver disease in US adolescents according to the new nomenclature.
Fibrosis and steatotic liver disease in US adolescents according to the new nomenclature.
复制标题
根据新命名法，美国青少年的纤维化和脂肪性肝病。
DOI：
10.1002/jpn3.12230
复制
发表时间：
2024
影响因子：
2.9
通讯作者：
Branch,AndreaD
中科院分区：
文献类型：
--
作者：
Ma,Ning;Bansal,Meena;Chu,Jaime;Branch,AndreaD
目的利用国家健康和营养检查调查（NHANES）数据，在青少年中应用脂肪性肝病（SLD）的新命名法，用代谢功能障碍相关性脂肪肝病（MASLD）取代非酒精性脂肪性肝病（NAFLD）。方法在 NHANES 中（2017 年至 2020 年 3 月）的 1410 名青少年（12-19 岁）中，瞬态的受控衰减参数（CAP）弹性成像（TE）用于定义脂肪变性和纤维化（TE ≥ 7.4 kPa）。根据实践指南，使用肥胖和丙氨酸氨基转移酶（ALT） ≥ 80 U/L 来确定符合肝病转诊资格的青少年。 NAFLD 被定义为没有特定暴露的肝脏脂肪变性；与 MASLD 不同，它没有心脏代谢危险因素要求。结果脂肪变性（是/否）是新诊断方案中的第一个决策点；然而，脂肪变性的标准尚未明确。在供应商 (EchoSens) 推荐的 CAP 阈值 240dB/m 下，30.5%（95% 置信区间 [CI]：27.1%–34.0%）的青少年患有 SLD，大约 85% 的 NAFLD 青少年符合 MASLD 标准。另外 15% 的人会得到隐源性 SLD 或可能的 MASLD 的模糊诊断。在较高的 CAP 阈值下，MASLD/NAFLD 一致性增加并接近 100%。在患有 MASLD 纤维化的青少年中，只有 8.8%（95% CI：0%–19.3%）超重/肥胖且 ALT ≥ 80 U/L。结论新命名强调了肝脏脂肪变性的高患病率。然而，在 240dB/m 的 CAP 阈值下，大约 15% 的青少年会得到不明确的诊断，这可能会导致混乱和担忧。不到 10% 的 MASLD 纤维化青少年超重/肥胖且 ALT ≥ 80 U/L。需要修订指南，以确保其他 90% 的人得到适当的转诊和肝病护理。
ObjectiveTo 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.MethodsAmong 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.ResultsSteatosis (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.ConclusionsThe 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.
2017-2018 年全国健康与营养检查调查中青少年瞬时弹性成像检测肝脏脂肪变性和纤维化的患病率。
影响因子：
12.6
作者：
S. Ciardullo;Tommaso Monti;G. Perseghin
通讯作者：
G. Perseghin
影响因子：
3.1
作者：
de Ledinghen, Victor;Hiriart, Jean-Baptiste;Paradis, Valerie
通讯作者：
Paradis, Valerie
成人肥胖和重度肥胖的患病率：美国，2017-2018 年。
影响因子：
--
作者：
Craig M. Hales;M. Carroll;C. Fryar;Cynthia L Ogden
通讯作者：
Cynthia L Ogden