{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:17:49Z","timestamp":1788589069781,"version":"build-2803163510"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Patients with metabolic syndrome (MetS) have a higher risk for NASH and significant fibrosis. Presence of NASH and advanced fibrosis are associated with adverse outcomes in patients with NAFLD. Using a noninvasive method, we determined the prevalence of at-risk NASH and its association with MetS components in a large population-based analysis. We used the 2017\u20132018 National Health and Nutrition Examination Survey and included adults \u226518 years with NAFLD (controlled attenuation parameter \u2265274\u00a0dB\/m). Pregnancy, subjects with other causes of liver disease or missing data were excluded. FibroScan-AST (FAST) score was calculated using aspartate aminotransferase, liver stiffness measurement, and controlled attenuation parameter. Patients with a FAST score &gt;0.35 were considered to have at-risk NASH, defined as NASH with NAFLD activity score \u22654 and fibrosis stage \u22652 on liver biopsy. The sample included 687 patients. The overall prevalence of at-risk NASH was 11.6% (95% CI: 8.8\u201315.1) and was higher in males than females (15.8% vs. 6.5%; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001). Subjects with comorbidities (diabetes mellitus, obesity, MetS, and insulin resistance) had between 1.3 and 1.7 times higher prevalence than the general population. Among MetS components, elevated glucose\/diabetes, large waist circumference, and low HDL were independent risk factors for at risk-NASH. The number of MetS components was also important\u2014one additional component increased the odds of at-risk NASH by 2 times. The FAST score had the highest correlation with alanine aminotransferase (<jats:italic toggle=\"yes\">r<\/jats:italic>= 0.70; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001). We estimated ~9 million people in the US have at-risk NASH and may benefit from active surveillance and therapy.<\/jats:p>","DOI":"10.1097\/hc9.0000000000000019","type":"journal-article","created":{"date-parts":[[2023,1,15]],"date-time":"2023-01-15T01:14:40Z","timestamp":1673745280000},"page":"e0019-e0019","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":29,"title":["Prevalence of at-risk NASH and its association with metabolic syndrome in US adults with NAFLD, 2017\u20132018"],"prefix":"10.1097","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-8709","authenticated-orcid":false,"given":"Julia Y.","family":"Payne","sequence":"first","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA"},{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9872-2391","authenticated-orcid":false,"given":"Naim","family":"Alkhouri","sequence":"additional","affiliation":[{"name":"Arizona Liver Health, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4788-773X","authenticated-orcid":false,"given":"Phuc","family":"Le","sequence":"additional","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2063-1876","authenticated-orcid":false,"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5978-6886","authenticated-orcid":false,"given":"Prido","family":"Polanco","sequence":"additional","affiliation":[{"name":"Arizona Liver Health, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celine","family":"Sakkal","sequence":"additional","affiliation":[{"name":"Arizona Liver Health, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1774-0104","authenticated-orcid":false,"given":"Srinivasan","family":"Dasarathy","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunity, Lerner Research Institute and Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, 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