{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:08:58Z","timestamp":1790636938517,"version":"4.1.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T00:00:00Z","timestamp":1622678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA016672"],"award-info":[{"award-number":["P30CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["RP160097"],"award-info":[{"award-number":["RP160097"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["RP170259"],"award-info":[{"award-number":["RP170259"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001299","name":"Prevent Cancer Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001299","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Non-alcoholic fatty liver disease (NAFLD) is increasingly common in the adult population. In the United States, the overall burden of NAFLD is unknown due to challenges with population-level NAFLD detection. The purpose of this study was to estimate prevalence of NAFLD and significant NAFLD fibrosis and identify factors associated with them in the U.S.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data came from the 2017\u20132018 cycle of National Health and Nutrition Examination Survey. We defined NAFLD by controlled attenuation parameter (CAP) scores of \u2265248 dB\/m in absence of excessive alcohol use and viral hepatitis. We defined significant fibrosis as Vibration controlled transient elastography (VCTE) liver stiffness measurements (LSM) value \u22657.9 kPa. We calculated the adjusted odds ratio (OR) and 95% confidential intervals (CI) for associations with NAFLD and significant NAFLD fibrosis using multivariable logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, among 4,024 individuals aged \u226520 years included in the analysis, 56.7% had NAFLD by CAP. In comparison, when defined by elevated liver enzymes, NAFLD prevalence was 12.4%. The prevalence of significant NAFLD fibrosis by VCTE LSM was 14.5%. NAFLD prevalence increased with age, was higher among men than women and among Hispanics compared with non-Hispanic whites. Individuals who were obese, had metabolic syndrome (MetS) and type 2 diabetes were more likely to have NAFLD compared to those that who were not obese or without MetS\/diabetes. Inadequate physical activity (OR = 1.57, 95% CI: 1.18\u20132.08) was also a factor associated with NAFLD. MetS, high waist circumstance, diabetes and hypertension were independently associated with significant NAFLD fibrosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>NAFLD and significant NAFLD fibrosis are highly prevalent in U.S. general population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252164","type":"journal-article","created":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T18:05:50Z","timestamp":1622743550000},"page":"e0252164","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":98,"title":["Prevalence and factors associated with NAFLD detected by vibration controlled transient elastography among US adults: Results from NHANES 2017\u20132018"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3968-5030","authenticated-orcid":true,"given":"Xiaotao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8086-3700","authenticated-orcid":true,"given":"Natalia I.","family":"Heredia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Balakrishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron P.","family":"Thrift","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,3]]},"reference":[{"issue":"6","key":"pone.0252164.ref001","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1002\/hep.28123","article-title":"Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009","volume":"62","author":"ZM Younossi","year":"2015","journal-title":"Hepatology"},{"issue":"22","key":"pone.0252164.ref002","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1001\/jama.2015.5370","article-title":"Nonalcoholic fatty liver disease: a systematic review","volume":"313","author":"ME Rinella","year":"2015","journal-title":"JAMA"},{"issue":"1","key":"pone.0252164.ref003","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1476-511X-9-42","article-title":"The role of hepatic fat accumulation in pathogenesis of non-alcoholic fatty liver disease (NAFLD)","volume":"9","author":"Q Liu","year":"2010","journal-title":"Lipids in health and disease"},{"key":"pone.0252164.ref004","article-title":"Non-alcoholic fatty liver disease (NAFLD): a review of epidemiology, risk factors, diagnosis and management","author":"T Huang","journal-title":"Intern Med J."},{"issue":"5","key":"pone.0252164.ref005","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1136\/gut.2003.019984","article-title":"Long term prognosis of fatty liver: risk of chronic liver disease and death","volume":"53","author":"S Dam-Larsen","year":"2004","journal-title":"Gut"},{"issue":"5","key":"pone.0252164.ref006","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1002\/hep.24001","article-title":"Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis","volume":"52","author":"H Tilg","year":"2010","journal-title":"Hepatology"},{"issue":"7681","key":"pone.0252164.ref007","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1038\/d41586-017-06925-2","article-title":"Disease progression: Divergent paths","volume":"551","author":"S. 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