{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:22:02Z","timestamp":1787239322914,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients. Methods: Hospitalization data from the 1998\u20132020 National Inpatient Sample were utilized. ICD-9 and ICD-10 codes were used to identify pediatric patients (age less than 18 years old) with NAFLD, and risk factors for mortality were analyzed by logistic regression. Results: We identified 68,869 pediatric hospitalizations involving NAFLD. Among those, 970 (1.4%) died during hospitalization. Hospitalization rates have been rapidly increasing from 1998 to 2020 (incidence rate ratio (IRR): 1.07; 95% CI: 1.06\u20131.07; p &lt; 0.001). There was a significant difference in mortality based on the type of hospital (rural, non-teaching urban, or teaching urban) in pediatric patients with NAFLD (p &lt; 0.05). Coagulopathy was significantly associated with increased odds of mortality, while age \u2265 12 years, diabetes and obesity were associated with decreased odds of mortality (p &lt; 0.05). Sex, race\/ethnicity, hepatitis B, hepatitis C, HIV, and IV drug use were not significantly associated with mortality. Conclusions: Our study has shown ever increasing hospitalization rates for NAFLD in pediatric populations and well as significant risk factors associated with mortality. Further studies should be performed as more data on this patient population are collected.<\/jats:p>","DOI":"10.3390\/children12010071","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T09:30:45Z","timestamp":1736328645000},"page":"71","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD): Trends, Mortality, and Socioeconomic Disparities in the U.S., 1998\u20132020"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7555-453X","authenticated-orcid":false,"given":"Paul","family":"Wasuwanich","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Naples Comprehensive Health, Naples, FL 34102, USA"},{"name":"Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"So","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Sadek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Naples Comprehensive Health, Naples, FL 34102, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaowapong","family":"Jarasvaraparn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songyos","family":"Rajborirug","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 550 N. Broadway 10th Floor Suite 1003, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben E.","family":"Quiros-Tejeira","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7288-5459","authenticated-orcid":false,"given":"Wikrom","family":"Karnsakul","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 550 N. Broadway 10th Floor Suite 1003, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","article-title":"Mechanisms of NAFLD development and therapeutic strategies","volume":"24","author":"Friedman","year":"2018","journal-title":"Nat. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00018-018-2947-0","article-title":"Molecular pathways of nonalcoholic fatty liver disease development and progression","volume":"76","author":"Bessone","year":"2019","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1146\/annurev-pathol-020117-043617","article-title":"Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease","volume":"13","author":"Arab","year":"2018","journal-title":"Annu. Rev. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.freeradbiomed.2020.02.025","article-title":"Role of oxidative stress in the pathogenesis of nonalcoholic fatty liver disease","volume":"152","author":"Chen","year":"2020","journal-title":"Free Radic. Biol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.jhep.2018.06.008","article-title":"Endoplasmic reticulum stress signalling and the pathogenesis of non-alcoholic fatty liver disease","volume":"69","author":"Lebeaupin","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00018-016-2161-x","article-title":"Pathogenesis of nonalcoholic steatohepatitis","volume":"73","author":"Liu","year":"2016","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1053\/j.gastro.2012.04.001","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology","volume":"142","author":"Chalasani","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e34437","DOI":"10.1097\/MD.0000000000034437","article-title":"Risk factors of nonalcoholic fatty liver disease in healthy women","volume":"102","author":"Guan","year":"2023","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1161\/HYPERTENSIONAHA.122.17982","article-title":"Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: A Review of Shared Cardiometabolic Risk Factors","volume":"79","author":"Peng","year":"2022","journal-title":"Hypertension"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17608","DOI":"10.1038\/s41598-022-22729-5","article-title":"The additive effect of genetic and metabolic factors in the pathogenesis of nonalcoholic fatty liver disease","volume":"12","author":"Seko","year":"2022","journal-title":"Sci Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3410","DOI":"10.3748\/wjg.v28.i27.3410","article-title":"Risk factors and diagnostic biomarkers for nonalcoholic fatty liver disease-associated hepatocellular carcinoma: Current evidence and future perspectives","volume":"28","author":"Ueno","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jpeds.2019.04.018","article-title":"The Role of Genetic Predisposition, Programing During Fetal Life, Family Conditions, and Post-natal Diet in the Development of Pediatric Fatty Liver Disease","volume":"211","author":"Mosca","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.eprac.2022.03.010","article-title":"American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD)","volume":"28","author":"Cusi","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non-alcoholic fatty liver disease","volume":"397","author":"Powell","year":"2021","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s10396-020-01061-3","article-title":"Histopathological findings of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis","volume":"47","author":"Kage","year":"2020","journal-title":"J. Med. Ultrason."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4574","DOI":"10.2174\/1381612825666190117102111","article-title":"Diagnosis of Non-alcoholic Fatty Liver Disease (NAFLD): Current Concepts","volume":"24","author":"Papatheodoridi","year":"2018","journal-title":"Curr Pharm Des."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Anderson, E.L., Howe, L.D., Jones, H.E., Higgins, J.P.T., Lawlor, D.A., and Fraser, A. (2015). The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0140908"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jpeds.2018.04.047","article-title":"Pediatric Nonalcoholic Fatty Liver Disease in New York City: An Autopsy Study","volume":"200","author":"Fernandes","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol., 64, 1388\u20131402.","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1002\/hep.20842","article-title":"Histopathology of pediatric nonalcoholic fatty liver disease","volume":"42","author":"Schwimmer","year":"2005","journal-title":"Hepatology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/MPG.0000000000003384","article-title":"Trends and Disparities in Pediatric Nonalcoholic Fatty Liver Disease-Associated Hospitalizations in the United States","volume":"74","author":"Dybbro","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1037\/a0040359","article-title":"Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families","volume":"71","author":"Hilliard","year":"2016","journal-title":"Am. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4094\/chnr.2023.29.1.7","article-title":"Family-centered interventions for children and adolescents with type 1 diabetes mellitus: An integrative review","volume":"29","author":"Ispriantari","year":"2023","journal-title":"Child Health Nurs. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3642818","DOI":"10.1155\/2017\/3642818","article-title":"The Effect of Early Life Factors and Early Interventions on Childhood Overweight and Obesity 2016","volume":"2017","author":"Wen","year":"2017","journal-title":"J. Obes."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"366","DOI":"10.15403\/jgld-3622","article-title":"Liver-related Mortality is Increased in Lean Subjects with Non-alcoholic Fatty Liver Disease Compared to Overweight and Obese Subjects","volume":"30","author":"Feldman","year":"2021","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2240","DOI":"10.1007\/s10620-020-06530-w","article-title":"Racial and socioeconomic disparities in hospitalization of pediatrics with liver disease from 2005 to 2015","volume":"66","author":"Martin","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_28","first-page":"56","article-title":"African Americans and their distrust of the health care system: Healthcare for diverse populations","volume":"14","author":"Kennedy","year":"2007","journal-title":"J. Cult. Divers."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"742","DOI":"10.2105\/AJPH.93.5.742","article-title":"Socioeconomic status and dissatisfaction with health care among chronically ill African Americans","volume":"93","author":"Becker","year":"2003","journal-title":"Am. J. Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.3748\/wjg.v28.i25.2890","article-title":"Non-alcoholic fatty liver disease and the impact of genetic, epigenetic and environmental factors in the offspring","volume":"28","author":"Wajsbrot","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5219","DOI":"10.2174\/13816128113199990381","article-title":"Genetic predisposition in NAFLD and NASH: Impact on severity of liver disease and response to treatment","volume":"19","author":"Dongiovanni","year":"2013","journal-title":"Curr. Pharm. Des."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"339","DOI":"10.14218\/JCTH.2021.00268","article-title":"Coagulation and Endothelial Dysfunction Associated with NAFLD: Current Status and Therapeutic Implications","volume":"10","author":"Ogresta","year":"2022","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1053\/j.gastro.2023.06.013","article-title":"AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review","volume":"165","author":"Wattacheril","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1053\/j.gastro.2018.04.034","article-title":"Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients with Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study","volume":"155","author":"Wong","year":"2018","journal-title":"Gastroenterology"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/71\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:24:39Z","timestamp":1759919079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/71"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["children12010071"],"URL":"https:\/\/doi.org\/10.3390\/children12010071","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]}}}