Abstract
There is a paucity of recent data about the epidemiology and long-term outcomes of nonalcoholic fatty liver disease (NAFLD) in the female population. Our aim was to assess the prevalence, risk factors, and mortality of NAFLD in female adults of the United States. Data from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2014 were used. NAFLD status was determined by the U.S. Fatty Liver Index (US-FLI) in the absence of other liver diseases and excessive alcohol consumption. The prevalence rates, risk factors, and 5-year all-cause and cardiovascular mortality were determined in women with NAFLD. The most recent prevalence of NAFLD among female adults (2007-2014) in the United States was 24.4% (95% confidence interval [CI], 22.48-26.33). Prevalence was higher among women >44 years of age and those with body mass index ≥30 kg/m(2). In addition, the average age of the female population with NAFLD has decreased over time. The fully adjusted odds ratios in women with NAFLD compared to those without NAFLD were 1.48 (95% CI, 1.20-1.82) for cardiovascular disease (CVD), 1.89 (95% CI, 1.42-2.52) for atherosclerotic cardiovascular disease (ASCVD) score ≥7.5%, and 1.76 (95% CI, 1.37-2.25) for either CVD or ASCVD ≥7.5%. The 5-year mortality for female adults with NAFLD was significantly higher than for those without NAFLD (adjusted hazard ratio, 1.48; 95% CI, 1.07-2.05). Among women with NAFLD, those with ASCVD ≥7.5% had significantly higher 5-year all-cause mortality and CVD mortality. Conclusion: The prevalence of NAFLD in female NHANES participants from the United States has continued over recent years. In the female population with NAFLD, ASCVD ≥7.5% is an independent predictor of overall and cardiac-specific mortality.