Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994

Am J Epidemiol. 2013 Jul 1;178(1):38-45. doi: 10.1093/aje/kws448. Epub 2013 May 23.


Previous estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)²), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

Keywords: ethnic variation; nonalcoholic fatty liver disease; population surveys; prevalence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Black People / statistics & numerical data
  • Fatty Liver / diagnostic imaging
  • Fatty Liver / epidemiology*
  • Female
  • Humans
  • Liver / diagnostic imaging
  • Male
  • Mexican Americans / statistics & numerical data
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease
  • Nutrition Surveys / statistics & numerical data*
  • Prevalence
  • Sex Factors
  • Socioeconomic Factors
  • Ultrasonography
  • United States / epidemiology
  • White People / statistics & numerical data
  • Young Adult