This population epidemiology study uses NHANES data to report trends in the prevalence of the metabolic syndrome in US adults between 2003 and 2012.

Metabolic syndrome is associated with increased risk for cardiovascular disease and all-cause mortality.^1,2 A previous study reported a prevalence of 33% in adults, which remained stable from 2007 to 2012.³ Understanding current trends in metabolic syndrome prevalence may help identify patients who would benefit from improved screening and optimization of cardiovascular risk profiles. We provide an updated analysis of metabolic syndrome prevalence through 2016.

Effective therapies for the hepatitis C virus (HCV) have transformed the landscape of chronic liver disease in the United States. Alcohol-associated liver disease (ALD) and nonalcoholic steatohepatitis (NASH) have emerged as significant clinical and economic health care burdens.^1,2 Lack of effective therapies for ALD and NASH contribute to increasing disease severity among patients with these diseases, leading to cirrhosis and end-stage liver disease requiring liver transplantation (LT). In this cohort study, we updated assessments of liver disease etiology trends among adults awaiting LT in the United States.

The landscape of chronic liver disease (CLD) in the US is rapidly changing. This condition is currently the fourth leading cause of death among persons aged 45 to 64 years.¹ With improvements in the management and treatment of viral hepatitis, the burden of liver disease is shifting toward alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD).^2-5 A recent US population-based study focusing on cirrhosis-related mortality observed that increasing cirrhosis death rates in the US were largely driven by alcoholic cirrhosis, with the greatest increases seen among young adults aged 25 to 34 years.⁶

Summary: Background: Risk factors and timing associated with disease progression and mortality in nonalcoholic fatty liver disease (NAFLD) are poorly understood.Aims: To evaluate the impact of disease severity, demographics and comorbidities on risk of mortality and time to progression in a large, real‐world cohort of diagnosed NAFLD patients.Methods: Claims data from a 20% Medicare representative sample between 2007 and 2015 were analysed retrospectively. Adults were categorised into disease severity groups: NAFLD/nonalcoholic steatohepatitis (NASH) alone, compensated cirrhosis, decompensated cirrhosis, liver transplant or hepatocellular carcinoma. Cumulative incidence of mortality and disease progression were calculated for each group and multivariate analyses performed adjusting for demographics, comorbidities and disease severity.Results: A total of 10 826 456, patients were assessed and the prevalence of NAFLD was 5.7% (N = 621 253). Among patients with NAFLD, 71.1% had NAFLD/NASH alone and 28.9% had NAFLD cirrhosis. Overall, 85.5% of patients had hypertension, 84.1% dyslipidemia, 68.7% had cardiovascular disease and 55.5% diabetes. The cumulative risk of progression of NAFLD to cirrhosis, and compensated cirrhosis to decompensated cirrhosis was 39% and 45%, respectively, over 8 years of follow‐up. The independent predictors of progression included cardiovascular disease, renal impairment, dyslipidemia and diabetes. The cumulative risk of mortality for NAFLD, NAFLD cirrhosis, decompensated cirrhosis and hepatocellular carcinoma was 12.6%, 31.1%, 51.4% and 76.2%, respectively.Conclusions: The present report (a) demonstrates that NAFLD is grossly underdiagnosed in real‐world clinical settings and (b) provides new evidence on the progression rates of NAFLD and risk factors of mortality across the spectrum of severity of NAFLD and cirrhosis.