Non-alcoholic fatty liver disease (NAFLD), active component, U.S. Armed Forces, 2000-2017

During 2000-2017, a total of 19,069 active component service members received incident diagnoses of non-alcoholic fatty liver disease (NAFLD), for a crude overall incidence rate of 77.7 cases per 100,000 person-years. The overall rate of incident NAFLD diagnoses among males was more than 1.5 times the rate among females. Overall incidence rates of NAFLD diagnoses increased with advancing age and were highest among service members aged 50 years or older. Asian/Pacific Islander and Hispanic service members had the highest overall incidence of NAFLD diagnoses compared to those in other race/ethnicity groups. The lowest overall incidence by race/ethnicity was observed among non-Hispanic black service members. Crude annual incidence rates of NAFLD diagnoses increased 12-fold between 2000 and 2017. During this period, annual rates of incident NAFLD diagnoses increased in both sexes and in all age groups. Increases in annual rates were seen over time in all race/ethnicity groups and in all services. More than two-thirds of incident NAFLD cases had one or more diagnosed metabolic comorbidities, with dyslipidemia affecting the greatest percentage of cases, followed by obesity/overweight and hypertension. The percentage of NAFLD cases with 2 or more metabolic comorbidities increased 36.0% during the 18-year surveillance period from 22.2% in 2001 to 30.2% in 2017. Selected recommendations from the American Association for the Study of Liver Diseases 2018 practice guidance document for the diagnosis and management of NAFLD are discussed.