Date of Completion


Embargo Period



Dr. Helen Swede, Dr. Angela Bermudez-Millan, Dr. Lina Jaradat

Field of Study

Public Health


Master of Public Health

Open Access

Open Access



Introduction: Non-Alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition in the U.S and is an emerging public health concern in adolescents. Risk factors for adolescent NAFLD remain largely unexamined.

Aim: To investigate if demographic and dietary-related factors are linked with NAFLD in adolescents.

Methods: Cross-sectional data from NHANES (2001-2006) ages 12-19 (n=4714) were analyzed. NAFLD was defined as >30 u/L ALT. Food Insecurity levels (child, adult, household), race/ethnicity, sex, BMI, and the Dietary Inflammatory Index (DII) were tested using multivariate binary logistic regression with elevated ALT (no, yes) as the dependent variable.

Results: Risk for elevated ALT among Non-Hispanic Blacks was 1.25 times greater compared to Non-Hispanic Whites (95% CI 1.00-1.57). Higher DII quartiles (i.e., increasingly pro-inflammatory) show a possible link with elevated ALT (e.g., Q2vsQ1: OR=1.23, 95% CI .95-1.59; Q3vsQ1: OR=1.31, 95% CI 1.01-1.69; Q4vsQ1: OR=1.14 95% CI .88-1.48). Findings regarding food security were inconclusive.

Conclusion: This study is the first report, to our knowledge, that Non-Hispanic Blacks might be at greater risk for adolescent NAFLD compared to Non-Hispanic Whites. Lack of an association with Hispanics is inconsistent with prior research in adults, however. Future research is suggested to understand underlying risk factors linked with disparate risk. A potential association with a pro-inflammatory diet also warrants further study. We posit that inconclusive results about food insecurity might due to lower rates of obesity, a known risk factor for NAFLD, in this vulnerable population.

Major Advisor

Dr. Helen Swede, Ph.D.