Which is the most common cause of liver cirrhosis in the United States?

• A. Alcohol
• B. Autoimmune hepatitis
• C. Hepatitis B infection
• D. Nonalcoholic fatty liver disease

Answer: (C)

Nonalcoholic fatty liver disease has become the leading cause of cirrhosis in the United States, driven by the obesity and metabolic syndrome epidemic. Fat accumulation in the liver can progress to nonalcoholic steatohepatitis, then to fibrosis and eventually cirrhosis in a significant subset of patients. This shift reflects the high and rising prevalence of insulin resistance, type 2 diabetes, dyslipidemia, and obesity, which together promote liver inflammation and scarring over time. While hepatitis B can cause cirrhosis, vaccines and antiviral therapies have reduced its contribution, and autoimmune hepatitis is relatively uncommon. Alcohol-related liver disease remains important but is no longer the most common sole cause of cirrhosis in the current U.S. population.