Racial/ethnic and gender disparity in the severity of NAFLD among people with diabetes or prediabetes

Abstract

Aim: Non-alcoholic fatty liver disease (NAFLD) exhibits a racial disparity. We examined the prevalence and the association between race, gender, and NAFLD among prediabetes and diabetes populations among adults in the United States.Methods: We analyzed data for 3,190 individuals ≥18 years old from the National Health and Nutrition Examination Survey (NHANES) 2017–2018. NAFLD was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values: S0 (none) < 238, S1 (mild) = 238–259, S2 (moderate) = 260–290, S3 (severe) > 290. Data were analyzed using Chi-square test and multinomial logistic regression, adjusting for confounding variables and considering the design and sample weights.Results: Of the 3,190 subjects, the prevalence of NAFLD was 82.6%, 56.4%, and 30.5% (p < 0.0001) among diabetes, prediabetes and normoglycemia populations respectively. Mexican American males with prediabetes or diabetes had the highest prevalence of severe NAFLD relative to other racial/ethnic groups (p < 0.05). In the adjusted model, among the total, prediabetes, and diabetes populations, a one unit increase in HbA1c was associated with higher odds of severe NAFLD [adjusted odds ratio (AOR) = 1.8, 95% confidence level (CI) = 1.4–2.3, p < 0.0001; AOR = 2.2, 95% CI = 1.1–4.4, p = 0.033; and AOR = 1.5, 95% CI = 1.1–1.9, p = 0.003 respectively].Conclusion: We found that prediabetes and diabetes populations had a high prevalence and higher odds of NAFLD relative to the normoglycemic population and HbA1c is an independent predictor of NAFLD severity in prediabetes and diabetes populations. Healthcare providers should screen prediabetes and diabetes populations for early detection of NAFLD and initiate treatments including lifestyle modification to prevent the progression to non-alcoholic steatohepatitis or liver cancer.

Racial and ethnic disparities in metabolic dysfunction-associated steatotic liver disease

“…Studies have found that within Hispanic populations in the United States, the prevalence of MASLD is higher in those of Mexican origin [12] . A study published in 2020 analyzed 4,538 adult participants from the National Health and Nutrition Examination Survey (NHANES) from 2011-2016 in the United States found that MASLD prevalence was highest among Mexican Americans (48.4%), and lowest among non-Hispanic Black individuals (8.0%) and Asians (18.1%) [19] . Another study utilizing NHANES data from 2017-2018 investigated 3,190 adults (categorized as normoglycemic, prediabetic, or diabetic) and found that Mexican American men had the highest prevalence of severe MASLD (defined as controlled attenuation parameter [CAP] score > 290 dB/m) in the normoglycemic and diabetic populations compared to non-Hispanic White, non-Hispanic Black, and other Hispanic groups [20] .…”

“…In the United States, Hispanic individuals have the highest prevalence of MASLD, followed by non-Hispanic White individuals and then non-Hispanic Black individuals [2,[11][12][13][14][15] Of patients with biopsy-proven MASLD, the frequency of MASH varies by race and ethnicity with highest frequency in Hispanic individuals, then non-Hlispanic White individuals, and then non-Hispanic Black individuals and Asian individuals [16] The largest rate of increase of hospital admissions with MASLD was found amongst Hispanic individuals, followed by non-Hispanic White individuals andthen non Hispanic Black individuals [18] Within Hispanic populations in the United States, the prevalence of MASLD is higlher in those of Mexican origin [12,15,19,20] Similar trends are found among young adults and adolescent populatiorns with Hispanic individuals having a significantly higher prevalence of MASLD than non Hispanic individuals [21,22] Non-Hispanic Black individuals are less likely to develop MASLD tthan non-Hispanic White individuals [25,26] MASH: Metabolic Dysfunction-associated Steatohepatitis; MASLD: Metabolic dysfunction-associated steatotic liver disease.…”

Prevalence of untreated prediabetes and glucose metabolism disturbances in Mexico: An analysis of nationally representative surveys spanning 2016-2021

“…While comprehensive data on the global burden of prediabetes are lacking, the International Diabetes Federation estimates a global prevalence of Impaired Glucose Tolerance (IGT) of 7.5% (374 million adults), of whom 72.2% reside in low-and middle-income countries (LMICs). Ethnicity is a known modifier of metabolic risk in individuals with prediabetes (3,4); in particular, Mexican mestizo populations have an increased risk of diabetes, which manifests at younger ages and lower body-mass index levels (5)(6)(7). However, epidemiological data on prediabetes among ethnically diverse populations are limited, including in Mexico, where diabetes mellitus is a leading cause of disability and death (8).…”