Disparities among ethnic groups in mortality and outcomes among adults with MASLD: A multicenter study.
Hispanic paradox
MASLD
Native Americans
ethnic disparities
liver decompensation
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
26 Feb 2024
26 Feb 2024
Historique:
revised:
11
02
2024
received:
18
09
2023
accepted:
13
02
2024
medline:
26
2
2024
pubmed:
26
2
2024
entrez:
26
2
2024
Statut:
aheadofprint
Résumé
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and 10%-20% occurs in lean individuals. There is little data in the literature regarding outcomes in an ethnically-diverse patient populations with MASLD. Thus, we aim to investigate the natural history and ethnic disparities of MASLD patients in a diverse population, and stratified by body mass index categories. We conducted a retrospective multicenter study on patients with MASLD at the Banner Health System from 2012 to 2022. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease, diabetes mellitus (DM), liver-related events (LREs), and cancer. We used competing risk and Cox proportional hazard regression analysis for outcome modelling. A total of 51 452 (cross-sectional cohort) and 37 027 (longitudinal cohort) patients were identified with 9.6% lean. The cohort was 63.33% European ancestry, 27.96% Hispanic ancestry, 3.45% African ancestry, and 2.31% Native American/Alaskan ancestry. Median follow-up was 45.8 months. After adjusting for confounders, compared to European individuals, Hispanic and Native American/Alaskan patients had higher prevalence of cirrhosis and DM, and individuals of Hispanic, African, and Native American/Alaskan ancestry had higher mortality and incidence of LREs and DM. Lean patients had higher mortality and incidence of LREs compared with non-lean patients. Native American/Alaskan, Hispanic, and African patients had higher mortality and incidence of LREs and DM compared with European patients. Further studies to explore the underlying disparities and intervention to prevent LREs in lean patients, particularly several ethnic groups, may improve clinical outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and 10%-20% occurs in lean individuals. There is little data in the literature regarding outcomes in an ethnically-diverse patient populations with MASLD. Thus, we aim to investigate the natural history and ethnic disparities of MASLD patients in a diverse population, and stratified by body mass index categories.
METHODS
METHODS
We conducted a retrospective multicenter study on patients with MASLD at the Banner Health System from 2012 to 2022. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease, diabetes mellitus (DM), liver-related events (LREs), and cancer. We used competing risk and Cox proportional hazard regression analysis for outcome modelling.
RESULTS
RESULTS
A total of 51 452 (cross-sectional cohort) and 37 027 (longitudinal cohort) patients were identified with 9.6% lean. The cohort was 63.33% European ancestry, 27.96% Hispanic ancestry, 3.45% African ancestry, and 2.31% Native American/Alaskan ancestry. Median follow-up was 45.8 months. After adjusting for confounders, compared to European individuals, Hispanic and Native American/Alaskan patients had higher prevalence of cirrhosis and DM, and individuals of Hispanic, African, and Native American/Alaskan ancestry had higher mortality and incidence of LREs and DM. Lean patients had higher mortality and incidence of LREs compared with non-lean patients.
CONCLUSION
CONCLUSIONS
Native American/Alaskan, Hispanic, and African patients had higher mortality and incidence of LREs and DM compared with European patients. Further studies to explore the underlying disparities and intervention to prevent LREs in lean patients, particularly several ethnic groups, may improve clinical outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347.
Le MH, Yeo YH, Zou B, et al. Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach. Clin Mol Hepatol. 2022;28(4):841-850.
Simon TG, Roelstraete B, Khalili H, Hagstrom H, Ludvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70(7):1375-1382.
Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016;65(3):589-600.
Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40(6):1387-1395.
Bambha K, Belt P, Abraham M, et al. Ethnicity and nonalcoholic fatty liver disease. Hepatology. 2012;55(3):769-780.
Samji NS, Snell PD, Singal AK, Satapathy SK. Racial disparities in diagnosis and prognosis of nonalcoholic fatty liver disease. Clin Liver Dis (Hoboken). 2020;16(2):66-72.
Schneider AL, Lazo M, Selvin E, Clark JM. Racial differences in nonalcoholic fatty liver disease in the U.S. population. Obesity (Silver Spring). 2014;22(1):292-299.
Espey DK, Jim MA, Cobb N, et al. Leading causes of death and all-cause mortality in American Indians and Alaska natives. Am J Public Health. 2014;104(Suppl 3):S303-S311.
Murphy S, Xu J, Kochanek K, Arias E, Tejada-vera B. Deaths: final data for 2018. Natl Vital Stat Rep. 2021;69(13):1-82.
Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(8):739-752.
Ha J, Yim SY, Karagozian R. Mortality and liver-related events in lean versus non-lean nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2022;21:2496-2507.e5.
Tang A, Ng CH, Phang PH, et al. Comparative burden of metabolic dysfunction in lean NAFLD vs non-lean NAFLD-a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(7):1750-1760 e1712.
Wijarnpreecha K, Li F, Lundin SK, et al. Higher mortality among lean patients with non-alcoholic fatty liver disease despite fewer metabolic comorbidities. Aliment Pharmacol Ther. 2023;57(9):1014-1027.
Ahmed OT, Gidener T, Mara KC, Larson JJ, Therneau TM, Allen AM. Natural history of nonalcoholic fatty liver disease with Normal body mass index: a population-based study. Clin Gastroenterol Hepatol. 2022;20(6):1374-1381 e1376.
Huang S, Bao Y, Zhang N, Niu R, Tian L. Long-term outcomes in lean and non-lean NAFLD patients: a systematic review and meta-analysis. Endocrine. 2023;1-8.
Leung JC, Loong TC, Wei JL, et al. Histological severity and clinical outcomes of nonalcoholic fatty liver disease in nonobese patients. Hepatology. 2017;65(1):54-64.
Weinberg EM, Trinh HN, Firpi RJ, et al. Lean Americans with nonalcoholic fatty liver disease have lower rates of cirrhosis and comorbid diseases. Clin Gastroenterol Hepatol. 2021;19(5):996-1008 e1006.
Hagstrom H, Vessby J, Ekstedt M, Shang Y. 99% of patients with NAFLD meet MASLD criteria and natural history is therefore identical. J Hepatol. 2023;80:e76-e77.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625-1638.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.
Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163.
Nguyen GC, Thuluvath PJ. Racial disparity in liver disease: biological, cultural, or socioeconomic factors. Hepatology. 2008;47(3):1058-1066.
Zhang X, Wong GL, Yip TC, et al. Risk of liver-related events by age and diabetes duration in patients with diabetes and nonalcoholic fatty liver disease. Hepatology. 2022;76(5):1409-1422.
Hagstrom H, Nasr P, Ekstedt M, et al. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: a long-term follow-up study. Hepatol Commun. 2018;2(1):48-57.
Nabi O, Lapidus N, Boursier J, et al. Lean individuals with NAFLD have more severe liver disease and poorer clinical outcomes (NASH-CO study). Hepatology. 2023;78(1):272-283.
Lan Y, Lu Y, Li J, et al. Outcomes of subjects who are lean, overweight or obese with nonalcoholic fatty liver disease: a cohort study in China. Hepatol Commun. 2022;6(12):3393-3405.
Long MT, Noureddin M, Lim JK. AGA clinical practice update: diagnosis and Management of Nonalcoholic Fatty Liver Disease in lean individuals: expert review. Gastroenterology. 2022;163(3):764-774.
Kuchay MS, Martinez-Montoro JI, Choudhary NS, Fernandez-Garcia JC, Ramos-Molina B. Non-alcoholic fatty liver disease in lean and non-obese individuals: current and future challenges. Biomedicine. 2021;9(10):1-21
Rich NE, Oji S, Mufti AR, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(2):198-210 e192.
Leung CW, Tester JM. The association between food insecurity and diet quality varies by race/ethnicity: an analysis of National Health and nutrition examination survey 2011-2014 results. J Acad Nutr Diet. 2019;119(10):1676-1686.
Romeo S, Kozlitina J, Xing C, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40(12):1461-1465.
Chahal D, Sharma D, Keshavarzi S, et al. Distinctive clinical and genetic features of lean vs overweight fatty liver disease using the UK biobank. Hepatol Int. 2022;16(2):325-336.
Romeo S, Valenti L. African genetic ancestry and protection against fatty liver disease. Liver Int. 2022;42(10):2122-2123.
Kubiliun MJ, Cohen JC, Hobbs HH, Kozlitina J. Contribution of a genetic risk score to ethnic differences in fatty liver disease. Liver Int. 2022;42(10):2227-2236.
Khan SU, Lone AN, Yedlapati SH, et al. Cardiovascular disease mortality among Hispanic versus non-Hispanic white adults in the United States, 1999 to 2018. J Am Heart Assoc. 2022;11(7):e022857.
Kim Y, Han E, Lee JS, et al. Cardiovascular risk is elevated in lean subjects with nonalcoholic fatty liver disease. Gut Liver. 2022;16(2):290-299.
Semmler G, Wernly S, Bachmayer S, et al. Nonalcoholic fatty liver disease in lean subjects: associations with metabolic dysregulation and cardiovascular risk-a single-center cross-sectional study. Clin Transl Gastroenterol. 2021;12(4):e00326.
Tang A, Ng CH, Phang PH, et al. Comparative burden of metabolic dysfunction in lean NAFLD vs non-lean NAFLD-a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2022;21(7):1750-1760.E12.
Fracanzani AL, Petta S, Lombardi R, et al. Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease, and association with visceral obesity. Clin Gastroenterol Hepatol. 2017;15(10):1604-1611.
Chen F, Esmaili S, Rogers GB, et al. Lean NAFLD: a distinct entity shaped by differential metabolic adaptation. Hepatology. 2020;71(4):1213-1227.
Neeland IJ, Ross R, Despres JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7(9):715-725.
Albhaisi S, Chowdhury A, Sanyal AJ. Non-alcoholic fatty liver disease in lean individuals. JHEP Rep. 2019;1(4):329-341.
Kang MK, Park JG. Low skeletal muscle mass is a risk factor for subclinical atherosclerosis in patients with nonalcoholic fatty liver disease. Diagnostics (Basel). 2021;11(5):1-10.