Abstract
Nonalcoholic steatohepatitis (NASH) is a more severe form of non-alcoholic liver disease (NAFLD) that is characterized by inflammation and liver damage. Previous studies have identified a strong association between NAFLD and race/ethnicity, but there has been less investigation of a racial disparity specifically in NASH. We tested the association between NASH and race/ethnicity in the adult US population of NHANES 17-18 (n=5492). Hepatic steatosis (HS) was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values (stages): S0 <238, S1 (mild)=238-259, S2 (moderate)=260-290, S3 (severe) >290. Participants with moderate/severe steatosis without the exclusion criteria (elevated transferrin level >50%, chronic hepatitis B, chronic hepatitis C, excessive alcohol use, or prescription medications that might cause HS) were considered to have NAFLD (n=3,292). Subjects with NAFLD and a HAIR score (defined by HOMA-IR, hypertension, and ALT) of ≥ 2 were considered to have NASH, as opposed to simple NAFLD. Data were analyzed using Chi square and multinomial regression adjusting for the other independent variables [demographics: (age, gender, education, poverty), physical activity, smoking, waist-hip ratio, body mass index, triglyceride, cholesterol, glucose, HbA1c, C-reactive protein (hsCRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and healthy eating index (HEI)] using SAS (Release V.9.1.3, 2002; SAS) and including sample weights and design. The overall prevalence of NASH was 7.6% and it varied by race/ethnicity. Mexican Americans had the highest prevalence (10.6%), followed by other Hispanics (9.1%); Non-Hispanic Whites had the lowest prevalence (6.8%) (p<0.05). Females had lower prevalence (4.8%) than males (10.4%) (p<0.05). Among males, Mexican Americans had the highest prevalence (14.3%), followed by Blacks (11.3%), and other race had the lowest prevalence (7.7%). In the overall adjusted model, Blacks had lower odds of NASH relative to Non-Hispanic Whites [Adjusted Odds Ratio (AOR)=0.4, 95% confidence interval (CI)=0.3-0.6, p<0.05)]. Although Mexican Americans had higher odds of NASH relative to Non-Hispanic Whites, it was not statistically significant (AOR=1.9, 95%CI=0.9-3.9, p=0.09). Among males and females, there was no statistical association between NASH and race/ethnicity (p>0.05). We concluded that the prevalence of NASH was highest among Mexican American males relative to the other groups. Targeted interventions for Mexican American males are needed to increase awareness, management and prevention related to NASH.
Grants: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.