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Sex and Race-Ethnic Disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease: An Analysis of 40,166 Individuals

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Abstract

Background

To overcome the limitations of the term “non-alcoholic fatty liver disease” (NAFLD), the term metabolic-associated steatotic liver disease (MASLD) was introduced. While epidemiologic studies have been conducted on MASLD, there is limited evidence on its associated sex and ethnic variations.

Aims

This study assesses the differences across sex and race-ethnicity on the prevalence, associated risk factors and adverse outcomes in individuals with MASLD.

Methods

Data retrieved from the National Health and Nutrition Examination Survey between 1999 to 2018 was analyzed. Prevalence, clinical characteristics, and outcomes were evaluated according to sex and race-ethnicity. Adverse outcomes and mortality events were analyzed using multivariate analyses.

Results

Of 40,166 individuals included, 37.63% had MASLD. There was a significant increase in MASLD prevalence from 1999 to 2018 among Mexican Americans (Annual Percentage Change [APC] + 1.889%, p < 0.001), other Hispanics (APC + 1.661%, p = 0.013), NH Whites (APC + 1.084%, p = 0.018), NH Blacks (APC + 1.108%, p = 0.007), and females (APC + 0.879%, p = 0.030), but not males. Females with MASLD were at lower risk of all-cause (HR: 0.766, 95%CI 0.711 to 0.825, p < 0.001), cardiovascular disease-related (CVD) (SHR: 0.802, 95% CI 0.698 to 0.922, p = 0.002) and cancer-related mortality (SHR: 0.760, 95% CI 0.662 to 0.873, p < 0.001). Significantly, NH Blacks have the highest risk of all-cause and CVD-related mortality followed by NH Whites then Mexican Americans.

Conclusion

There has been an increase in prevalence in most race-ethnicities over time. While the change in definition shows no significant differences in previous associations found in NAFLD, the increased mortality in NH Whites relative to Mexican Americans remains to be explored.

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Data availability

The National Health and Nutrition Examination Survey data has been publicly made available. All articles in this manuscript are available from Medline and Embase.

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Funding

No funding was required for this study.

Author information

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore 10 Medical Dr, Singapore, 117597, Singapore

    Clarissa Elysia Fu, Christen Ong, Benjamin Koh, Wen Hui Lim, Darren Jun Hao Tan, Jia Hong Koh, Nicholas Syn, Cheng Han Ng & Mark Muthiah

  2. Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore

    Margaret Teng, Daniel Tung, Jia Hong Koh, Benjamin Nah & Mark Muthiah

  3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Vijay Ramadoss & Nicholas Syn

  4. National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore

    Nicholas Syn & Mark Muthiah

  5. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan

    Nobuharu Tamaki

  6. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Mohammad Shadab Siddiqui

  7. Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA

    Karn Wijarnpreecha

  8. Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA, USA

    George N. Ioannou

  9. Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan

    Atsushi Nakajima

  10. Houston Research Institute, Houston Methodist Hospital, Houston, USA

    Mazen Noureddin

  11. Department of Internal Medicine, Stravitz-Sanyal Institute of Liver Disease and Metabolic Health,, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Arun J. Sanyal

  12. Ministry of Health Holdings, Singapore, Singapore

    Cheng Han Ng

  13. Department of Medicine, Kurume University School of Medicine, Kurume, Japan

    Cheng Han Ng

Authors
  1. Clarissa Elysia Fu
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  2. Margaret Teng
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  5. Christen Ong
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  6. Benjamin Koh
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  7. Wen Hui Lim
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  8. Darren Jun Hao Tan
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  9. Jia Hong Koh
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  10. Benjamin Nah
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  11. Nicholas Syn
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  12. Nobuharu Tamaki
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  14. Karn Wijarnpreecha
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  15. George N. Ioannou
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  16. Atsushi Nakajima
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  17. Mazen Noureddin
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  18. Arun J. Sanyal
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  19. Cheng Han Ng
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  20. Mark Muthiah
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Contributions

Conception and design: Cheng Han Ng, Mark Muthiah. Administrative support: Nicholas Syn, Nobuharu Tamaki, Mohammad Shadab Siddiqui, Karn Wijarnpreecha, George N. Ioannou, Atsushi Nakajima, Mazen Noureddin, Arun J Sanyal. Provision of study materials or patient: N.A. Collection and assembly of data: Clarissa Elysia Fu, Margaret Teng, Christen Ong, Benjamin Koh, Jia Hong Koh, Benjamin Nah, Nicholas Syn, Nobuharu Tamaki, Mohammad Shadab Siddiqui, Karn Wijarnpreecha. Data analysis and interpretation: Clarissa Elysia Fu, Margaret Teng, Daniel Tung, Vijay Ramadoss, Wen Hui Lim, Darren Jun Hao Tan, Jia Hong Koh, Benjamin Nah, George N. Ioannou, Atsushi Nakajima, Mazen Noureddin, Arun J Sanyal. Manuscript writing: All authors. Final approval of manuscript: All authors. All authors have read and approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Cheng Han Ng.

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Conflict of interest

All authors have completed the ICMJE uniform disclosure form. C.H.N. and M.M. has served as a consultant in Boxer Capital. A.J.S. is the President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect and Galmed. He has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz and Genfit. He has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen and Bristol Myers Squibb. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland and Norvatis. He receives royalties from Elsevier and UptoDate. M.N. has been on the advisory board/consultant for 89BIO, Altimmune, Gilead, cohBar, Cytodyn, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Madrgial, NorthSea, Prespecturm, Terns, Siemens and Roche diagnostic; Dr Noureddin has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking and Zydus; He is a shareholder or has stocks in Anaetos, Chrownwell, Ciema, Rivus Pharma and Viking. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated. The study was conducted in accordance with the Declaration of Helsinki.

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Fu, C.E., Teng, M., Tung, D. et al. Sex and Race-Ethnic Disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease: An Analysis of 40,166 Individuals. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08540-4

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