Racial differences in nonalcoholic fatty liver disease in the U.S. population

Authors

  • Andrea L. C. Schneider,

    Corresponding author
    1. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
    2. Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, Maryland, USA
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  • Mariana Lazo,

    1. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
    2. Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, Maryland, USA
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  • Elizabeth Selvin,

    1. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
    2. Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, Maryland, USA
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  • Jeanne M. Clark

    1. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
    2. Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, Maryland, USA
    3. Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • Funding agencies: A.L.C.S. was supported by NIH/NIDDK training grant T32 DK062707. E.S. was supported by NIH/NIDDK grants K01 DK076595 and R01 DK089174. J.M.C. and M.L. were supported by grant R01 DK083393 from NIH/NIDDK. M.L. was also supported by the American Diabetes Association.

  • Disclosure: No potential conflicts of interest relevant to this article were reported. All participants provided written informed consent. NHANES III data are publically available at http://www.cdc.gov/nchs/nhanes/nh3data.htm.

Abstract

Objective

To characterize the prevalence of nonalcoholic fatty liver disease (NAFLD) by race in a nationally representative sample of the U.S. population and to investigate potential explanatory factors for racial disparities.

Design and Methods

Cross-sectional study of 4,037 non-Hispanic white, 2,746 non-Hispanic black, and 2,892 Mexican-American adults in the Third National Health and Nutrition Examination Survey. NAFLD was defined using ultrasound and with elevated aminotransferases.

Results

Age-adjusted prevalence of NAFLD was highest in Mexican-Americans (21.2%), followed by non-Hispanic whites (12.5%), and was lowest in non-Hispanic blacks (11.6%). Even after adjustment for demographic, lifestyle, adiposity, and metabolic factors, compared to non-Hispanic whites, Mexican-Americans were more likely to have NAFLD (OR: 1.67, 95% CI: 1.26, 2.22). Non-Hispanic blacks were significantly less likely to have NAFLD with elevated aminotransferases (OR: 0.51, 95% CI: 0.27, 0.97). Racial differences were attenuated among those with normal BMI and among “never drinkers.”

Conclusion

In this representative sample of the U.S. population, we found significant racial differences in the prevalence of ultrasound-defined NAFLD (with and without elevated liver enzymes). The racial differences were not fully explained by lifestyle, adiposity, and metabolic factors. More works is needed to identify potential contributors.

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