Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Clin Gastroenterol Hepatol. 2018 Feb;16(2):198-210.e2. doi: 10.1016/j.cgh.2017.09.041. Epub 2017 Sep 29.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75-100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis.
We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model.
We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%-55.5%) than population-based cohorts (range, 13.0%-22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98-1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60-0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD.
In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）是美国最常见的慢性肝病，影响了 7500 万至 1 亿美国人。然而，这种疾病的负担在不同种族或族裔之间可能并不均等。我们进行了一项系统综述和荟萃分析，以描述 NAFLD 患病率、严重程度和预后方面的种族和族裔差异。
我们检索了 MEDLINE、EMBASE 和 Cochrane 数据库，截至 2016 年 8 月，以获取报告人群或高危队列中 NAFLD 患病率、NAFLD 严重程度（包括非酒精性脂肪性肝炎[NASH]和显著纤维化的存在）和 NAFLD 预后（包括肝硬化并发症和死亡率的发展）的研究。使用随机效应模型的 DerSimonian 和 Laird 方法，针对每个结局计算按种族和族裔分层的汇总相对风险。
我们确定了 34 项研究，这些研究共包含 368569 名独特的患者，这些研究描述了 NAFLD 患病率、严重程度或预后方面的差异。西班牙裔人群的 NAFLD 患病率最高，白种人处于中间水平，黑种人最低，但高危队列（范围为 47.6%-55.5%）中的组间差异小于人群队列（范围为 13.0%-22.9%）。在患有 NAFLD 的患者中，西班牙裔患者患 NASH 的风险更高（相对风险，1.09；95%CI，0.98-1.21），黑种人患者的风险较低（相对风险，0.72；95%CI，0.60-0.87）。然而，种族或族裔之间显著纤维化的比例没有显著差异。关于 NAFLD 患者结局的种族或族裔差异的数据有限且不一致。
在一项系统综述和荟萃分析中，我们发现美国 NAFLD 的患病率和严重程度存在显著的种族和族裔差异，西班牙裔人群的负担最高，黑种人最低。然而，关于 NAFLD 患者结局的种族或族裔差异的数据不一致。
