Aboona Majd B, Faulkner Claire, Rangan Pooja, Ng Cheng Han, Huang Daniel Q, Muthiah Mark, Nevah Rubin Moises I, Han Ma Ai Thanda, Fallon Michael B, Kim Donghee, Chen Vincent L, Wijarnpreecha Karn
Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Liver Int. 2024 Jun;44(6):1316-1328. doi: 10.1111/liv.15880. Epub 2024 Feb 26.
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.
代谢功能障碍相关脂肪性肝病（MASLD）是慢性肝病的主要病因，10%-20%发生在体重正常的个体中。关于不同种族的MASLD患者的预后，文献中的数据很少。因此，我们旨在调查不同人群中MASLD患者的自然病史和种族差异，并按体重指数类别进行分层。
我们对2012年至2022年在班纳医疗系统中患有MASLD的患者进行了一项回顾性多中心研究。主要结局包括死亡率以及肝硬化、心血管疾病、糖尿病（DM）、肝脏相关事件（LREs）和癌症的发生率。我们使用竞争风险和Cox比例风险回归分析进行结局建模。
共识别出51452名（横断面队列）和37027名（纵向队列）患者，其中9.6%为体重正常者。该队列中63.33%为欧洲血统，27.96%为西班牙裔血统，3.45%为非洲血统，2.31%为美洲原住民/阿拉斯加原住民血统。中位随访时间为45.8个月。在调整混杂因素后，与欧洲人相比，西班牙裔和美洲原住民/阿拉斯加原住民患者的肝硬化和DM患病率更高，西班牙裔、非洲裔和美洲原住民/阿拉斯加原住民血统的个体的死亡率以及LREs和DM的发生率更高。与非体重正常患者相比，体重正常患者的死亡率和LREs发生率更高。
与欧洲患者相比，美洲原住民/阿拉斯加原住民、西班牙裔和非洲裔患者的死亡率以及LREs和DM的发生率更高。进一步研究以探索潜在差异并采取干预措施预防体重正常患者尤其是几个种族群体发生LREs，可能会改善临床结局。
