Díaz Luis Antonio, Lazarus Jeffrey V, Fuentes-López Eduardo, Idalsoaga Francisco, Ayares Gustavo, Desaleng Hailemichael, Danpanichkul Pojsakorn, Cotter Thomas G, Dunn Winston, Barrera Francisco, Wijarnpreecha Karn, Noureddin Mazen, Alkhouri Naim, Singal Ashwani K, Wong Robert J, Younossi Zobair M, Rinella Mary E, Kamath Patrick S, Bataller Ramon, Loomba Rohit, Arrese Marco, Arab Juan Pablo
MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA, USA.
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Commun Med (Lond). 2024 Oct 29;4(1):219. doi: 10.1038/s43856-024-00649-x.
The 2023 nomenclature defined criteria for steatotic liver disease (SLD), including metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and the overlapping MASLD/ALD (MetALD). We aimed to assess racial and ethnic disparities in the SLD prevalence among United States (US) adults based on this new nomenclature.
We undertook a cross-sectional study employing the 2017-2018 National Health and Nutrition Examination Survey (NHANES) database. We identified SLD according to a controlled attenuation parameter ≥288 dB/m, liver stiffness ≥7.2 kPa, or elevated aminotransferase levels. Alcohol use thresholds were established according to the updated SLD definition. We estimated prevalences using the complex design of the NHANES survey. Multivariable logistic regressions with complex design weights were employed.
A total of 5532 individuals are included. The mean age is 45.4 years, and 50.9% are women. The adjusted estimated prevalence of MASLD is 42.4% (95% CI: 41.1-43.8%), MetALD 1.7% (95% CI: 1.3-2.0%), and ALD 0.6% (95% CI: 0.3-0.8%). Hispanics exhibit a higher prevalence of SLD, but there are no significant differences in advanced fibrosis prevalence due to SLD among racial/ethnic groups. In MASLD, men, individuals aged 40-64 and ≥65 years, Hispanics, those with health insurance, higher BMI, diabetes, hypertension, hypertriglyceridemia, and low high-density lipoprotein (HDL) cholesterol or use of lipid-lowering agents are independently associated with a higher risk, while Blacks have the lowest risk. In MetALD, men and higher BMI are independently associated with a higher risk of MetALD in adjusted multivariable analysis. In ALD, the adjusted multivariable analysis shows that only health insurance is independently associated with a lower ALD risk.
MASLD prevalence is high in the US, especially in men, older individuals, and Hispanics. MetALD and ALD prevalence was substantial but could be underestimated.
2023年的命名法定义了脂肪性肝病（SLD）的标准，包括代谢功能障碍相关的SLD（MASLD）、酒精性肝病（ALD）以及重叠的MASLD/ALD（MetALD）。我们旨在基于这一新的命名法评估美国成年人中SLD患病率的种族和民族差异。
我们采用2017 - 2018年国家健康与营养检查调查（NHANES）数据库进行了一项横断面研究。我们根据受控衰减参数≥288 dB/m、肝脏硬度≥7.2 kPa或转氨酶水平升高来确定SLD。根据更新后的SLD定义确定饮酒阈值。我们使用NHANES调查的复杂设计来估计患病率。采用了带有复杂设计权重的多变量逻辑回归分析。
共纳入5532人。平均年龄为45.4岁，女性占50.9%。经调整后的MASLD估计患病率为42.4%（95%置信区间：41.1 - 43.8%），MetALD为1.7%（95%置信区间：1.3 - 2.0%），ALD为0.6%（95%置信区间：0.3 - 0.8%）。西班牙裔的SLD患病率较高，但种族/民族群体中因SLD导致的晚期纤维化患病率没有显著差异。在MASLD中，男性、40 - 64岁及≥65岁的个体、西班牙裔、有医疗保险者、较高的体重指数、糖尿病、高血压、高甘油三酯血症以及低高密度脂蛋白（HDL）胆固醇或使用降脂药物者独立地与较高风险相关，而黑人风险最低。在MetALD中，经调整的多变量分析显示男性和较高的体重指数独立地与MetALD的较高风险相关。在ALD中，经调整的多变量分析表明只有医疗保险与较低的ALD风险独立相关。
在美国，MASLD患病率很高，尤其是在男性、老年人和西班牙裔中。MetALD和ALD的患病率相当，但可能被低估。
