Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis
Open accessAbstract
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.Methods 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.Results 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.Conclusions 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.
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A meta-analysis of 34 studies reported that the prevalence and severity of MASLD differs among ethnic groups in the US.
“However, a meta-analysis of 34 studies reported that the prevalence and severity of MASLD differs among ethnic groups in the US.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [71]
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- Authors
- Rich, N. E., Oji, S., Mufti, A. R., Browning, J. D., Parikh, N. D., Odewole, M., Mayo, H., & Singal, A. G.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Singal, Amit G.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 16
- Issue
- 2
- Pages
- 198-210.e2
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC5794571
- OpenAlex
- W2759630103
- Cited by
- 486
- References
- 47
- Citations by year
- 2026: 40 · 2025: 66 · 2024: 87 · 2023: 61 · 2022: 73 · 2021: 62 · 2020: 49 · 2019: 25 · 2018: 18 · 2017: 1
- FWCI
- 3.37
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001105)
- Agency for Healthcare Research and Quality (R24HS022418)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007745)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, racial and ethnic disparities, NAFLD prevalence, nonalcoholic steatohepatitis, liver fibrosis, cirrhosis complications, mortality, Hispanic Americans, African Americans, white, health disparities
- MeSH terms
- Race Factors, Fatty Liver, Humans, Liver Cirrhosis, United States, Prevalence, Survival Analysis, Non-alcoholic Fatty Liver Disease
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