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. 2024 Jul 25;12(15):1478.
doi: 10.3390/healthcare12151478.

Manifestation and Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease in a Predominately African American Population at a Multi-Specialty Healthcare Organization

Astha Saini  1 , Brian Rutledge  1 , Anirudh R Damughatla  1 , Mina Rasheed  1 , Paul Naylor  1 , Milton Mutchnick  1
Affiliations

Manifestation and Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease in a Predominately African American Population at a Multi-Specialty Healthcare Organization

Astha Saini et al. Healthcare (Basel). .

Abstract

African Americans (AA) have a high incidence of risk factors associated with MASLD (metabolic dysfunction-associated steatotic liver disease); the AA population has a lower incidence of MASLD and MASH (metabolic-associated steatotic hepatitis) than Caucasian and Hispanic Americans (non-AA). We investigated if underlying risk factor variation between AA and non-AA individuals could provide a rationale for the racial diversity seen in MASLD/MASH. Using ICD-10 codes, patients from 2017 to 2020 with MASLD/MASH were identified and confirmed to have either MASLD or MASH. Despite the large (>80%) AA population in our clinics, only 54% of the MASLD/MASH patients were African American. When the non-invasive NAFLD Fibrosis Scores (NFS) evaluated at early diagnosis were compared to the most recent values, the only increase in fibrosis score by NFS over time was in non-AA MASH patients. The increase in fibrosis only in non-AA MASLD patients is consistent with racial disparity in the disease progression in non-AA as compared to AA patients. Even with the large proportion of AA patients in our study, there was no significant racial disparity in the earliest assessment of either risk factors, laboratory values, or fibrosis scores that would account for racial disparity in the development and progression of MASLD.

Keywords: MASH; MASLD; non-invasive serum markers; racial disparity in NASH/NAFLD; risk factors in NASH/NAFLD.

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Conflict of interest statement

The authors have no conflicts of interest with respect to the manuscript.

Figures

Figure 1
Figure 1
Criteria used for non-invasive testing of liver fibrosis.
Figure 2
Figure 2
Ratio for MASLD to MASH by race and gender. The primary racial disparity was that MASH was incorrectly diagnosed primarily in AA males (p < 0.0009). Note that the diagnosis codes were based on the physician interpretation of NAFLD vs. NASH since the newly recommended nomenclature has not yet been adopted by the ICD-10 coding system.
Figure 3
Figure 3
Four non-invasive markers of fibrosis were evaluated for utility in differentiating between patients with steatosis and minimal fibrosis (MASLD) and those with significant fibrosis (MASH). With respect to average, all four were greater in MASH as compared to MASLD but there was significant overlap with respect to individual values.
Figure 4
Figure 4
Change in fibrosis by three non-invasive assessment in MASLD/MASH patients. NAFLD Fibrosis Score increased over time in MASLD/MASH patients. Non-AA MASH patients had the largest increase over time (p = 0.004 using pair-wise analysis). The racial difference in fibrosis progression in MASH patients was also found in APRI and FIB-4 fibrosis.
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