P0986 - Racial Disparities in Extrahepatic Manifestations Among NAFLD Patients

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD, Thabet Qapaja, MD, Osama Hamid, MD, MRCPI, Muaz Alsabbagh, MD, Talal Sarmini, MD, Jamile Wakim-Fleming, MD
Cleveland Clinic, Cleveland, OH

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) has become a significant health care burden with a significant. racial disparity in its prevalence in the United States. NAFLD is associated with several extrahepatic manifestations, but there is limited knowledge on racial disparities of extrahepatic manifestations of NAFLD. We aim to examine the prevalence and the association between race and extrahepatic manifestations of NAFLD patients among adults in the United States.

Methods: We conducted a retrospective cohort study using the TrinNetX database, a multi-institutional database. The study included all adult patients aged 18 years or older diagnosed with NAFLD, the study population was divided into two groups based on White and Black race. Data on extrahepatic manifestations was gathered. We excluded patients with alcoholic liver disease, drug induced liver injury, autoimmune hepatitis, viral hepatitis and cirrhosis. We employed 1:1 propensity score matching for age, gender, tobacco use, obesity, diabetes and alcohol abuse.

Results: Following matching, 87,433 patients White and Black with NAFLD were included. Black males with prediabetes or diabetes had the highest prevalence of severe NAFLD relative to other racial/ethnic groups (p < 0.05). Black patients with NAFLD were at higher risk of having chronic kidney disease (CKD), sarcopenia, heart failure, ischemic heart disease and gastric cancer when compared with white. We also found that Black patients with NAFLD were less likely to have anxiety, depression, hypothyroidism, osteoporosis, psoriasis, esophageal cancer and HCC. There was no significant difference in having obstructive sleep apnea (OSA), pancreatic cancer and colon cancer.

Discussion: We found significant racial disparities in extrahepatic manifestations between Black and White patients with NAFLD in the United States. This racial disparity may be related to genetic, biological, and environmental factors. Black patients with NAFLD had higher odds of gastric cancer, CKD, IHD and sarcopenia. Healthcare providers should pay attention to the racial disparities in extrahepatic manifestations of NAFLD patients.

Figure: Figure 1: Racial disparities in extrahepatic manifestations in Blacks vs Whites patients with NAFLD after propensity score matching. Odds ratio represents odds of Blacks with NAFLD compared to odds of Whites with NAFLD. Abbreviations: OR: odds ratio, CI: confidence interval, CKD:chronic kidney disease, OSA: obstructive sleep apnea, COPD: chronic obstructive pulmonary disease, GAD: general anxiety disorder, HCC: Hepatocelluliar carcinoma, MI: myocardial infarction, HF: heart failure.

Demographics	Before propensity score matching			After propensity score matching
	Black with NAFLD (87,434)	White with NAFLD (678,618)	P value	Black with NAFLD (87,433)	White with NAFLD (87,433)	P value
Age	50.7 +/- 14.7	52.1 +/- 15.6	< 0.001	50.7 +/- 14.7	50.6 +/- 14.7	0.819
Female	54,020	370,516	< 0.001	54,019 (61.8%)	54,013 (61.8%)	0.976
Male	33,411	308,063	< 0.001	33,411 (38.2%)	33,416 (38.2%)	0.980
Comorbidities
Tobacco use	4,938 (5.6%)	23,869 (3.5%)	< 0.001	4,937 (5.6%)	4,788 (5.5%)	0.120
Alcohol abuse	5,724 (6.5%)	26,005 (3.8%)	< 0.001	5,723 (6.5%)	5,597 (6.4%)	0.221
BMI 30-39	10,910 (12.5%)	72,933 (10.7%)	< 0.001	10,910 (12.5%)	10,737 (12.3%)	0.209
BMI >40	11,014 (12.6%)	49,691 (7.3%)	< 0.001	11,014 (12.6%)	10,979 (12.6%)	0.801
HTN	47,754 (54.6%)	277,804 (40.9%)	< 0.001	47,753 (54.6%)	47,845 (54.7%)	0.659
HLD	31,658 (36.2%)	252,335 (37.2%)	< 0.001	31,658 (36.2%)	31,566 (36.1%)	0.647
DM	27,989 (32%)	143,875 (21.2%)	< 0.001	27,988 (32%)	28,008 (32%)	0.918

Table: Table 1: Comparison of Demographic Parameters between Blacks vs Whites patients with Non-alcoholic Fatty Liver Disease (NAFLD) before and after propensity score matching. Abbreviations: HTN: Hypertension; HLD: Hyperlipidemia; DM: Diabetes Mellitus.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Thabet Qapaja indicated no relevant financial relationships.

Osama Hamid indicated no relevant financial relationships.

Muaz Alsabbagh indicated no relevant financial relationships.

Talal Sarmini indicated no relevant financial relationships.

Jamile Wakim-Fleming indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi, MD, Thabet Qapaja, MD, Osama Hamid, MD, MRCPI, Muaz Alsabbagh, MD, Talal Sarmini, MD, Jamile Wakim-Fleming, MD. P0986 - Racial Disparities in Extrahepatic Manifestations Among NAFLD Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.