Trends in the Racial and Ethnic Disparity and Predictors of Hepatic Steatosis: Data From NHANES III and NHANES 2017–2018

Hepatic steatosis is a serious problem worldwide and it affects Hispanics at a higher rate than Blacks. This disparity is an important public health problem. The purpose of this study was to examine the trend in the racial/ethnic disparity of hepatic steatosis among a representative sample of the U.S. adult ≥20 years old in two time-periods. Data from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 2017–2018 were analyzed. The sample size in the two respective cycles was 13,910 and 5,492 respectively. Hepatic steatosis in NHANES III was diagnosed using ultrasound while in NHANES 2017–2018, fibroscan was used. We analyzed the data using bivariate Chi square, and multiple logistic regression to adjusting for confounding variables and considering the design and sample weights. In both time-periods, Mexican American had the highest prevalence of hepatic steatosis (28% in NHANES III and 43% in NHANES 2017–2018) compared to the other racial/ethnic groups (p<0.05). In the adjusted logistic regression model, relative to the white population, Mexican-Americans had 40% higher odds of hepatic steatosis in NHANES III (adjusted odds ratio [AOR]=1.4, 95% confidence level [CL]=1.1–1.9, p<0.05) and 200% higher odds of hepatic steatosis in NHANES 2017–2018 (AOR=2.0, 95% CL=1.3–3.1, p<0.05). The common predictors of hepatic steatosis in the two time periods were gender, high waist-to-hip ratio, borderline and high levels of triglyceride, and prediabetes and diabetes as diagnosed by HbA1c (p<0.05). For CRP, independent of the method used, mild and significant inflammation were predictors of hepatic steatosis (p<0.05). In NHANES 2017–2018, participants ≥ 65 years (compared to 20–34 years of age) and Blacks (relative to Whites) had a lower chance of hepatic steatosis in the adjusted regression model (p<0.05), and those inactive (relative to those who met the physical activity guideline) had a higher chance of hepatic steatosis (p<0.05). The increased prevalence of hepatic steatosis in 2017–2018 compared to 1988–1994, may be related to the obesity epidemic, although differences in methodological factors may also play a role. Our study indicated that the racial/ethnic disparity in hepatic steatosis especially among Mexican American persisted over time. Future work is needed to explore the persistence of the racial/ethnic disparity of hepatic steatosis and its underlying mechanisms.