Abstract

Introduction: Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) describes a group of patients with liver fat and metabolic risk factors for liver and cardiac issues. Patients who have significant liver fibrosis are classified as Metabolic dysfunction--Associated Steatohepatitis (MASH) and are at high risk for cirrhosis and hepatocellular carcinoma. This study evaluates racial disparity using a predominantly African American (AA) clinic population. Since weight loss and exercise are cornerstones of MASLD management, we evaluated non-invasive scoring systems for correlating weight changes and its impact on fibrosis.
Methodology: Patients were identified using ICD-10 billing codes and imaging for steatosis or the presence of the metabolic risk factors were confirmed using the medical records. The primary noninvasive fibrosis assessment was the NAFLD Fibrosis Score (NFS).
Results: There were 317 patients with MASLD/MASH seen between 2017 and 2023 with similar numbers for AA (177) and Non-AA (140) patients. Although AA were less likely to develop MASLD, the risk for developing MASH was similar. Regardless of race, NFS scores improved with weight loss and were worse with weight gain.
Discussion: This study confirms that AA are less likely to develop MASLD but are at similar risk for transition from MASLD to MASH. Weight loss correlated with improved fibrosis by NSF scoring regardless of the disease fibrosis or race. Weight gain led to a worsening of fibrosis.
Conclusion: Although the clinic’s population was 80% AA, MASLD/MASH rates among AA were only slightly higher compared to non-AA. However, if AA patients are diagnosed with MASLD, they are at similar risk for developing advanced fibrosis (MASH) as non-AA individuals. Given the similar risk of MASH regardless of race, the importance of referral to GI for evaluation of advanced fibrosis and using NFS as an assessment tool for fibrosis status should be emphasized

Keywords

MASLD, MASH, Fibrosis, NFS, Steatosis, Steatohepatitis, NASLD, NASH African American