title: Ethnic and sex differences in fatty liver on cardiac computed tomography: the multi-ethnic study of atherosclerosis.
abstract: OBJECTIVE
  To describe ethnic and sex differences in the prevalence and determinants of fatty liver in a multiethnic cohort.
  
  
  METHODS
  We studied participants of the Multi-Ethnic Study of Atherosclerosis who underwent baseline noncontrast cardiac computed tomography between July 17, 2000, and August 29, 2002, and had adequate hepatic and splenic imaging for fatty liver determination (n=4088). Fatty liver was defined as a liver/spleen attenuation ratio of less than 1. We compared the prevalence and severity of fatty liver, in 4 ethnicities (white, Asian, African American, and Hispanic), and the factors associated with fatty liver in each ethnicity, stratifying by obesity and metabolic syndrome. Multivariable ordinal logistic regression was used to determine the effect of cardiometabolic risk factors on the prevalence of fatty liver in different ethnicities.
  
  
  RESULTS
  The prevalence of fatty liver varied significantly by ethnicity (African American, 11%; white, 15%; Asian, 20%; and Hispanic, 27%; P<.001). Although African Americans had the highest prevalence of obesity, a smaller percentage of obese African Americans received a diagnosis of fatty liver than did other ethnicities (African American, 17%; white, 31%; Asian, 37%; and Hispanic 39%; P<.001). Hispanics had the highest prevalence of fatty liver, including the obese and metabolic syndrome population. An increase in insulin resistance predicted a 2-fold increased prevalence of fatty liver in all ethnicities after multivariable adjustment.
  
  
  CONCLUSIONS
  African Americans have a lower prevalence and Hispanics have a higher prevalence of fatty liver than do other ethnicities. There are distinct ethnic variations in the prevalence of fatty liver even in patients with the metabolic syndrome or obesity, suggesting that genetic factors may play a substantial role in the phenotypic expression of fatty liver.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Department of Cardiology, Danbury Hospital, Danbury, CT.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Tota-Maharaj
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.affiliation: University of Washington, Seattle.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Center for Prevention and Wellness Research, Baptist Health Medical Group, Florida International University, Miami, FL; Department of Medicine, Herbert Wertheim College of Medicine, and Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL. Electronic address: knasir1@jhmi.edu.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000235:genetics / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000473:pathology; D015331:Cohort Studies; D005006:Ethnicity / Q000235:genetics / Q000706:statistics & numerical data*; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000473:pathology; D005260:Female; D006630:Hispanic or Latino / Q000235:genetics / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000208:ethnology / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States / Q000453:epidemiology; D044465:White People / Q000235:genetics / Q000706:statistics & numerical data