title: Epidemiology of NAFLD and Type 2 Diabetes: Health Disparities Among Persons of Hispanic Origin.
abstract: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition in the USA and worldwide and affects Hispanics disproportionally. In this review, we aim to document and contrast the epidemiology of NAFLD and type 2 diabetes, provide a framework to study health disparities in NAFLD in Hispanic populations, and identify points of action within the health care system to tackle these health disparities. NAFLD shares many common risk factors with type 2 diabetes, specially obesity and insulin resistance, but shows different prevalence patterns by ethnicity: while Hispanics are disproportionately affected by both NAFLD and type 2 diabetes, non-Hispanic black populations have a low prevalence of NAFLD. The current literature suggests a strong role of polymorphisms in the PNPLA3 gene and potential interactions with environmental factors in the pathogenesis of NAFLD. However, given potential interactions and the shared risk factors with type 2 diabetes, a health disparity approach that acknowledges upstream determinants is needed. Solutions to these determinants can also be found in the health system. The role of interventions that have shown efficacy in type 2 diabetes, like community health workers, may be implemented to prevent and control NAFLD.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mlazo@jhu.edu.|The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, 2024 E. Monument Street 2-615, Baltimore, MD, 21205, USA. mlazo@jhu.edu.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W6604, Baltimore, MD, 21205, USA. mlazo@jhu.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, 2024 E. Monument Street 2-615, Baltimore, MD, 21205, USA. ubilal@jhmi.edu.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W6604, Baltimore, MD, 21205, USA. ubilal@jhmi.edu.
authors.forename: Usama
authors.initials: U
authors.lastname: Bilal
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, 135 College St. (Suite 200), New Haven, CT, 06510, USA. rafael.perez-escamilla@yale.edu.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perez-Escamilla
mesh_terms: D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D006630:Hispanic or Latino; D006801:Humans; D007333:Insulin Resistance; D065626:Non-alcoholic Fatty Liver Disease / Q000208:ethnology*; D009765:Obesity; D015995:Prevalence; D012307:Risk Factors
keywords: Epidemiology; Health disparities; Hispanics; Non-alcoholic fatty liver disease; PNPLA3; Type 2 diabetes