title: Race/ethnic and sex disparities in the non-alcoholic fatty liver disease-abdominal aortic calcification association: The Multi-Ethnic Study of Atherosclerosis.
abstract: This study investigated the associations of non-alcoholic fatty liver disease (NAFLD) and abdominal aortic calcification (AAC) volume and density, and whether these relationships vary by race/ethnicity and/or sex, information that are limited in current literature.
  
  
  
  We studied 1004 adults from the Multi-Ethnic Study of Atherosclerosis to assess the relationship between NAFLD (liver-to-spleen ratio <1) and the following measures of AAC: presence (volume score >0, using Poisson regression); change in volume score (increasing vs. no change, using Poisson regression); and morphology (volume and density score, where volume score >0, using linear regression); and interaction by race/ethnicity and sex.
  
  
  
  Among Blacks, those with NAFLD had greater prevalence for AAC compared to Whites regardless of sex (Prevalence Ratio [PR] = 1.41, CI = 1.15-1.74, p-interaction = 0.02). Concurrent interaction by race/ethnicity and sex was found comparing Chinese and Blacks to Whites (p-interaction = 0.017 and 0.042, respectively) in the association between NAFLD and the prevalence of increasing AAC. Among women, this relationship was inverse among Chinese (PR = 0.59, CI = 0.28-1.27), and positive among Whites (PR = 1.34, CI = 1.02-1.76). This finding was reversed evaluating the men counterpart. Black men also had a positive association (PR = 1.86, CI = 1.29-2.70), which differed from the inverse relationship among White men, and was greater compared to Black women (PR = 1.45, CI = 1.09-1.94). NAFLD was unrelated to AAC morphology.
  
  
  
  NAFLD was related to the presence of AAC, however, limited to Blacks. Significant concurrent interaction by race/ethnicity (Chinese and Blacks vs. Whites) and sex was found in the relationship between NAFLD and increasing AAC. These findings suggest disparities in the pathophysiologic pathways in which atherosclerosis develops.
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA. Electronic address: rremigiobaker@gmail.com.
authors.forename: Rosemay A
authors.initials: RA
authors.lastname: Remigio-Baker
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
authors.forename: Nketi I
authors.initials: NI
authors.lastname: Forbang
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
authors.forename: Cheryl A M
authors.initials: CAM
authors.lastname: Anderson
authors.affiliation: University of California, Los Angeles Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: University of California, San Diego, Department of Pediatrics, La Jolla, CA, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
authors.affiliation: Johns Hopkins Medical Institute, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Johns Hopkins Medical Institute, Women's Cardiovascular Health Center, Baltimore, MD, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.affiliation: University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000208:ethnology*; D001027:Aortography / Q000379:methods; D001213:Asian; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000208:ethnology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000208:ethnology*; D044465:White People
keywords: Abdominal aortic calcification (AAC); MESA; Non-alcoholic fatty liver disease (NAFLD); Race/ethnicity; Sex