{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T15:08:54Z","timestamp":1780758534049,"version":"3.54.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01MD012579"],"award-info":[{"award-number":["R01MD012579"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["S21MD000103"],"award-info":[{"award-number":["S21MD000103"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["U54MD007598"],"award-info":[{"award-number":["U54MD007598"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R24DA017298"],"award-info":[{"award-number":["R24DA017298"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR000124"],"award-info":[{"award-number":["UL1TR000124"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Non-alcoholic fatty liver disease (NAFLD) is spreading worldwide, with a racial\/ethnic disparity. We examined the gender role in the racial\/ethnic difference in NAFLD in the US population. We analyzed data for 3,292 individuals \u226518 years old from NHANES 2017\u20132018, a representative sample of the non-institutionalized adult population in the US. Exclusions were subjects with elevated transferrin level, chronic hepatitis B or C, excessive alcohol use, or prescription medications that might cause hepatic steatosis. NAFLD was diagnosed by FibroScan<jats:sup>\u00ae<\/jats:sup> using controlled attenuation parameter (CAP) values: S0 &amp;lt;238, S1 = 238\u2013259, S2 = 260\u2013290, S3 &amp;gt;290. Data were analyzed using Chi square and multinomial regression. The overall prevalence of NAFLD was 47.9% [S2 = 16.1%, and S3 = 31.8%]. The prevalence of S3 was highest among Mexican Americans (46%), lowest among Blacks (22.7%), 29.9% in other Hispanics and 32.1% in Whites (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). It was higher among Mexican American males (54.1%) compared to Mexican American females (37.7%) (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). In the adjusted model, Mexican Americans were two times more likely than Whites to have S2 and S3 (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). Only male Mexican Americans had higher odds of S2 and S3 relative to male White (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). Males had higher odds of S3 relative to non-menopausal females (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). There was no difference in the odds of S2 or S3 NAFLD among the menopausal females with or without hormone therapy relative to non-menopausal females (<jats:italic>p<\/jats:italic> &amp;gt; 0.05). While Mexican Americans had the highest prevalence of severe NAFLD relative to the other racial\/ethnic groups, only male Mexican Americans, but not females, had higher likelihood of both moderate and severe NAFLD relative to Whites. Interventions that specifically target Mexican American males are needed to increase awareness about NAFLD and its prevention.<\/jats:p>","DOI":"10.3389\/fmed.2021.795421","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T08:51:55Z","timestamp":1638435115000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":28,"title":["Sex-Specific Differences in the Association Between Race\/Ethnicity and NAFLD Among US Population"],"prefix":"10.3389","volume":"8","author":[{"given":"Magda","family":"Shaheen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina M.","family":"Schrode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deyu","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dulcie","family":"Kermah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishwajeet","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Zarrinpar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Elisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia M.","family":"Najjar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore C.","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.cgh.2017.09.041","article-title":"Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the united states: a systematic review and meta-analysis","volume":"16","author":"Rich","year":"2018","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.jhep.2018.10.033","article-title":"Non-alcoholic fatty liver disease - a global public health perspective","volume":"70","author":"Younossi","year":"2019","journal-title":"J Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1111\/apt.13012","article-title":"Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey","volume":"41","author":"Ruhl","year":"2015","journal-title":"Aliment Pharmacol Ther."},{"key":"B4","first-page":"603","article-title":"Nonalcoholic fatty liver disease: common questions and answers on diagnosis and management","volume":"102","author":"Westfall","year":"2020","journal-title":"Am Fam Phys."},{"key":"B5","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1053\/j.gastro.2014.11.039","article-title":"Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States","volume":"148","author":"Wong","year":"2015","journal-title":"Gastroenterology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1002\/hep.28785","article-title":"The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"B7","first-page":"661","article-title":"Noninvasive diagnosis of NASH and liver fibrosis within the spectrum of NAFLD","volume":"8","author":"Alkhouri","year":"2012","journal-title":"Gastroenterol Hepatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.jhep.2011.08.002","article-title":"Touching some firm ground in the epidemiology of NASH","volume":"56","author":"Ratziu","year":"2012","journal-title":"J Hepatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/j.jhep.2016.07.033","article-title":"NAFLD and liver transplantation: current burden and expected challenges","volume":"65","author":"Pais","year":"2016","journal-title":"J Hepatol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/j.metabol.2016.01.010","article-title":"Nonalcoholic fatty liver disease and hepatocellular carcinoma","volume":"65","author":"Zoller","year":"2016","journal-title":"Metab Clin Exp."},{"key":"B11","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1053\/gast.2001.25540","article-title":"Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese","volume":"121","author":"Dixon","year":"2001","journal-title":"Gastroenterology."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.3390\/jcm10061161","article-title":"Natural history of NAFLD","volume":"10","author":"Pais","year":"2021","journal-title":"J Clin Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1001\/jama.2015.5370","article-title":"Nonalcoholic fatty liver disease: a systematic review","volume":"313","author":"Rinella","year":"2015","journal-title":"JAMA."},{"key":"B14","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1111\/j.1365-2036.2011.04724.x","article-title":"Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon","year":"2011","journal-title":"Aliment Pharmacol Therap"},{"key":"B15","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1002\/cld.948","article-title":"Racial disparities in diagnosis and prognosis of nonalcoholic fatty liver disease","volume":"16","author":"Samji","year":"2020","journal-title":"Clin Liver Dis"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1775","article-title":"Reassessment of the Hispanic disparity: hepatic steatosis is more prevalent in Mexican Americans than other Hispanics","author":"Shaheen","year":"2021","journal-title":"Hepatol Commun"},{"key":"B17","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1038\/ijo.2017.309","article-title":"Protective effect of black relative to white race against non-alcoholic fatty liver disease in patients with severe obesity, independent of type 2 diabetes","volume":"42","author":"Browning","year":"2018","journal-title":"Int J Obes."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1038\/ng.257","article-title":"Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease","volume":"40","author":"Romeo","year":"2008","journal-title":"Nat Genet."},{"key":"B19","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1038\/ng.2901","article-title":"Exome-wide association study identifies a TM6SF2 variant that confers susceptibility to nonalcoholic fatty liver disease","volume":"46","author":"Kozlitina","year":"2014","journal-title":"Nat Genet."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1053\/j.gastro.2016.01.032","article-title":"The MBOAT7-TMC4 variant rs641738 increases risk of nonalcoholic fatty liver disease in individuals of European descent","volume":"150","author":"Mancina","year":"2016","journal-title":"Gastroenterology."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1007\/s10620-016-4143-0","article-title":"Global epidemiology of nonalcoholic fatty liver disease and perspectives on us minority populations","volume":"61","author":"Sherif","year":"2016","journal-title":"Digest Dis Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1002\/hep.21580","article-title":"Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: a national study","volume":"45","author":"Nguyen","year":"2007","journal-title":"Hepatology."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2042","DOI":"10.1111\/j.1572-0241.2003.07659.x","article-title":"The natural history of nonalcoholic fatty liver disease: a clinical histopathological study","volume":"98","author":"Harrison","year":"2003","journal-title":"Am J Gastroenterol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","article-title":"EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease","volume":"64","year":"2016","journal-title":"J Hepatol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"274","DOI":"10.4254\/wjh.v6.i5.274","article-title":"Gender and racial differences in nonalcoholic fatty liver disease","volume":"6","author":"Pan","year":"2014","journal-title":"World J Hepatol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1002\/hep.23784","article-title":"Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease","volume":"52","author":"NASH Clinical Research","year":"2010","journal-title":"Hepatology."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1002\/hep.20466","article-title":"Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity","volume":"40","author":"Browning","year":"2004","journal-title":"Hepatology."},{"key":"B28","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.cgh.2014.08.037","article-title":"Prevalence of suspected nonalcoholic fatty liver disease in Hispanic\/Latino individuals differs by heritage","volume":"13","author":"Kallwitz","year":"2015","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"572490","DOI":"10.3389\/fendo.2020.572490","article-title":"Non-alcoholic fatty liver disease as a canonical example of metabolic inflammatory-based liver disease showing a sex-specific prevalence: relevance of estrogen signaling","volume":"11","author":"Della Torre","year":"2020","journal-title":"Front Endocrinol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e13236","DOI":"10.1111\/eci.13236","article-title":"Macrophages in the pathophysiology of NAFLD: the role of sex differences","volume":"50","author":"Ministrini","year":"2020","journal-title":"Eur J Clin Investig."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1002\/hep.30626","article-title":"Sex differences in nonalcoholic fatty liver disease: state of the art and identification of research gaps","volume":"70","author":"Lonardo","year":"2019","journal-title":"Hepatology."},{"key":"B32","doi-asserted-by":"publisher","first-page":"51","DOI":"10.37349\/emed.2020.00005","article-title":"Sex differences in non-alcoholic fatty liver disease: hints for future management of the disease","volume":"1","author":"Salvoza","year":"2020","journal-title":"Explor Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"164","DOI":"10.21037\/hbsn.2018.12.04","article-title":"Nonalcoholic fatty liver disease: does sex matter?","volume":"8","author":"Lonardo","year":"2019","journal-title":"Hepatobiliary Surg Nutr."},{"key":"B34","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.aohep.2019.04.012","article-title":"Gender-specific differences in clinical and metabolic variables associated with NAFLD in a Mexican pediatric population","volume":"18","author":"Villanueva-Ortega","year":"2019","journal-title":"Ann Hepatol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1053\/gast.2003.50004","article-title":"Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States","volume":"124","author":"Ruhl","year":"2003","journal-title":"Gastroenterology."},{"key":"B36","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1111\/j.1572-0241.2003.07486.x","article-title":"The prevalence and etiology of elevated aminotransferase levels in the United States","volume":"98","author":"Clark","year":"2003","journal-title":"Am J Gastroenterol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1093\/aje\/kws448","article-title":"Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988\u20131994","volume":"178","author":"Lazo","year":"2013","journal-title":"Am J Epidemiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1002\/oby.20426","article-title":"Racial differences in nonalcoholic fatty liver disease in the U.S. population","volume":"22","author":"Schneider","year":"2014","journal-title":"Obesity."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1016\/j.cgh.2020.08.017","article-title":"Prevalence of fatty liver disease and fibrosis detected by transient elastography in adults in the United States, 2017\u20132018","volume":"19","author":"Kim","year":"2021","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"e0252164","DOI":"10.1371\/journal.pone.0252164","article-title":"Prevalence and factors associated with NAFLD detected by vibration controlled transient elastography among US adults: Results from NHANES 2017\u20132018","volume":"16","author":"Zhang","year":"2021","journal-title":"PLoS ONE."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10620-021-07124-w","article-title":"Metabolic risk profiles for hepatic steatosis differ by race\/ethnicity: an elastography-based study of US adults","author":"Zhou","year":"2021","journal-title":"Dig Dis Sci."},{"key":"B42","doi-asserted-by":"publisher","first-page":"237","DOI":"10.3748\/wjg.v18.i3.237","article-title":"Aging is a risk factor of nonalcoholic fatty liver disease in premenopausal women","volume":"18","author":"Hamaguchi","year":"2012","journal-title":"World J Gastroenterol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1097\/GME.0000000000000352","article-title":"Prevalence of nonalcoholic fatty liver disease and its metabolic risk factors in women of different ages and body mass index","volume":"22","author":"Wang","year":"2015","journal-title":"Menopause."},{"key":"B44","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s00330-010-1905-5","article-title":"The diagnostic accuracy of US, CT, MRI and 1 H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis","volume":"21","author":"Bohte","year":"2011","journal-title":"Eur Radiol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.795421\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T08:52:01Z","timestamp":1638435121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.795421\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,2]]},"references-count":44,"alternative-id":["10.3389\/fmed.2021.795421"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.795421","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,2]]},"article-number":"795421"}}