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. 2021 Oct 28;10(21):5019.
doi: 10.3390/jcm10215019.

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Mar Talens  1 , Natalia Tumas  1   2   3 , Jeffrey V Lazarus  4 , Joan Benach  1   2   5 , Juan M Pericàs  1   2   6   7
Affiliations

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Mar Talens et al. J Clin Med. .

Abstract

With prevalence high and rising given the close relationship with obesity and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is progressively becoming the most common chronic liver condition worldwide. However, little is known about the health inequalities in NAFLD distribution and outcomes. This review aims to analyze health inequalities in NAFLD distribution globally and to assess the health disparities in NAFLD-related outcomes. We conducted a scoping review of global health inequalities in NAFLD distribution and outcomes according to gender/sex, ethnicity/race, and socioeconomic position from PubMed's inception to May 2021. Ultimately, 20 articles were included in the review, most (75%) of them carried out in the United States. Males were found to have a higher NAFLD prevalence (three articles), while available evidence suggests that women have an overall higher burden of advanced liver disease and complications (four articles), whereas they are less likely to be liver-transplanted once cirrhosis develops (one article). In the US, the Hispanic population had the highest NAFLD prevalence and poorer outcomes (seven articles), whereas Whites had fewer complications than other ethnicities (two articles). Patients with low socioeconomic status had higher NAFLD prevalence (four articles) and a higher likelihood of progression and complications (five articles). In conclusion, globally there is a lack of studies analyzing NAFLD prevalence and outcomes according to various axes of inequality through joint intersectional appraisals, and most studies included in our review were based on the US population. Available evidence suggests that NAFLD distribution and outcomes show large inequalities by social group. Further research on this issue is warranted.

Keywords: health inequalities; non-alcoholic fatty liver disease; social determinants of health.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of studies disposition throughout the search and article selection process according to PRISMA guidelines for scoping reviews [18].
See this image and copyright information in PMC

References

    1. Argo C.K., Caldwell S.H. Epidemiology and Natural History of Non-Alcoholic Steatohepatitis. Clin. Liver Dis. 2009;13:511–531. doi: 10.1016/j.cld.2009.07.005. - DOI - PubMed
    1. Dietrich P., Hellerbrand C. Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Pract. Res. Clin. Gastroenterol. 2014;28:637–653. doi: 10.1016/j.bpg.2014.07.008. - DOI - PubMed
    1. Fouad Y., Waked I., Bollipo S., Gomaa A., Ajlouni Y., Attia D. What’s in a name? Renaming ‘NAFLD’ to ‘MAFLD’. Liver Int. 2020;40:1254–1261. doi: 10.1111/liv.14478. - DOI - PubMed
    1. Younossi Z., Anstee Q.M., Marietti M., Hardy T., Henry L., Eslam M., George J., Bugianesi E. Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention. Nat. Rev. Gastroenterol. Hepatol. 2018;15:11–20. doi: 10.1038/nrgastro.2017.109. - DOI - PubMed
    1. Powell E.E., Wong V.W., Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;6736:1–13. - PubMed

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