Race/ethnic and sex disparities in the non-alcoholic fatty liver disease-abdominal aortic calcification association: The Multi-Ethnic Study of Atherosclerosis

Rosemay A. Remigio-Baker, Matthew A. Allison, Nketi I. Forbang, Rohit Loomba, Cheryl A.M. Anderson, Matthew Budoff, Jeffrey B. Schwimmer, Roger S. Blumenthal, Pamela Ouyang, Michael H. Criqui

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background and aims 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
StatePublished - Mar 1 2017


  • Abdominal aortic calcification (AAC)
  • MESA
  • Non-alcoholic fatty liver disease (NAFLD)
  • Race/ethnicity
  • Sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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