Abstract P236: Sex and Race/ethnic Disparities in the Non-alcoholic Fatty Liver Disease-abdominal Aortic Calcification Association: The Multi-Ethnic Study of Atherosclerosis
Authors: Remigio-Baker Rosemay A , Allison Matthew A , Criqui Michael H , Forbang Nketi I , Loomba Rohit , Anderson Cheryl A , Budoff Matthew , Schwimmer Jeffrey , Blumenthal Roger S , Ouyang Pamela 
Published: July 2021

Introduction:
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the US and is associated with subclinical atherosclerosis; however, it is not known whether this association differs by sex or race/ethnicity. In this regard, the prevalence of NAFLD among postmenopausal women is higher than that in older men, and Blacks have a lower prevalence of NAFLD compared to Whites. Given this, we determined the association between NAFLD and abdominal aortic calcification (AAC), a validated measure of aortic atherosclerosis, and whether any associations varied by sex or race/ethnicity.

Methods:
We studied 1,004 adults enrolled in the Multi-Ethnic Study of Atherosclerosis to assess the relationship between NAFLD (defined as a liver-to-spleen ratio <1) and the following measures of AAC: 1) presence or absence (based on volume score >0 or =0, respectively, using Poisson regression with robust error variance); 2) morphology (volume and density score, where volume score > 0; using linear regression); and 3) change in volume score over time (average follow-up=3.2 years, categorized as increasing or no change; using Poisson regression with robust error variance). Separate assessment for interaction by sex or race/ethnicity was conducted. We adjusted for socio-demographic factors, health behaviors, comorbidities, medication use, c-reactive protein, lipids, and measures of adiposity.

Results:
NAFLD and AAC Volume (presence/absence): Among women, those with NAFLD had 13% greater prevalence for AAC versus those without NAFLD (CI=1.003, 1.27), which was different from the null association found among men (Prevalence Ratio [PR]=1.00, CI=0.87, 1.15; interaction p=0.20). Among Blacks, NAFLD was associated with a 41% greater prevalence of AAC (CI=1.15, 1.74), which was statistically different from the null association found among Whites (PR=1.02, CI=0.90, 1.17; interaction p =0.01). NAFLD and AAC Morphology: NAFLD was not related to AAC volume or density score when volume score > 0. NAFLD and Change in AAC Volume: Among women, those with NAFLD at baseline were 35% more likely to have an increasing AAC volume compared to those without NAFLD at baseline (CI=1.10, 1.65), which was statistically different from the null association found among men (PR=0.79, CI=0.52, 1.19; interaction p=0.02). Among Blacks, those with NAFLD at baseline were 51% more likely to have increasing AAC volume compared to those without NAFLD at baseline (CI=1.17, 1.95; interaction p [Blacks vs. Whites]=0.02). In all analyses, null associations were found for other race/ethnic groups.

Conclusion:
Our study found that the association between NAFLD and measures of AAC varied by sex and race/ethnicity with positive relationships found only among women and Blacks. Future studies are needed to elucidate the mechanisms by which the association between NAFLD and AAC may differ by sex or race/ethnicity.