Prevalence of Metabolic Dysfunction–Associated Steatotic Liver Disease in African Immigrants Is High but Hepatic Fibrosis Is Low: Implications for Developing Strategies for Better Health

Introduction and Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease globally and is linked to obesity and diabetes. MASLD can progress to hepatic fibrosis, cancer and premature death. As metabolic risk is increasing in Africa and the United States, African immigrants may be at high risk. Yet, prevalence and risk for MASLD in African immigrants are unknown; so we determined the prevalence of MASLD and associated risk factors in African immigrants. Methods: MASLD was evaluated in 515 African immigrants (female 37% (189/515), age 41±10y, BMI 28±4.5 kg/m2) who immigrated as adults and reported consuming <7 alcoholic drinks/week. MASLD was diagnosed if hepatic steatosis index >36 and at least one metabolic syndrome parameter was present. Hepatic fibrosis was defined by FIB4≥1.3. Glucose tolerance was assessed by OGTT, insulin resistance by Matsuda index, and poor sleep quality by Pittsburgh Sleep Quality Index (PSQI)>5. Statistical tests were: chi-squared and modified Poisson regressions with robust variance identified independent correlates. Results: MASLD prevalence was 54% (278/515), higher in women than men (61% (115/189) vs 49% 160/326), P<0.01) and increased across glucose tolerance categories (normal: 43% (131/302); prediabetes: 64% (114/178); diabetes: 91% (32/35), P<0.01). Hepatic fibrosis prevalence was 16% (80/515) and did not differ by glucose tolerance status. MASLD was independently associated with insulin resistance (adjusted prevalence ratio [aPR] 1.61, P<0.01), female sex (aPR 1.42, P<0.01), older age (aPR 1.03, P<0.01), weight gain (aPR 1.02, P<0.01), shorter U.S residence (aPR 0.98, P=0.04), poor sleep quality trended towards significance (aPR 1.24, P=0.06). Conclusion: MASLD was common in African immigrants but the prevalence of hepatic fibrosis was low. Especially in women, preventing postmigration weight gain and improving sleep quality may reduce risk of MASLD. Disclosure: K. Ntabadde: None. G. Smith: None. C. DuBose: None. A. Sumner: None.