Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

doi:10.3748/wjg.v24.i37.4281

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Oct 7, 2018; 24(37): 4281-4290
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4281

Table 1 Socio-demographic characteristics of the study sample n (%)

	Male			P value¹		Female			P value¹
	Mexico cohort (REF)	NHANES Mexico born	NHANES US born	Mexico born	US born	Mexico cohort (REF)	NHANES Mexico born	NHANES US born	Mexico born	US born
Total sample sizes	3010 (58.9)	1021 (20.0)	1076 (21.1)	0.925	0.897	6475 (68.3)	944 (10.9)	1233 (14.3)	0.923	0.845
Age (yr)
20-44	1680 (55.8)	380 (58.6)	377 (59.8)			3357 (51.8)	356 (55.5)	460 (56.9)
45-59	951 (31.6)	239 (25.6)	222 (22.7)			2031 (31.4)	196 (24.3)	256 (23.4)
60+	379 (12.6)	402 (15.9)	477 (17.5)			1087 (16.8)	392 (20.2)	517 (19.8)
Marital status				0.074	0.804				0.088	0.423
Never married/single	458 (15.2)	73 (9.8)	162 (22.4)			1489 (23.0)	81 (10.0)	169 (19.5)
Married/living together	2390 (79.4)	843 (83.)	746 (65.2)			3701 (57.2)	580 (67.8)	697 (57.3)
Divorced/separated/widowed	162 (5.4)	105 (6.6)	167 (12.4)			1285 (19.8)	283 (22.2)	367 (23.2)
Education
Less than high school	706 (23.5)	724 (61.7)	381 (24.8)	0.000	0.463	2073 (32.0)	660 (61.3)	436 (24.8)	0.002	0.705
High school graduate	574 (19.1)	136 (17.6)	246 (26.2)			1121 (17.3)	108 (14.6)	279 (23.6)
More than high school	1730 (57.5)	160 (20.7)	447 (48.9)			3281 (50.7)	173 (24.1)	513 (51.5)

¹The Chi square test was used to determine differences between groups.

Table 2 Age-adjusted means and prevalence of chronic liver disease risk factors

	Male			Female
	Mexico cohort (REF)	NHANES VII Mexico-born	NHANES VII US-born	Mexico cohort (REF)	NHANES VII Mexico-born	NHANES VII US-born
Elevated ALT ( > 40 IU/L)¹, %	26.7	22.1	25.2	8.7	8.3	10.2
ALT (IU/L), mean	35.9	35.0	36.0	23.0	23.7	25.3^a
Elevated AST ( > 40 IU/L)², %	11.2	8.4	12.2	5.2	4.6	5.2
AST (IU/L), mean	27.9	30.1	29.5	22.2	23.6^a	25.9^b
Hepatitis B or C, %	2.6	0.4^b	3.0	1.7	0.3^b	0.8^a
Metabolic syndrome³, %	27.5	23.5	33.4	30.8	28.6	27.6
Elevated total cholesterol (mg/dL)⁴, %	39.8	48.8^b	39.1	36.0	40.5^a	40.2^a
Total cholesterol (mg/dL), mean	193.6	199.1^a	192.7	189.6	193.1^a	193.6^a
Low HDL cholesterol (HDL < 40)⁵, %	62.9	35.4^b	27.7^b	50.1	14.1^b	12.0^b
HDL cholesterol (mg/dL), mean	37.6	45.1^b	46.7^b	40.7	52.7^b	55.1^b
LDL cholesterol (mg/dL), mean	116.5	124.1^b	117.2	115.2	110.9	11.5^a
Elevated triglycerides⁶ (mg/dL), %	57.5	35.4^b	41.0^b	34.5	31.9	23.8^b
Triglycerides (mg/dL), mean	202.4	150.0^b	173.9^a	143.5	132.0^a	123.8^b
Diabetic⁷, %	6.3	11.0^a	16.1^b	6.9	14.4^b	11.0^a
Overweight (BMI ≥ 25)⁸, %	48.1	46.3	37.3^b	37.2	31.1^a	26.7^b
Obesity (BMI ≥ 30)⁹, %	17.1	30.0^b	45.0^b	19.2	39.2^b	46.6^b
BMI (kg/m²), mean	26.7	28.3^b	30.1^b	26.4	29.0^b	30.2^b
Abdominal obesity¹⁰, %	15.8	36.0^b	49.0^b	48.3	68.3^b	67.9^b
Waist circumference (cm), mean	91.4	98.7^a	103.1^b	88.5	94.7^b	97.2^b
Heavy or binge drinker¹¹, %	38.0	75.1^b	71.3^b	9.6	33.8^b	54.0^b
Current smoker¹², %	36.9	21.6^b	21.9^b	20.8	8.2^b	14.2^b

¹Elevated alanine aminotransferase (ALT) was defined as ALT > 40 IU/L for males and females;

²Elevated alanine aminotransferase (AST) was defined as AST > 40 IU/L for males and females;

³Metabolic syndrome was defined base on the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel III criteria;

⁴Elevated total cholesterol was defined as ≥ 200 mg/dL;

⁵Low High Density Lipoprotein-Cholesterol (HDL-C) was defined as < 40 mg/dL;

⁶Elevated triglycerides was defined as ≥ 150 mg/dL;

⁷Diabetes was defined as having a plasma glucose level > 125 mg/dL after a more than 8 h fast, and/or a medical history of diabetes, and/or currently taking medication for diabetes, and/or a random glucose test >200 mg/dL;

⁸Overweight was defined as having a body mass index (BMI) of ≥ 25.0 kg/m²;

⁹Obesity was defined as having a BMI of ≥ 30.0 kg/m²;

¹⁰Abdominal obesity was defined as having a waist circumference > 102 cm for males, and a waist circumference > 88 cm for females;

¹¹Heavy drinking was defined as two to four drinks per day for females and three to four drinks per day for males, and binge drinking was defined as having five or more drinks at one time for both males and females;

¹²Current cigarette smoking was defined as having smoked at least 100 cigarettes and being a current smoker.

^aP value ≤ 0.05;

^bP value ≤ 0.001.

Table 3 Effect measures comparing prevalence of risk factors among males by country of residence/birth

	Elevated ALT or AST¹	Hepatitis B or C	Metabolic syndrome²	High cholesterol	Diabetes³	Obesity⁴	Abdominal obesity⁵	Heavy/binge drinker⁶
Odds ratios
HWCS (Mexico)	1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0
NHANES- Mexico-born	0.8 (0.5-1.2)	0.2 (0.1-0.6)^a	0.8 (0.6-1.1)	1.4 (1.1-1.8)^a	1.7 (1.02.8)	2.1 (1.7-2.6)^a	3.3 (1.8-6.2)^a	3.9 (3.2-4.7)^a
NHANES- US-born	0.9 (0.6-1.4)	1.3 (0.7-2.4)	1.4 (1.11.9)^a	0.9 (0.7-1.2)	3.0 (1.9-4.8)^a	3.9 (3.1-4.9)^a	5.4 (2.9-10.1)^a	4.1 (3.4-5.1)^a
Predicted probabilities
HWCS (Mexico)	25.0	2.4	30.2	40.9	8.5	17.4	16.8	36.4
NHANES- Mexico-born	20.8	0.5	25.8	49.3	13.0	30.6	39.3	67.1
NHANES- US-born	24.0	3.2	38.0	39.6	20.4	44.7	51.1	68.5
Prevalence ratios (95%CI)
NHANES- Mexico-born vs HWCS	0.8 (0.6, 1.1)	0.2 (0.0, 0.4)^a	0.9 (0.7, 1.1)	1.2 (1.0, 1.4)^a	1.5 (0.9, 2.2)^a	1.8 (1.5, 2.0)^a	2.3 (1.2, 3.5)^a	1.8 (1.7, 2.0)^a
NHANES- US-born vs HWCS	1.0 (0.7, 1.3)	1.3 (0.6, 2.0)	1.3 (1.0, 1.5)^a	1.0 (0.8, 1.1)	2.4 (1.5, 3.3)^a	2.6 (2.2, 2.9)^a	3.0 (1.6, 4.5)^a	1.9 (1.7, 2.0)^a
Prevalence differences (95%CI)
NHANES- Mexico-born vs HWCS	-4.2 (-11.5, 3.1)	-1.9 (-3.0, -0.9)^a	-4.3 (-10.4, 1.7)	8.5 (2.4, 14.5)^a	4.5 (0.0, 8.9)^a	13.2 (9.0, 17.4)^a	22.6 (13.2, 32.0)^a	30.7 (26.4, 35.0)^a
NHANES- US-born vs HWCS	-1.0 (-8.5, 6.5)	0.7 (-0.8, 2.3)	7.8 (1.4, 14.2)^a	-1.3 (-6.9, 4.3)	11.8 (7.2, 16.5)^a	27.3 (22.1, 32.4)^a	34.4 (25.3, 43.5)^a	32.1 (28.2, 36.0)^a

Logistic regression models adjusted for age, marital status and education. Predicted probabilities, prevalence ratios and prevalence differences were produced using marginal standardization.

¹Elevated alanine aminotransferase (ALT) and elevated alanine aminotransferase (AST) were defined as > 40 IU/L;

²Metabolic syndrome was defined base on the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel III criteria;

³Diabetes was defined as having a plasma glucose level > 125 mg/dL after a more than 8 h fast, a medical history of diabetes, currently taking medication for diabetes, and/or a random glucose test > 200 mg/dL;

⁴Obesity was defined as having a body mass index (BMI) of ≥ 30.0 kg/m²;

⁵Abdominal obesity was defined as having a waist circumference > 102 cm for males, and a waist circumference > 88 cm for females;

⁶Heavy drinking was defined as two to four drinks per day for females and three to four drinks per day for males, and binge drinking was defined as having five or more drinks at one time for both males and females.

^aP< 0.05 for testing the null hypothesis of no difference between groups.

Table 4 Effect measures comparing prevalence of risk factors among females by country of residence/birth

	Elevated ALT or AST¹	Hepatitis B or C	Metabolic syndrome²	High cholesterol	Diabetes³	Obesity⁴	Abdominal obesity⁵	Heavy/binge drinker⁶
Odds ratios
HWCS (Mexico)	1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0
NHANES- Mexico-born	0.8 (0.5, 1.1)	0.3 (0.1, 1.8)	0.7 (0.5, 1.1)	1.2 (1.0, 1.5)	2.2 (1.4, 3.4)^a	2.5 (1.8, 3.5)^a	2.1 (1.2, 3.6)^a	5.6 (4.2, 7.3)^a
NHANES- US-born	1.0 (0.8, 1.3)	0.4 (0.2, 1.1)	0.8 (0.6, 1.2)	1.1 (0.9, 1.4)	1.7 (1.2, 2.6)^a	3.5 (2.5, 4.9)^a	2.3 (1.4, 3.8)^a	12.8 (10.0, 16.3)^a
Predicted probabilities
HWCS (Mexico)	10.2	2.2	34.9	41.2	8.3	20.0	51.1	8.4
NHANES- Mexico-born	8.2	0.7	28.8	45.8	15.4	38.4	67.8	32.1
NHANES- US-born	10.6	1.0	31.2	43.3	12.9	46.3	69.6	50.3
Prevalence ratios (95%CI)
NHANES- Mexico-born vs HWCS	0.8 (0.5, 2.1)	0.3 (0.0, 0.9)^a	0.8 (0.6, 1.0)	1.1 (1.0, 1.2)	1.9 (1.2, 2.5)^a	1.9 (1.4, 2.4)^a	1.3 (1.0, 1.6)^a	3.8 (3.0, 4.6)^a
NHANES- US-born vs HWCS	1.0 (0.8, 1.2)	0.4 (0.0, 0.8)^a	0.9 (0.7, 1.1)	1.1 (0.9, 1.2)	1.6 (1.1, 2.1)^a	2.3 (1.7, 2.9)^a	1.4 (1.0, 1.7)^a	6.0 (4.9, 7.1)^a
Prevalence differences (95%CI)
NHANES- Mexico-born vs HWCS	-2.1 (-4.7, 0.6)	-1.5 (-2.8, -0.2)^a	-6.1 (-13.0, 0.8)	4.6 (-0.7, 9.8)	7.1 (1.8, 12.4)^a	18.4 (12.5, 24.3)^a	16.8 (4.6, 29.0)^a	23.7 (19.4, 28.0)^a
NHANES- US-born vs HWCS	0.3 (-1.7, 2.3)	-1.2 (-2.7, 0.0)	-3.7 (-10.2, 2.7)	2.2 (-2.9, 7.3)	4.7 (1.3, 8.0)^a	26.2 (20.5, 31.9)^a	18.5 (6.5, 30.6)^a	41.9 (38.0, 45.9)^a

Logistic regression models adjusted for age, marital status and education. Predicted probabilities, prevalence ratios and prevalence differences were produced using marginal standardization.

¹Elevated alanine aminotransferase (ALT) and elevated alanine aminotransferase (AST) were defined as > 40 IU/L;

²Metabolic syndrome was defined base on the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel III criteria;

⁴Obesity was defined as having a body mass index (BMI) of ≥ 30.0 kg/m²;

⁵Abdominal obesity was defined as having a waist circumference > 102 cm for males, and a waist circumference > 88 cm for females;

^aP < 0.05 for testing the null hypothesis of no difference between groups.

Citation: Flores YN, Zhang ZF, Bastani R, Leng M, Crespi CM, Ramírez-Palacios P, Stevens H, Salmerón J. Risk factors for liver disease among adults of Mexican descent in the United States and Mexico. World J Gastroenterol 2018; 24(37): 4281-4290
URL: https://www.wjgnet.com/1007-9327/full/v24/i37/4281.htm
DOI: https://dx.doi.org/10.3748/wjg.v24.i37.4281