Elsevier

Journal of Hepatology

Volume 50, Issue 4, April 2009, Pages 797-804
Journal of Hepatology

Influence of ethnicity on histological differences in non-alcoholic fatty liver disease

https://doi.org/10.1016/j.jhep.2008.11.017Get rights and content

Background/Aims

Previous studies examining ethnic differences in non-alcoholic fatty liver disease (NAFLD) are limited by small sample sizes and the lack of liver biopsy as a diagnostic modality.

Methods

We retrospectively examined the influence of ethnicity on the biochemical and liver histological differences in NAFLD patients.

Results

The proportion of African Americans (AA) in the NAFLD sample (total 238 patients; 15.1% AA) was lower than in the base population (68.2%). Median ALT (47 IU/L; p = 0.05) and triglyceride (134 mg/dL, p = 0.002) levels were lower in AA than other ethnicities. AA showed lower degrees of steatosis [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22–0.89; p = 0.02] than Whites. In contrast, Asians showed higher grades of ballooning than Whites (OR 2.67, 95% CI 1.03–6.93; p = 0.04) and other ethnicities combined (OR 2.71, 95% CI 1.06–6.92; p = 0.04). Hispanics showed a higher rate of Mallory bodies than Whites (OR 2.38, 95% CI 1.05–5.39; p = 0.04) and other ethnicities combined (OR 2.41, 95% CI 1.09–5.34; p = 0.03).

Conclusions

African Americans showed a lower degree of steatosis than Whites. In contrast, Asians and Hispanics showed higher grades of ballooning and Mallory bodies, respectively, than Whites and other ethnicities combined. These findings highlight the need for prospective studies to evaluate ethnic differences in NAFLD.

Introduction

NAFLD represents a broad spectrum of clinical and histopathological manifestations, ranging from mild hepatic steatosis through non-alcoholic steatohepatitis (NASH), to fibrosis and ultimately cirrhosis and hepatocellular carcinoma. Several studies suggest a significant variation in the risk for NAFLD and differences in clinical features based upon ethnicity, as well as the potential role of ethnicity as an independent risk factor for disease severity [1], [2], [3], [4], [5], [6], [7], [8]. NAFLD is associated with obesity, type II diabetes mellitus (DM), dyslipidemia, and the metabolic syndrome (MS) [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. Since obesity and DM are known to be highly prevalent in AA, an increased prevalence of NAFLD is expected in AA. Contrary to expectations, several studies have shown a relative paucity of NAFLD among AA as compared with White and Hispanics [1], [2], [3], [5], [6], [8]. In addition, NAFLD among Asians has also been relatively understudied and has not been compared with White, Hispanic and African origin populations in a multiethnic urban population. Previous studies examining ethnic differences in NAFLD are also somewhat limited by small ethnic minority populations and by the lack of liver biopsy as the diagnostic modality, relying upon radiologic and/or laboratory findings rather than histology.

Hence, ethnic differences in NAFLD, specifically using liver biopsy as a diagnostic modality are relatively understudied and may contribute to a greater understanding of the pathophysiologic mechanisms and progression of NAFLD, as well as the formulation of effective therapy. The present study analysed the largest series of biopsy-proven NAFLD patients examined to date to investigate the influence of ethnicity on the biochemical and liver histological differences in patients with NAFLD in a diverse urban population including Whites, AA, Asians and Hispanics.

Section snippets

Study design

NAFLD patients were selected from the University of Chicago Hospital (UCH) pathology database (June 1, 1995 to June 30, 2005) based on 683 biopsy reports mentioning “steatosis”, “steatohepatitis”, and/or “fat”. Our pathologist was blinded to ethnicity. The comparison groups included both inpatient and outpatient populations from the UCH administrative Eclipsys database and UCH Hepatology clinic (January 1, 1999 to December 31, 2005). Patient-related clinical and laboratory data were collected

Results

Out of the 683 biopsy reports, 238 patients met the criteria of NAFLD and 445 patients were excluded. The reasons for ineligibility are listed in Table 1. A total 46 wedge biopsies out of 238 biopsies were taken during bariatric or laparoscopic cholecystectomy surgeries. None of the wedge surgical biopsies showed evidence of compact clusters of neutrophils consistent with surgical hepatitis. The ethnic distribution of NAFLD patients was 64.7% Whites, 15.1% AA, 13.4% Hispanics and 6.7% Asians.

Discussion

Previous studies examining ethnic differences in NAFLD are limited by small ethnic minority populations and the lack of liver biopsy as the diagnostic modality. In the present study, we examined the influence of ethnicity on the biochemical and liver histological differences in patients with NAFLD in a diverse urban population. Our results show that AA have less frequent NAFLD compared to the other three groups. AA also showed lower grades of steatosis and a trend towards significance for lower

References (50)

  • A. Galassi et al.

    Metabolic syndrome and risk of cardiovascular disease: a meta-analysis

    Am J Med

    (2006)
  • R. Ajjan et al.

    Ethnic differences in cardiovascular risk factors in healthy Caucasian and South Asian individuals with the metabolic syndrome

    J Thromb Haemost

    (2007)
  • C. Namikawa et al.

    Polymorphisms of microsomal triglyceride transfer protein gene and manganese superoxide dismutase gene in non-alcoholic steatohepatitis

    J Hepatol

    (2004)
  • C.E. Ruhl et al.

    Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States

    Gastroenterology

    (2003)
  • A.F. Celona et al.

    Hepatitis C in a Los Angeles public hepatitis clinic: demographic and biochemical differences associated with race-ethnicity

    Clin Gastroenterol Hepatol

    (2004)
  • R.K. Sterling et al.

    A comparison of the spectrum of chronic hepatitis C virus between Caucasians and African Americans

    Clin Gastroenterol Hepatol

    (2004)
  • J.D. Browning et al.

    Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity

    Hepatology

    (2004)
  • J.D. Browning et al.

    Ethnic differences in the prevalence of cryptogenic cirrhosis

    Am J Gastroenterol

    (2004)
  • M.V. Louthan et al.

    Decreased prevalence of nonalcoholic fatty liver disease in black obese children

    J Pediatr Gastroenterol Nutr

    (2005)
  • J.B. Schwimmer et al.

    Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents

    Pediatrics

    (2005)
  • S.R. Weston et al.

    Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease

    Hepatology

    (2005)
  • P. Angulo

    Nonalcoholic fatty liver disease

    N Engl J Med

    (2002)
  • C.P. Day

    Non-alcoholic steatohepatitis (NASH): where are we now and where are we going?

    Gut

    (2002)
  • S.K. Kumar et al.

    Nonalcoholic steatohepatitis

    Mayo Clinic Proc

    (2000)
  • S.G. Sheth et al.

    Nonalcoholic steatohepatitis

    Ann Intern Med

    (1997)
  • Cited by (119)

    • Ethnicity-specific alterations of plasma and hepatic lipidomic profiles are related to high NAFLD rate and severity in Hispanic Americans, a pilot study

      2021, Free Radical Biology and Medicine
      Citation Excerpt :

      Conversely, hepatic steatosis and lobular inflammation scores correlated with many plasma metabolites, but these did not pass FDR-adjustment (Table S14). Hispanics are impacted with higher prevalence and progression rate of NAFLD [6–11]. However, the biological background for this disparity is not clear.

    View all citing articles on Scopus

    The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

    View full text