Influence of ethnicity on histological differences in non-alcoholic fatty liver disease☆
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
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The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.