African Americans have a distinct clinical and histologic profile with lower prevalence of NASH and advanced fibrosis relative to Caucasians

Background and Aims Racial/ethnic disparities have been reported in the prevalence of nonalcoholic fatty liver disease (NAFLD). Thus, we aimed to understand the inter-ethnic clinical, biochemical, and histological differences in a large cohort of Caucasians and African-Americans (AA). Methods Laboratory and liver biopsy data of 942 NAFLD patients were retrospectively analyzed. Nine hundred seven patients were included in the analysis: 677 (74.6%) Caucasians and 230 (25.3%) AA. Results AA had higher mean BMI compared to Caucasians (42.6 +/- 9.5 vs. 39 +/- 8.6 kg/m(2)). The prevalence of nonalcoholic steatohepatitis (NASH), defined by NAFLD activity score (NAS >= 5), was higher in the Caucasians (n = 67) compared to AA (n = 7) (9.8% vs. 3%, P = 0.0007). One hundred fifteen patients (12.8%) had advanced fibrosis: 109 (16.2%) Caucasians and six (2.6%) AA. No AA patients had stage 4 fibrosis or cirrhosis. Multivariate logistic regression analysis revealed advanced fibrosis was significantly associated with age at liver biopsy (OR 1.03, 95% CI 1.0-1.1, P = 0.017, lower platelet count (OR 0.99, 95% CI 0.98-0.99, P = <0.0001), AST/ALT ratio (OR 5.19, 95% CI 2.9-9.2, P<0.0001) and Caucasian race (OR 7.49, 95% CI 2.53-22.2, P = 0.0003). Advanced fibrosis in AA was predicted by lower platelet count and AST/ALT ratio. Whereas Advanced fibrosis in Caucasians was predicted by age at biopsy, lower platelet count and AST/ALT ratio. Conclusion The AA have a distinct clinical and histologic phenotype. Caucasians have a significantly greater proportion of NASH and are eight times more likely to develop advanced fibrosis than AA. (C) 2020 Wolters Kluwer Health, Inc. All rights reserved.

Automated summary

This study found that there are clinical, biochemical, and histological differences between African-Americans and Caucasians in NAFLD. Caucasians have a higher rate of NASH and are more likely to develop advanced fibrosis compared to African-Americans.