The Histologic Spectrum of Liver Disease in African-American, Non-Hispanic White, and Hispanic Obesity Surgery Patients

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a prominent cause of chronic liver disease in African Americans, non-Hispanic whites, and Hispanics. The aim of this study was to evaluate ethnic differences in the prevalence of NAFLD and non-alcoholic steatohepatitis (NASH) and to compare the severity of histologic features of NASH in obesity surgery patients. METHODS: Subjects consisted of 238 patients who had a routine liver biopsy at the time of obesity surgery. Demographic and clinical variables pertaining to the metabolic syndrome were collected retrospectively. Liver biopsies were evaluated according to the scoring system proposed by the Nonalcoholic Steatohepatitis Clinical Research Network and NASH was defined as a NASH activity score >= 5. RESULTS: African Americans had lower rates of steatosis than non-Hispanic whites (P < 0.001) and Hispanics (P = 0.03). Among patients with steatosis, African Americans had lower rates of NASH than non-Hispanic whites (P = 0.05) and Hispanics (P = 0.02) and lower rates of fibrosis score >= F2 than non-Hispanic whites (P = 0.002) and Hispanics (P = 0.04). Ethnic differences in rates of NAFLD, NASH, and fibrosis >= F2 persisted when controlling for demographic variables and features of the metabolic syndrome in logistic regression analysis. There were no significant differences in steatosis, NASH, or fibrosis >= F2 between non-Hispanic whites and Hispanics. CONCLUSIONS: African-American obesity surgery patients have a lower rate of NAFLD, NASH, and less severe fibrosis than non-Hispanic whites and Hispanics.