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Abstract Details
African Americans Have a Distinct Clinical and Histologic Profile With Lower Prevalence of NASH and Advanced Fibrosis Relative to Caucasians
Sanjaya K Satapathy 1 2, Hemnishil K Marella3, Rajiv P Heda 3, Surosree Ganguli4, Yala Kirthi Reddy5, Pradeep S B Podila 1, Ian Clark 6, Benedict Maliakkal 1
Author information
1Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, Tennessee.
2Division of Hepatology and Liver Transplantation, Sandra Atlas Bass Center for Liver Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York.
3University of Tennessee Health Science Center, College of Medicine, Methodist University Hospital, Memphis, Tennessee.
4Department of Medicine, University of Louisville, Louisville, Kentucky.
5Department of Medicine, University of Tennessee Health Science Center.
6Department of Pathology, Methodist University Hospital, Memphis, Tennessee, USA.
Abstract
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/m2). 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.