Nonalcoholic fatty liver disease (NAFLD) is increasingly common worldwide. We explored clinical, laboratory, and histological features of NAFLD as well as risk factors for histologically advanced disease among under-represented ethno-racial groups. Patient records from one NAFLD clinic in California from 1998-2008 were reviewed. Biopsies were graded using Brunt criteria by a hepatopathologist blinded to clinical data. We used multivariate logistic regression to assess associations between ethno-racial group and histological severity of NAFLD, while controlling for other factors. We identified 90 biopsy-proven cases of NAFLD. Mean age was 49 years (standard deviation [SD]= 11.6), and half were female. 52% of patients were Caucasian, 20% Latino-American, 18% Asian-American, and 10% Middle Eastern-American. There were significant differences among groups with respect to age, weight, body mass index (BMI), and grade of hepatic steatosis (all P<0.05). In multivariate analysis, older age was associated with severe (Brunt ≥ 2) inflammation (odds ratio [OR] 1.1, P = 0.002) and severe (Brunt ≥ 3) fibrosis (OR 1.2, P = 0.001), diabetes was associated with severe inflammation (OR 3.18, P = 0.07) and severe fibrosis (OR 8.81, P = 0.002), and increased BMI was associated with severe fibrosis (OR 2.43, P = 0.07). Additionally, compared to Caucasians, Asian-Americans showed a trend toward an association with severe (Brunt>2) steatosis (OR 3.83, P = 0.08) and severe inflammation (OR 5.42, P = 0.06).
The findings from this ethno-racially diverse clinic-based cohort are consistent with prior studies and also suggest that Asian-Americans may be at risk for advanced NAFLD. This may have implications for the prevention, evaluation, and treatment of patients with NAFLD that merit further study.
Nonalcoholic fatty liver disease across ethno-racial groups: do Asian-American adults represent a new at-risk population?