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Published in: Current Hepatology Reports 4/2020

01-12-2020 | Fatty Liver | Fatty Liver Disease (D Halegoua-De Marzio, Section Editor)

National and Global Ethnicity Differences in Non-alcoholic Fatty Liver Disease

Authors: Anita Krishnarao, Carmi S. Punzalan

Published in: Current Hepatology Reports | Issue 4/2020

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Abstract

Purpose of Review

Non-alcoholic fatty liver disease (NAFLD) remains a leading cause of chronic liver disease and a growing public health concern. This review aims to examine the reported national and international ethnicity differences in NAFLD.

Recent Findings

Prior studies have shown that Latino populations were disproportionately affected by both NAFLD and non-alcoholic steatohepatitis (NASH) in the USA compared to non-Latino White populations. Black and Asian Americans are reported to have a lower prevalence of NAFLD. Contributing factors for ethnic disparities may include socioeconomic factors, body fat distribution trends, genetic factors, and prevalence of associated disease states.

Summary

Ethnic differences in NAFLD have been identified in the USA and internationally. The Latino population seems to have the highest prevalence of NAFLD in the USA, but ethnicity-related differences in disease characteristics and outcomes have yet to be fully elucidated.
Literature
1.
go back to reference Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM, et al. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology. 2005;41(2):372–9.CrossRef Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM, et al. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology. 2005;41(2):372–9.CrossRef
2.
go back to reference Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics. 2005;115(5):561–5.CrossRef Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics. 2005;115(5):561–5.CrossRef
3.
go back to reference •• Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors, and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11–20. This review represents one of the most recent summaries of genetic and environmental risk factors for NAFLD and NASH and their variable distribution across different ethnicities and countries worldwide.CrossRef •• Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors, and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11–20. This review represents one of the most recent summaries of genetic and environmental risk factors for NAFLD and NASH and their variable distribution across different ethnicities and countries worldwide.CrossRef
4.
go back to reference Saab S, Manne V, Nieto J, Schwimmer JB, Chalasani NP. Nonalcoholic fatty liver disease in Latinos. Clin Gastroenterol Hepatol. 2016;14:5–12.CrossRef Saab S, Manne V, Nieto J, Schwimmer JB, Chalasani NP. Nonalcoholic fatty liver disease in Latinos. Clin Gastroenterol Hepatol. 2016;14:5–12.CrossRef
5.
go back to reference Caldwell SH, Harris DM, Patrie JT, Hespenheide EE. Is NASH underdiagnosed among African Americans? Am J Gastroenterol. 2002;97:1496–500.CrossRef Caldwell SH, Harris DM, Patrie JT, Hespenheide EE. Is NASH underdiagnosed among African Americans? Am J Gastroenterol. 2002;97:1496–500.CrossRef
6.
go back to reference • Golabi P, Paik J, Hwang JP, Wang S, Lee HM, Younossi ZM. Prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among Asian American adults in the United States. Liver Int. 2019;39:748–57. https://doi.org/10.1111/liv.14038. This study is one of the few that analyzes NAFLD prevalence and risk factors in Asian Americans. • Golabi P, Paik J, Hwang JP, Wang S, Lee HM, Younossi ZM. Prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among Asian American adults in the United States. Liver Int. 2019;39:748–57. https://​doi.​org/​10.​1111/​liv.​14038. This study is one of the few that analyzes NAFLD prevalence and risk factors in Asian Americans.
8.
go back to reference Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313:2263–73.CrossRef Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313:2263–73.CrossRef
9.
go back to reference Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine. 2012;91:319–27. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine. 2012;91:319–27.
10.
go back to reference •• Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16:198–210. This study is a unique meta-analysis that helps characterize ethnic disparities in NAFLD prevalence and severity based on recent population-based studies in the US.CrossRef •• Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16:198–210. This study is a unique meta-analysis that helps characterize ethnic disparities in NAFLD prevalence and severity based on recent population-based studies in the US.CrossRef
11.
go back to reference Fleischman MW, Budoff M, Zeb I, Li D, Foster T. NAFLD prevalence differs among Hispanic subgroups: the multi-ethnic study of atherosclerosis. World J Gastroenterol. 2014;20:4987–93.CrossRef Fleischman MW, Budoff M, Zeb I, Li D, Foster T. NAFLD prevalence differs among Hispanic subgroups: the multi-ethnic study of atherosclerosis. World J Gastroenterol. 2014;20:4987–93.CrossRef
12.
go back to reference Lomonaco R, Ortiz-Lopez C, Orsak B, Finch J, Webb A, Bril F, et al. Role of ethnicity in overweight and obese patients with nonalcoholic steatohepatitis. Hepatology. 2011;54:837–45. Lomonaco R, Ortiz-Lopez C, Orsak B, Finch J, Webb A, Bril F, et al. Role of ethnicity in overweight and obese patients with nonalcoholic steatohepatitis. Hepatology. 2011;54:837–45.
13.
go back to reference Bambha K, Belt P, Abraham M, Wilson LA, Pabst M, Ferrell L, et al. Ethnicity and nonalcoholic fatty liver disease. Hepatology. 2012;55:769–80. Bambha K, Belt P, Abraham M, Wilson LA, Pabst M, Ferrell L, et al. Ethnicity and nonalcoholic fatty liver disease. Hepatology. 2012;55:769–80.
14.
go back to reference Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.
15.
go back to reference Pan JJ, Fallon MB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol. 2014;6:274–83.CrossRef Pan JJ, Fallon MB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol. 2014;6:274–83.CrossRef
16.
go back to reference Guerrero R, Vega GL, Grundy SM, Browning JD. Ethnic differences in hepatic steatosis: an insulin resistance paradox? Hepatology. 2009;49:791–801.CrossRef Guerrero R, Vega GL, Grundy SM, Browning JD. Ethnic differences in hepatic steatosis: an insulin resistance paradox? Hepatology. 2009;49:791–801.CrossRef
17.
go back to reference Bril F, Portillo-Sanchez P, Liu IC, Kalavalapalli S, Dayton K, Cusi K. Clinical and histologic characterization of nonalcoholic steatohepatitis in African American patients. Diabetes Care. 2018;41:187–92.CrossRef Bril F, Portillo-Sanchez P, Liu IC, Kalavalapalli S, Dayton K, Cusi K. Clinical and histologic characterization of nonalcoholic steatohepatitis in African American patients. Diabetes Care. 2018;41:187–92.CrossRef
18.
go back to reference Setiawan VW, Stram DO, Porcel J, Lu SC, Le Marchand L, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology. 2016;64:1969–77.CrossRef Setiawan VW, Stram DO, Porcel J, Lu SC, Le Marchand L, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology. 2016;64:1969–77.CrossRef
19.
go back to reference Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: disparate associations among Asian populations. World J Hepatol. 2014;6:263–73.CrossRef Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: disparate associations among Asian populations. World J Hepatol. 2014;6:263–73.CrossRef
21.
go back to reference Petersen KF, Dufour S, Feng J, Befroy D, Dziura J, Dalla Man C, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc Natl Acad Sci. 2006;103:18273–7. Petersen KF, Dufour S, Feng J, Befroy D, Dziura J, Dalla Man C, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc Natl Acad Sci. 2006;103:18273–7.
23.
go back to reference Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States. J Clin Gastroenterol. 2015;49:690–6. Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States. J Clin Gastroenterol. 2015;49:690–6.
24.
go back to reference Bialek SR, Redd JT, Lynch A, Vogt T, Lewis S, Wilson C, et al. Chronic liver disease among two American Indian patient populations in the southwestern United States, 2000-2003. J Clin Gastroenterol. 2008;42:849–54. Bialek SR, Redd JT, Lynch A, Vogt T, Lewis S, Wilson C, et al. Chronic liver disease among two American Indian patient populations in the southwestern United States, 2000-2003. J Clin Gastroenterol. 2008;42:849–54.
25.
go back to reference Noureddin M, Zelber-Sagi S, Wilkens LR, Porcel J, Boushey CJ, Le Marchand L, et al. Diet associations with nonalcoholic fatty liver disease and an ethnically diverse populations: the multiethnic cohort. Hepatology. 2020;71:1940–52.CrossRef Noureddin M, Zelber-Sagi S, Wilkens LR, Porcel J, Boushey CJ, Le Marchand L, et al. Diet associations with nonalcoholic fatty liver disease and an ethnically diverse populations: the multiethnic cohort. Hepatology. 2020;71:1940–52.CrossRef
26.
go back to reference Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40:1461–5. Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40:1461–5.
27.
go back to reference Wagenknecht LE, Palmer ND, Bowden DW, Rotter JI, Norris JM, Ziegler J, et al. Association of PNPLA3 with non-alcoholic fatty liver disease in a minority cohort: the Insulin Resistance Atherosclerosis Family Study. Liver Int. 2011;31:412–6. Wagenknecht LE, Palmer ND, Bowden DW, Rotter JI, Norris JM, Ziegler J, et al. Association of PNPLA3 with non-alcoholic fatty liver disease in a minority cohort: the Insulin Resistance Atherosclerosis Family Study. Liver Int. 2011;31:412–6.
28.
go back to reference Sookoian S, Pirola CJ. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology. 2011;53:1883–94.CrossRef Sookoian S, Pirola CJ. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology. 2011;53:1883–94.CrossRef
29.
go back to reference Browning JD. Common genetic variants and nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2013;11:1191–3.CrossRef Browning JD. Common genetic variants and nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2013;11:1191–3.CrossRef
30.
go back to reference Chow EA, Foster H, Gonzalez V, McIver L. The disparate impact of diabetes on racial/ethnic minority populations. Clin Diabetes. 2012;30:130–3.CrossRef Chow EA, Foster H, Gonzalez V, McIver L. The disparate impact of diabetes on racial/ethnic minority populations. Clin Diabetes. 2012;30:130–3.CrossRef
31.
go back to reference Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet. 2017;389:1431–41.CrossRef Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet. 2017;389:1431–41.CrossRef
32.
go back to reference Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–63.CrossRef Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–63.CrossRef
33.
go back to reference Noureddin M, Yates KP, Vaughn IA, Neuschwander-Tetri BA, Sanyal AJ, McCullough A, et al. Clinical and histological determinants of nonalcoholic steatohepatitis and advanced fibrosis in elderly patients. Hepatology. 2013;58(5):1644–54. Noureddin M, Yates KP, Vaughn IA, Neuschwander-Tetri BA, Sanyal AJ, McCullough A, et al. Clinical and histological determinants of nonalcoholic steatohepatitis and advanced fibrosis in elderly patients. Hepatology. 2013;58(5):1644–54.
34.
go back to reference Neuschwander-Tetri BA, Loomba R, Sanyal AJ, Lavine JE, Van Natta ML, Abdelmalek MF, et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet. 2015;385(9972):956–65.CrossRef Neuschwander-Tetri BA, Loomba R, Sanyal AJ, Lavine JE, Van Natta ML, Abdelmalek MF, et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet. 2015;385(9972):956–65.CrossRef
35.
go back to reference Younossi ZM, Ratziu V, Loomba R, Rinella M, Anstee QM, Goodman Z, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019;394:2184–96.CrossRef Younossi ZM, Ratziu V, Loomba R, Rinella M, Anstee QM, Goodman Z, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019;394:2184–96.CrossRef
36.
go back to reference Wilder J, Saraswathula A, Hasselblad V, Muir A. A systematic review of race and ethnicity in hepatitis C clinical trial enrollment. J Natl Med Assoc. 2016;108:24–9.CrossRef Wilder J, Saraswathula A, Hasselblad V, Muir A. A systematic review of race and ethnicity in hepatitis C clinical trial enrollment. J Natl Med Assoc. 2016;108:24–9.CrossRef
37.
go back to reference Geller SE, Koch AR, Roesch P, Filut A, Hallgren E, Carnes M. The more things change, the more they stay the same: a study to evaluate compliance with inclusion and assessment of women and minorities in randomized controlled trials. Acad Med. 2018;93:630.CrossRef Geller SE, Koch AR, Roesch P, Filut A, Hallgren E, Carnes M. The more things change, the more they stay the same: a study to evaluate compliance with inclusion and assessment of women and minorities in randomized controlled trials. Acad Med. 2018;93:630.CrossRef
38.
go back to reference Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–55. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–55.
39.
go back to reference Eshraghian A. High prevalence of nonalcoholic fatty liver disease in the Middle East: lifestyle and dietary habits. Hepatology. 2017;65:1077.CrossRef Eshraghian A. High prevalence of nonalcoholic fatty liver disease in the Middle East: lifestyle and dietary habits. Hepatology. 2017;65:1077.CrossRef
40.
go back to reference Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10:330–44.CrossRef Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10:330–44.CrossRef
41.
go back to reference Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10:686–90.CrossRef Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10:686–90.CrossRef
42.
go back to reference Younes R, Bugianesi E. NASH in lean individuals. Semin Liver Dis. 2019;39(1):86–95.CrossRef Younes R, Bugianesi E. NASH in lean individuals. Semin Liver Dis. 2019;39(1):86–95.CrossRef
43.
go back to reference Neukam K, Sanjay BS, Rodger A, Oben J, Nirmal D, Jain A, et al. High prevalence of non-alcoholic fatty liver disease (NAFLD) among Gujarati Indians in North London: a population based study. Clin Lipidol. 2017;12:33–9. Neukam K, Sanjay BS, Rodger A, Oben J, Nirmal D, Jain A, et al. High prevalence of non-alcoholic fatty liver disease (NAFLD) among Gujarati Indians in North London: a population based study. Clin Lipidol. 2017;12:33–9.
44.
go back to reference Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol. 2017;67:862–73.CrossRef Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol. 2017;67:862–73.CrossRef
45.
go back to reference Yousef MH, Juboori AA, Albarrak AA, Ibdah JA, Tahan V. Fatty liver without a large “belly”: magnified review of non-alcoholic fatty liver disease in non-obese patients. World J Gastrointest Pathophysiol. 2017;8:100–7.CrossRef Yousef MH, Juboori AA, Albarrak AA, Ibdah JA, Tahan V. Fatty liver without a large “belly”: magnified review of non-alcoholic fatty liver disease in non-obese patients. World J Gastrointest Pathophysiol. 2017;8:100–7.CrossRef
46.
go back to reference Olusanya TO, Lesi OA, Adeyomoye AA, Fasanmade OA. Non alcoholic fatty liver disease in a Nigerian population with type II diabetes mellitus. Pan Afr Med J. 2016;24:20.CrossRef Olusanya TO, Lesi OA, Adeyomoye AA, Fasanmade OA. Non alcoholic fatty liver disease in a Nigerian population with type II diabetes mellitus. Pan Afr Med J. 2016;24:20.CrossRef
47.
Metadata
Title
National and Global Ethnicity Differences in Non-alcoholic Fatty Liver Disease
Authors
Anita Krishnarao
Carmi S. Punzalan
Publication date
01-12-2020
Publisher
Springer US
Keyword
Fatty Liver
Published in
Current Hepatology Reports / Issue 4/2020
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-020-00552-8

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