African Americans Have Less NASH, Advanced Fibrosis Relative to White Patients With NAFLD

A team of investigators sought to better understand the interethnic clinical, biochemical, and histologic differences in the prevalence of NAFLD and NASH.

African American (AA) patients with nonalcoholic fatty liver disease (NAFLD) have a distinct clinical and histologic profile with a lower prevalence of nonalcoholic steatohepatitis (NASH) and advanced fibrosis compared with White patients with NAFLD, according to the results of a study published in the European Journal of Gastroenterology & Hepatology.

Along with the rising global epidemic of obesity, the prevalence NAFLD and NASH is also growing. As racial/ethnic disparities have been reported related to the prevalence of NAFLD, researchers sought to better understand interethnic clinical, biochemical, and histologic differences in a cohort of 907 patients (677 (74.6%) White and 230 (25.3%) African American).

The researchers found that African American patients had a higher mean body mass index (BMI) compared with White patients (42.6 ± 9.5 vs 39 ± 8.6 kg/m2). The prevalence of NASH, defined by NAFLD Activity Score (NAS ≥ 5), was higher in White (n=67) compared with African American (n=7) patients (9.8% vs 3%, P=.0007). Advanced fibrosis was reported in 115 (12.8%) patients, of whom 109 (16.2%) were White and 6 (2.6%) were African American. Of note, no African American patients had stage 4 fibrosis or cirrhosis.

Multivariate logistic regression analysis revealed that advanced fibrosis was significantly associated with age at liver biopsy (P=.017), lower platelet count (P≤.0001), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (P<.0001), and White race (P=.0003). Although advanced fibrosis in African American patients was predicted by lower platelet count and AST/ALT ratio, in White patients it was predicted by age at biopsy, lower platelet count, and AST/ALT ratio.

The authors concluded, “Despite a similar prevalence of metabolic risk factors in both groups, [African American patients] have lower [NAFLD Activity Scores] and advanced fibrosis (F3-F4).” They added, “[Whites] are nearly eight times more likely to develop advanced fibrosis than [African Americans] despite having similar metabolic risk profile.‍‍”


Satapathy SK, Marella HK, Heda RP, et al.  African Americans have a distinct clinical and histologic profile with lower prevalence of NASH and advanced fibrosis relative to Caucasians. Eur J Gastroenterol Hepatol. 2021;33:388-398. doi:10.1097/MEG.0000000000001735