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.

Continue Reading

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