title: Nonalcoholic fatty liver disease across ethno-racial groups: do Asian-American adults represent a new at-risk population?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. jtabibi1@jhmi.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Tabibian
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Durazo
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001213:Asian / Q000706:statistics & numerical data*; D001706:Biopsy; D005234:Fatty Liver / Q000208:ethnology / Q000473:pathology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D044465:White People / Q000706:statistics & numerical data