title: Global Epidemiology of Nonalcoholic Fatty Liver Disease and Perspectives on US Minority Populations.
abstract: BACKGROUND
  Non-alcoholic fatty liver disease (NAFLD) is a clinical syndrome predicted to be the next global epidemic affecting millions of people worldwide. The natural course of this disease including its subtype, non-alcoholic steatohepatitis (NASH), is not clearly defined especially in the African-American segment of the US population.
  
  
  OBJECTIVE
  To conduct a review of the global epidemiology of NAFLD with emphasis on US minority populations.
  
  
  METHODS
  A thorough search of evidence-based literature was conducted using the Pubmed database and commercial web sources such as Medscape and Google Scholar.
  
  
  RESULTS
  NAFLD and its subtype NASH are becoming the principal cause of chronic liver disease across the world. In the US, Hispanics are the most disproportionately affected ethnic group with hepatic steatosis, and elevated aminotransferase levels, whereas African-Americans are the least affected. Genetic disparities involved in lipid metabolism seem to be the leading explanation for the lowest incidence and prevalence of both NAFLD and NASH in African-Americans.
  
  
  CONCLUSIONS
  The unprecedented rise in the prevalence of NAFLD globally requires an initiation of population cohort studies with long-term follow-up to determine the incidence and natural history of NAFLD and its underrepresentation in African-Americans. Future studies should also focus on the delineation of the interplay between genetic and environmental factors that trigger the development of NAFLD and NASH.
authors.affiliation: Department of Biochemistry and Molecular Biology, Howard University, 520 W Street NW, Washington, DC, 20059, USA. zaki.sherif@howard.edu.|College of Medicine, Howard University, Washington, DC, USA. zaki.sherif@howard.edu.
authors.forename: Zaki A
authors.initials: ZA
authors.lastname: Sherif
authors.affiliation: Cancer Center, Howard University, Washington, DC, USA.
authors.forename: Armana
authors.initials: A
authors.lastname: Saeed
authors.affiliation: Department of Medicine, Howard University, Washington, DC, USA.|Howard University Hospital, Howard University, Washington, DC, USA.
authors.forename: Shima
authors.initials: S
authors.lastname: Ghavimi
authors.affiliation: Department of Medicine, Howard University, Washington, DC, USA.|Howard University Hospital, Howard University, Washington, DC, USA.
authors.forename: Seyed-Mehdi
authors.initials: SM
authors.lastname: Nouraie
authors.affiliation: Department of Medicine, Howard University, Washington, DC, USA.|Division of Gastroenterology, Howard University, Washington, DC, USA.|Howard University Hospital, Howard University, Washington, DC, USA.
authors.forename: Adeyinka O
authors.initials: AO
authors.lastname: Laiyemo
authors.affiliation: Department of Pathology, Howard University, Washington, DC, USA.|Cancer Center, Howard University, Washington, DC, USA.|College of Medicine, Howard University, Washington, DC, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Brim
authors.affiliation: Department of Medicine, Howard University, Washington, DC, USA.|Cancer Center, Howard University, Washington, DC, USA.|Howard University Hospital, Howard University, Washington, DC, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Ashktorab
mesh_terms: D001741:Black or African American; D014943:Global Health; D006801:Humans; D008913:Minority Groups; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Epidemiology, obesity, African-Americans (AAs), nonalcoholic fatty liver disease (NAFLD); Insulin resistance (IR); Metabolic syndrome (MetS); Nonalcoholic steatohepatitis (NASH)