Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients

Bril, Fernando; Portillo-Sánchez, Paola; Liu, I-Chia; Kalavalapalli, Srilaxmi; Dayton, Kristin; Cusi, Kenneth

doi:10.2337/dc17-1349

Cited by 38 publications

(39 citation statements)

References 28 publications

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“…Moreover, studies assessing insulin resistance (IR) with state-of-the-art techniques (e.g., euglycemic clamp) have demonstrated that NAFL is a major risk factor for IR and type 2 diabetes (T2D), independent from visceral and intramyocellular lipid accumulation. (7) Ethnic differences in the prevalence of NAFLD have been reported in adults (8,9) and children, (1,10) with Hispanics showing the highest prevalence and blacks showing a relative protection from hepatic fat accumulation, even in the presence of morbid obesity and severe IR. (11) So far, no data in pediatrics are available about putative differences among the three major ethnic groups in the United States in the metabolic profile associated with NAFL and about the predictors of changes in hepatic fat fraction (HFF) over time.…”

Section: Metabolic Features Of Nonalcoholic Fatty Liver (Nafl) In Obementioning

confidence: 99%

“…Ethnic differences in the prevalence of NAFLD have been reported in adults and children, with Hispanics showing the highest prevalence and blacks showing a relative protection from hepatic fat accumulation, even in the presence of morbid obesity and severe IR . So far, no data in pediatrics are available about putative differences among the three major ethnic groups in the United States in the metabolic profile associated with NAFL and about the predictors of changes in hepatic fat fraction (HFF) over time …”

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confidence: 99%

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Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings From a Multiethnic Cohort

Tricò¹,

Caprio²,

Umano³

et al. 2018

Hepatology

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We conducted a prospective study in a large, multiethnic cohort of obese adolescents to characterize clinical and genetic features associated with pediatric nonalcoholic fatty liver (NAFL), the most common cause of chronic liver disease in youth. A total of 503 obese adolescents were enrolled, including 191 (38.0%) whites, 134 (26.6%) blacks, and 178 (35.4%) Hispanics. Participants underwent abdominal magnetic resonance imaging (MRI) to quantify hepatic fat fraction (HFF), an oral glucose tolerance test (OGTT) to assess glucose tolerance and insulin sensitivity, and the genotyping of three single‐nucleotide polymorphisms (SNPs) associated with nonalcoholic fatty liver disease (NAFLD) (patatin‐like phospholipase domain‐containing protein 3 [PNPLA3] rs738409, glucokinase regulatory protein [GCKR] rs1260326, and transmembrane 6 superfamily member 2 [TM6SF2] rs58542926). Assessments were repeated in 133 subjects after a 2‐year follow‐up. Prevalence of nonalcoholic fatty liver (NAFL) was 41.6% (209 patients) and ranged widely among ethnicities, being 42.9% in whites, 15.7% in blacks, and 59.6% in Hispanics (P < 0.0001). Among adolescents with NAFL, blacks showed the highest prevalence of altered glucose homeostasis (66%; P = 0.0003). Risk factors for NAFL incidence were white or Hispanic ethnicity (P = 0.021), high fasting C‐peptide levels (P = 0.0006), and weight gain (P = 0.0006), whereas baseline HFF (P = 0.004) and weight loss (P = 0.032) predicted resolution of NAFL at follow‐up. Adding either gene variant to these variables improved significantly the model predictive performance. Conclusion: Black obese adolescents are relatively protected from liver steatosis, but are more susceptible to the deleterious effects of NAFL on glucose metabolism. The combination of ethnicity/race with markers of insulin resistance and genetic factors might help identify obese youth at risk for developing NAFL.

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Section: Metabolic Features Of Nonalcoholic Fatty Liver (Nafl) In Obementioning

confidence: 99%

mentioning

confidence: 99%

Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings From a Multiethnic Cohort

Tricò¹,

Caprio²,

Umano³

et al. 2018

Hepatology

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“…We agree that the prevalence of hepatic steatosis (fat) is lower in African Americans than it is in Caucasians (2), yet it is unclear whether the sample size of merely 67 African Americans provides adequate power to support the conclusion by Bril et al that NASH in a fatty liver occurs as frequently in blacks as it does in whites (1). In a very recent large systematic review of 34 studies and over 350,000 subjects, the risk of NASH in patients with steatosis was lower in blacks relative to Caucasians (relative risk 0.72 [95% CI 0.60-0.87]) (3).…”

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confidence: 47%

“…In Bril et al (1), the fibrosis scores were not statistically different between the ethnic groups. However, because of the aforementioned limitations between comparators, we don't believe the results are definitive.…”

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confidence: 75%

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Comment on Bril et al. Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients. Diabetes Care 2018;41:187–192

2018

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Noninvasive tests to identify liver fibrosis in metabolic dysfunction‐associated steatotic liver disease are affected by race

Bril,

Gray

2023

Obesity

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ObjectiveThe objective of this study was to assess the performance of noninvasive tests (NITs) across different racial and ethnic groups in a large multiethnic cohort.MethodsData were derived from the National Health and Nutrition Examination Survey (NHANES) 2017 through 2020. Participants without valid transient elastography measurements or with alternative etiologies of liver steatosis disease were excluded from the study.ResultsAmong the 6359 adults included in the study, fatty liver index and nonalcoholic fatty liver disease liver fat scores performed well for the prediction of metabolic dysfunction‐associated steatotic liver disease, without significant changes across racial and ethnic groups. However, significant differences were observed across racial and ethnic groups for the prediction of advanced fibrosis and cirrhosis. The fibrosis‐4 (FIB‐4) index, aspartate aminotransferase to platelet ratio index (APRI), and nonalcoholic fatty liver disease fibrosis score underperformed in non‐Hispanic Black patients for the detection of cirrhosis. For the detection of advanced fibrosis, their performance was also numerically worse in non‐Hispanic Black patients but only reached statistical significance for APRI. Using a cutoff point of 12 kPa for advanced fibrosis, both APRI and the FIB‐4 index performed significantly worse in non‐Hispanic Black patients.ConclusionsIn a large, diverse national cohort, the performance of NITs was overall poor compared with transient elastography, and NITs showed differences across racial and ethnic groups. Given the widespread use of NITs, it is imperative that the scores are equitable across racial and ethnic groups.

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Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients

Cited by 38 publications

References 28 publications

Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings From a Multiethnic Cohort

Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings From a Multiethnic Cohort

Comment on Bril et al. Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients. Diabetes Care 2018;41:187–192

Noninvasive tests to identify liver fibrosis in metabolic dysfunction‐associated steatotic liver disease are affected by race

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