What is the racial predilection of fatty liver disease?

Updated: Apr 12, 2018
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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Findings from a 2016 study demonstrated that the causes and prevalence of chronic liver disease and cirrhosis vary widely among different racial/ethnic groups. [95] Japanese Americans (6.9%) and Latinos (6.7%) appear to be the most affected by chronic liver disease, followed by white persons (4.1%) as well as black persons and Native Hawaiians (3.9%). NAFLD was the most common etiology of chronic liver disease and of cirrhosis among all the groups; however, the most common causes of cirrhosis by ethnicity were NAFLD in Japanese Americans, Native Hawaiians, and Latinos; ALD in white persons; and hepatitis C in black persons. [95]

Very little data are available on racial differences in the incidence of ALD; however, some studies have suggested overall differences. A study of 42,862 US adults showed differences in drinking patterns among different races; white individuals were the most likely to drink, but black individuals had the highest volume of intake and frequency of heavy drinking. [11] Other studies have shown a higher rate of cirrhosis among black persons.

Fatty liver has been found across all races, but NAFLD is most common in white persons, and it is in this population that most of the research has been done. In general, Hispanics do not have higher rates of NASH than white patients unless diabetes is also present. [12] Mutations for hemochromatosis appear to put white individuals at a higher risk for more advanced fibrosis. [13]

A small study evaluating fatty liver disease in the Indian population found its association with the nonobese and its recovery with simple lifestyle habits. [7] However, obesity, when present, was a significant risk factor for NASH in Indians, as well as in Koreans. [6]

It has been observed (and is supported in the author’s clinical practice) that Asian patients often develop NAFLD and NASH at BMIs that are in the normal range for the patient’s ethnicity but tend toward the higher end of the range. A diagnosis of cirrhosis in an 80-year-old, 5-ft, 110-lb Asian female with a BMI of 21 kg/m2 is not unusual.

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