Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Gastroenterol Hepatol. 2011 Mar;26(3):501-9. doi: 10.1111/j.1440-1746.2010.06443.x.
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.
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.
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).
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.
非酒精性脂肪性肝病（NAFLD）在全球范围内越来越普遍。我们探讨了代表性不足的族裔群体中 NAFLD 的临床、实验室和组织学特征，以及组织学上进展性疾病的危险因素。
回顾了 1998 年至 2008 年加利福尼亚州一家 NAFLD 诊所的患者记录。通过一位对临床数据盲法的肝病病理学家，使用 Brunt 标准对活检进行分级。我们使用多变量逻辑回归来评估族裔群体与 NAFLD 组织学严重程度之间的关联，同时控制其他因素。
我们确定了 90 例经活检证实的 NAFLD 病例。平均年龄为 49 岁（标准差[SD]=11.6），其中一半为女性。52%的患者为白种人，20%为拉丁裔美国人，18%为亚裔美国人，10%为中东海湾地区裔美国人。各组在年龄、体重、体重指数（BMI）和肝脂肪变性程度方面存在显著差异（均 P <0.05）。多变量分析显示，年龄较大与严重（Brunt≥2）炎症（比值比[OR]1.1，P=0.002）和严重（Brunt≥3）纤维化（OR 1.2，P=0.001）相关，糖尿病与严重炎症（OR 3.18，P=0.07）和严重纤维化（OR 8.81，P=0.002）相关，BMI 增加与严重纤维化（OR 2.43，P=0.07）相关。此外，与白种人相比，亚裔美国人有发生严重（Brunt>2）脂肪变性（OR 3.83，P=0.08）和严重炎症（OR 5.42，P=0.06）的趋势。
本项基于族裔多样性的临床队列研究结果与既往研究一致，还提示亚裔美国人可能存在发生进展性 NAFLD 的风险。这可能对 NAFLD 患者的预防、评估和治疗产生影响，值得进一步研究。
