Bonacini Maurizio, Kassamali Farah, Kari Swathi, Lopez Barrera Nieves, Kohla Mohamed
Department of Gastroenterology and Hepatology, California Pacific Medical Center, California Pacific Medical Center, San Francisco, CA 94115, United States.
Department of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco, CA 94115, United States.
World J Hepatol. 2021 Jul 27;13(7):763-773. doi: 10.4254/wjh.v13.i7.763.
The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease (NAFLD). We reviewed the published literature that reported prevalence, severity, and genetic associations of NAFLD in different ethnic groups. The metabolic syndrome (MetS) has been associated with NAFLD, but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar. An elevated triglyceride (TG) level seems to have the strongest association with NAFLD. The latter is more prevalent in Hispanic patients; Blacks have lower TG levels and a lower NAFLD prevalence, compared to Caucasians or Hispanics. The severity of liver fibrosis is lower in some, but not all biopsy-based studies of Black patients. No study has evaluated the severity of liver disease controlling for the individual components of MetS, especially TG. Important racial differences in the prevalence of selected genetic polymorphisms, particularly PNPLA-3 and MBOAT7 have been documented, together with their effects on the prevalence of liver steatosis and fibrosis. Data on overall and liver mortality have found no significant differences according to race/ethnicity, with the possible exception of one paper reporting lower cirrhosis mortality in Black patients. We conclude that NAFLD is more prevalent in Hispanics and less in Blacks. This is supported by differences in key genetic polymorphisms associated with hepatic fat storage. However, there is presently insufficient evidence to firmly conclude that race, per se, plays a role in the development of liver fibrosis and its complications. Further studies, appropriately controlled for diet, exercise, and individual MetS parameters are needed.
本综述的目的是评估关于非酒精性脂肪性肝病（NAFLD）患病率和严重程度种族差异的证据。我们回顾了已发表的报告不同种族群体中NAFLD患病率、严重程度及基因关联的文献。代谢综合征（MetS）与NAFLD相关，但MetS的各个组成部分在不同种族中的存在比例各异，且它们对NAFLD的影响似乎也不相同。甘油三酯（TG）水平升高似乎与NAFLD的关联最为密切。NAFLD在西班牙裔患者中更为普遍；与白种人或西班牙裔相比，黑人的TG水平较低，NAFLD患病率也较低。在一些（但并非所有）基于活检的黑人患者研究中，肝纤维化的严重程度较低。尚无研究评估在控制MetS各个组成部分，尤其是TG的情况下肝病的严重程度。已记录了所选基因多态性，特别是PNPLA - 3和MBOAT7患病率方面的重要种族差异，以及它们对肝脂肪变性和纤维化患病率的影响。关于总体死亡率和肝脏死亡率的数据未发现种族/族裔之间存在显著差异，可能有一篇论文报告黑人患者肝硬化死亡率较低是个例外。我们得出结论，NAFLD在西班牙裔中更为普遍，在黑人中则较少见。这一点得到了与肝脏脂肪储存相关的关键基因多态性差异的支持。然而，目前尚无足够证据确凿地得出种族本身在肝纤维化及其并发症发展中起作用的结论。需要进一步开展适当控制饮食、运动和个体MetS参数的研究。
