Severe obesity is a risk factor for nonalcoholic steatohepatitis (NASH), particularly among ethnic minority groups. The aim of this analysis was to evaluate ethnic group differences in the prevalence of NASH in a large multiethnic sample of bariatric patients not previously well-described in the literature.
Methods:
A cross-sectional retrospective analysis of 611 liver biopsies among patients, who underwent bariatric surgery from 2001 to 2010, from one bariatric surgery practice in South Florida was conducted. Logistic regression analysis predicted the ethnic group-specific odds of having NASH.
Results:
Hispanics (43%) and non-Hispanic whites (NHW) (46%) were significantly more likely than non-Hispanic blacks (NHB) (21%) to have advanced steatosis (p = 0.002). Conversely, NHB were significantly more likely to have mild or moderate steatosis (48%) versus both NHW (34%) and Hispanics (36%). Women were over two and a half times as likely as men to have NASH (OR 2.66, 95% CI 1.68–4.24). NHB were almost twice as likely as NHW to have NASH (OR 1.86, 95% CI 1.17–2.94).
Conclusions:
The prevalence of NASH varies significantly by ethnicity and gender among bariatric surgery patients. These findings have important clinical implications for postoperative health maintenance as NASH carries a risk of progressive liver disease.
Get full access to this article
View all access options for this article.
References
1.
OgdenCL, CarrollMD, KitBK, FlegalKM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA, 2014; 311:806–814.
2.
OlshanskySJ, PassaroDJ, HershowRC, et al.A potential decline in life expectancy in the United States in the 21st century. N Engl J Med, 2005; 352:1138–1145.
3.
KarterAJ, FerraraA, LiuJY, MoffetHH, AckersonLM, SelbyJV. Ethnic disparities in diabetic complications in an insured population. JAMA, 2002; 287:2519–2527.
4.
McWilliamsJM, MearaE, ZaslavskyAM, AyanianJZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Ann Inter Med, 2009; 150:505–515.
MarchesiniG, BriziM, BianchiG, et al.Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes, 2001; 50:1844–1850.
7.
BrowningJD, SzczepaniakLS, DobbinsR, et al.Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology, 2004; 40:1387–1395.
8.
ClarkJM, BrancatiFL, DiehlAM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol, 2003; 98:960–967.
9.
IoannouGN, BoykoEJ, LeeSP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol, 2006; 101:76–82.
10.
LazoM, HernaezR, EberhardtMS, et al.Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol, 2013; 178:38–45.
11.
SchneiderAL, LazoM, SelvinE, ClarkJM. Racial differences in nonalcoholic fatty liver disease in the U.S. population. Obesity (Silver Spring, Md.), 2014; 22:292–299.
12.
SmitsMM, IoannouGN, BoykoEJ, UtzschneiderKM. Non-alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: results of a US national survey in three ethnic groups. J Gastroenterol Hepatol, 2013; 28:664–670.
13.
WestonSR, LeydenW, MurphyR, et al.Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology (Baltimore, Md.), 2005; 41:372–379.
14.
WilliamsCD, StengelJ, AsikeMI, et al.Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology, 2011; 140:124–131.
15.
YounossiZM, StepanovaM, NegroF, et al.Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine, 2012; 91:319–327.
16.
KallwitzER, GuzmanG, TenCateV, et al.The histologic spectrum of liver disease in African-American, non-Hispanic white, and Hispanic obesity surgery patients. Am J Gastroenterol, 2009; 104:64–69.
17.
RuhlCE, EverhartJE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology, 2003; 124:71–79.
18.
SchwimmerJB, McGrealN, DeutschR, FinegoldMJ, LavineJE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics, 2005; 115:e561–e565.
19.
SolgaSF, ClarkJM, AlkhuraishiAR, et al.Race and comorbid factors predict nonalcoholic fatty liver disease histopathology in severely obese patients. Surg Obes Relat Dis, 2005; 1:6–11.
20.
LazoM, ClarkJM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis, 2008; 28:339–350.
21.
DunnW, XuR, WingardDL, et al.Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study. Am J Gastroenterol, 2008; 103:2263–2271.
22.
OngJP, PittsA, YounossiZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol, 2008; 49:608–612.
23.
YounossiZM, OtgonsurenM, VenkatesanC, MishraA. In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabolism, 2013; 62:352–360.
24.
NairS, MasonA, EasonJ, LossG, PerrilloRP. Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis?. Hepatology, 2002; 36:150–155.
25.
KleinerDE, BruntEM, Van NattaM, BehlingC, ContosMJ, CummingsOW, et al.Nonalcoholic Steatohepatitis Clinical Research Network. Gastrointestinal surgery for severe obesity. NIH consensus development conference, March 25–27,1991. Nutrition, 1996; 12:397–404.
26.
KleinerDE, BruntEM, Van NattaM, et al.Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology, 2005; 41:1313–1321.
27.
PanJJ, FallonMB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol, 2014; 6:274–283.
28.
VernonG, BaranovaA, YounossiZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther, 2011; 34:274–285.
29.
BambhaK, BeltP, AbrahamM, et al.Ethnicity and nonalcoholic fatty liver disease. Hepatology, 2012; 55:769–780.
30.
KrasnoffJB, PainterPL, WallaceJP, BassNM, MerrimanRB. Health-related fitness and physical activity in patients with nonalcoholic fatty liver disease. Hepatology, 2008; 47:1158–1166.
31.
Gordon-LarsenP, HarrisKM, WardDS, PopkinBM. Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health. Soc Sci Med, 2003; 57:2023–2034.
32.
PopkinBM, UdryJR. Adolescent obesity increases significantly in second and third generation U.S. immigrants: the National Longitudinal Study of Adolescent Health. J Nutr, 1998; 128:701–706.
33.
WinklebyMA, AlbrightCL, Howard-PitneyB, LinJ, FortmannSP. Hispanic/white differences in dietary fat intake among low educated adults and children. Prev Med, 1994; 23:465–473.
34.
de la Cruz-MunozN, MessiahSE, ArheartKL, Lopez-MitnikG, LipshultzSE, LivingstoneA. Bariatric surgery significantly decreases the prevalence of type 2 diabetes mellitus and pre-diabetes among morbidly obese multiethnic adults: long-term results. J Am Coll Surg, 2011; 212:505–511; discussion 512–503.
35.
KhorgamiZ, ArheartKL, ZhangC, MessiahSE, de la Cruz-MunozN. Effect of ethnicity on weight loss after bariatric surgery. Obes Surg, 2015; 25:769–776.
36.
KhorgamiZ, ZhangC, MessiahSE, de la Cruz-MunozN. Predictors of postoperative aftercare attrition among gastric bypass patients. Bariatr Surg Pract Patient Care, 2015; 10:79–83.
