Comparison of Clinical, Biochemical, and Histopathologic Profiles Between NAFLD in Asian-Indians and United States Adults

Abstract

Background & Aim: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver disorders in Asian and Western countries. The epidemiological and demographic characters of NAFLD patients differ with geographic variation. Studies across ethnicities in the U.S. reveal a higher prevalence in Hispanics and African-Americans with limited studies involving Asians. Data suggest that Asian-Indian patients tend to have different characteristics than their counterparts in the West. This study is the first attempt at comparing the characteristics of Asian-Indian and U.S. NAFLD patients. Methods: A retrospective analysis of clinical, biochemical and histological parameters was performed for 633 Asian-Indian NAFLD patients with 451 U.S. NAFLD patients. Comparisons among the study cohort included clinical (i.e., age, gender, BMI, diabetes, hypertension, etc.), biochemical tests (i.e., liver function tests, lipid profile, fasting blood sugar), hepatic ultrasound, and hepatic histology. Results: The majority of U.S. NAFLD patients (82.3%) were more than 40 years of age compared to half of Asian-Indian patients (χ2 = 109.551, P ≤ 0.01). There was similar gender prevalence in U.S. (male 56.3%) and Asian-Indians (male 81.7%) (χ2 = 82.442, P ≤ 0.01value). U.S. patients had higher rates of obesity (BMI 32.6 ± 5.3 kg/m2 vs. 26.2 ± 3.4 kg/m2). U.S. patients had a higher prevalence of both diabetes and hypertension (diabetes 42.1% vs. 33%, and hypertension 56.8% vs. 29.7%, respectively, P ≤ 0.01). U.S. NAFLD patients have significantly higher ALT levels compared to Asian-Indians (ALT 82.78 ± 71.30 vs. 53.66 ± 37, P ≤ 0.01). Histological studies showed that a greater proportion of U.S. patients had more advanced liver disease at time of diagnosis compared to Asian-Indians (Stage 3 fibrosis 10.42% vs. 0%, respectively, and Stage 4 fibrosis 2.66% vs. 0%, respectively, P ≤ 0.01). Conclusions: Significant differences between Asian-Indian and US NAFLD patients exist. Further study is needed to better understand mechanistically why these differences exist.