Which Liver Disease Affects Hispanics Disproportionately?

Cases of non-alcoholic fatty liver disease (NAFLD) – the world’s most common chronic hepatologic condition – are growing, and experts predict the disease will only become more prevalent as the obesity epidemic continues. This is of particular significance to South Florida because NAFLD affects Hispanics disproportionately.

The reasons for the increase are several:

• Both the medical and lay communities have become more aware of the disease.
• Imaging is used more frequently in health care.
• A sedentary lifestyle can contribute to a wide range of metabolic problems.

“More than anything, it’s probably lifestyle,” says David Goldberg, M.D., a hepatologist with the University of Miami Health System. “And it’s not just how much we eat but also what we eat.”

Non-alcoholic fatty liver disease (too much fat stored in liver cells) affects about 25% of the general population.

But for Latinos, those numbers are higher.

At a 2017 American Association for the Study of Liver Diseases forum, an international group of experts presented an alarming statistic.

The prevalence of NAFLD in South America is 32%, with a wide range among countries depending on the prevalence of obesity.

For example, the lowest rate in the region was reported in Peru (12.5%), where only 15% of the population is considered obese. In contrast, Belize, where 35% of the people are obese, ranked at the top of the list.

Numbers for U.S. Hispanics are comparable.

One study examining NAFLD rates among racial and ethnic groups found that close to 28% of Hispanic Americans had fatty liver disease, though it varied according to nationality.

It was highest among Mexican Americans (42.8%), who were two times more likely to have severe cases. Non-Hispanic African Americans had the lowest rate, with 21.6%.

But it’s not just the extra pounds that lead to this higher prevalence, Dr. Goldberg says. A genetic marker predisposes people to store extra fat in liver cells — the PNPLA3 G allele – is found more often in those of Hispanic origin. PNPLA3 is also associated with greater severity of NAFLD.

A stealth condition, non-alcoholic fatty liver disease often causes no symptoms. Some early signs may include fatigue, especially in the morning, or pain in the upper abdomen, but these are rare. In the more advanced stages, symptoms may include:

• Jaundice (yellowing skin and/or in eyes).
• Enlarged spleen.
• Red palms.
• Abdominal swelling, known as ascites.

“Most patients don’t know they have it,” Dr. Goldberg says. “It’s usually diagnosed when it’s quite advanced or incidentally, when there’s some kind of imaging involved or when liver enzymes are elevated in a routine blood test.”

One kind of NAFLD is known as non-alcoholic steatohepatitis or NASH.

This subtype is rare but aggressive. It can progress to cirrhosis (advanced scarring), hepatocellular carcinoma (HCC), and even death. The damage is comparable to that of alcohol use. However, it’s hard to pinpoint the chances of developing NASH, though recent studies show a link to type 2 diabetes.

With that chronic blood sugar condition on the rise, experts predict a 178% increase in liver deaths associated with NASH by 2030.

There is no known cure or drug treatment for fatty liver disease.

In fact, hepatologists don’t know precisely why some people go on to develop cirrhosis from NAFLD while others don’t.

Dr. Goldberg says the medical community has been debating whether to recommend liver screening for the entire population as fatty liver disease cases continue to climb. This suggestion, however, hasn’t gotten much traction because possible remedies are limited, and general screening would be costly.

“The only cure we have right now is weight loss,” Dr. Goldberg says. 

As researchers learn more about this growing threat, Dr. Goldberg says there’s plenty we can do to hedge the risk of developing NAFLD:

• Maintain a healthy weight and body mass index. If you’re overweight or obese, lose weight.
• Eat a healthy diet heavy on plant foods. Limit your carbs.
• Avoid alcoholic beverages.
• Exercise and, when possible, focus on decreasing belly fat. People who store the extra weight around their abdomen are at higher risk.
• Keep tabs on your blood sugar. Prediabetes and type 2 diabetes are closely linked to the prevalence of the liver condition.
• Check your triglycerides. High levels of fat in the blood have also been associated with NAFLD.
• Know your family history. Remember that the PNPLA3 G allele, the gene on chromosome 22, can be inherited. It’s linked to more severe non-alcoholic fatty liver disease.

Researchers estimate that NAFLD will become twice as common as it was 30 years ago.

“This isn’t going to abate,” Dr. Goldberg concludes. “It’s only going to continue increasing.”

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: cholesterol and triglycerides, Dr. David Goldberg, insulin resistance, liver failure, metabolic syndrome, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis nash