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Racial Differences in the Association Between Adiposity Measures and the Risk of Hepatitis C-related Liver Disease

White, Donna L. PhD*,†,‡; Tavakoli-Tabasi, Shahriar MD§,∥; Kuzniarek, Jill BS*,‡; Ramsey, David J. PhD*,‡; El-Serag, Hashem B. MD, MPH*,†,‡

Journal of Clinical Gastroenterology: October 2012 - Volume 46 - Issue 9 - p 779–788
doi: 10.1097/MCG.0b013e318266f6eb

Background: African Americans have lower reported likelihood of hepatitis C virus-related cirrhosis than whites. It is unknown whether relative differences in the distribution of adipose tissue, lean mass, and other anthropometric measurements may explain these observed interethnic differences in disease risk.

Aim: To evaluate the association between anthropometric measurements and advanced liver disease in a cross-sectional study of African American and white male veterans.

Methods: We used the validated FibroSURE-ActiTest to assess hepatic pathology, and direct segmental multichannel bioelectric impedance analysis for anthropometric measurements. Race-stratified logistic regression was employed to evaluate risk of high fibrosis progression rate (FPR) and advanced inflammation (A2 to A3).

Results: Among 330 eligible males (59% African American), there were 43 white and 57 African American males with high FPR, and 70 African American and 59 white with advanced inflammation. Percentage body fat (%BF) was a stronger predictor of high FPR risk than was a high body mass index in African Americans [odds ratio (OR)adj=2.08; 95% confidence interval (CI),0.83-5.23 for highest %BF vs. lowest tertile and ORadj=1.50; 95% CI,0.60-3.75 for obese vs. normal body mass index, respectively], but not in whites. Highest lean leg mass was associated with a nonsignificant increased risk of both high FPR and advanced inflammation in African Americans (ORhighFPRadj=1.73; 95% CI, 0.73-4.10; ORAdvancedinflammationAdj=1.65; 95% CI, 0.76-3.56) versus a decreased risk of both in whites (ORhighFPRadj=0.62; 95% CI, 0.21-1.79; ORAdvancedinflammationAdj=0.58; 95% CI, 0.22-1.48).

Conclusions: Interethnic differences in nontraditional anthropometric measurements like %BF suggests their potential role in understanding interethnic differences in hepatitis C virus-related liver disease risk in males.

*Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center

Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine

Departments of Medicine, Section of Health Services Research

Section of Infectious Diseases, Baylor College of Medicine, Michael E. DeBakey Veterans Medical Center

§Hepatitis C Clinic, Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported in part by a VA Clinical Research and Development Merit Review Award (H-22934, PI: H.B.E.-S.), the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK081736-01, K01 DK078154-03, PIs, El-Serag and White, respectively), Texas Medical Center Digestive Disease Center (P30 DK56338), and the Houston VA HSR&D Center of Excellence.

The US Department of Veteran Affairs, the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Disease played no role in design, implementation, analysis, interpretation or decision to report these results.

The authors declare that they have nothing to disclose.

Reprints: Donna L. White, PhD, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. (MS 152) Houston, TX 77030 (e-mail:

Received March 23, 2012

Accepted June 27, 2012

© 2012 Lippincott Williams & Wilkins, Inc.