Heterogeneity on the steatosis related hepatic injuries of patients with metabolic associated fatty liver disease between Han Chinese and Caucasian

Abstract Background & Aims: Despite the increasing prevalence of metabolic-associated fatty liver disease (MAFLD) worldwide, the ethnic differences between Han Chinese and Caucasian inclinical features remainunknown. Methods: This is a cross-sectional study comparing Han Chinese MAFLD patients from 2 University-affiliated Medical Centers of fatty liver in south China from January 2015 to January 2022 and Caucasian MAFLD patients from UK Biobank database. Liver fat content was defined using the magnetic resonance imaging proton density fat fraction (MRI-PDFF). Results: Han Chinese MAFLD patients(n=588) had higher proportions of moderate and severe grades of steatosis than that of Caucasian MAFLD patients (n=829) (25.7% vs 16.4%, P<0.001). There was a linear positive correlation between serum alanine aminotransferase (ALT) levels and the average liver fat content（LFC）in Han Chinese MAFLD patients but not in Caucasian. Multivariate linear regression analysis demonstrated that such positive correlations between ALT levels and LFC remained (β' =0.192, P<0.001 in male patients; β'=0.229, P<0.001 in female patients), and patients with liver biopsies further confirmed that Han Chinese patients presenting more liver histological severity as LFC increased (median 14.97% vs. 23.14% vs. 25.99%, P=0.001). Conclusions: Compared with Caucasians, Han Chinese MAFLD patients with higher LFC tended to suffer from higher risk of liver injury.