Ethnic Disparities in Adiposity: Focus on Non-alcoholic Fatty Liver Disease, Visceral, and Generalized Obesity

  • Uchenna Agbim
  • Rotonya M. Carr
  • Octavia Pickett-Blakely
  • Sam Dagogo-JackEmail author
Obesity Treatment (CM Apovian, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity Treatment


Purpose of Review

Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD).

Recent Findings

Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk.


Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.


Visceral adiposity NAFLD Obesity Ethnicity Race Health disparities 



Adipose tissue


Body fat percentage


Body mass index


Dallas Heart Study


Food and Drug Administration


Free fatty acids


Framingham Heart Study


Gluteofemoral adipose tissue


High-density lipoprotein


International Diabetes Federation


Insulin resistance


Jackson Heart Study


Multi-Ethnic Study of Atherosclerosis


Metabolically healthy obese


Magnetic resonance imaging


Metabolically unhealthy obese


Non-alcoholic fatty liver disease


Non-alcoholic steatohepatitis


Nonalcoholic Steatohepatitis Clinical Research Network


National Health and Nutrition Examination Survey


Non-Hispanic black


Non-Hispanic white


Patatin-like phospholipase domain containing 3


Subcutaneous adipose tissue


Single-nucleotide polymorphism


Type 2 diabetes mellitus


Visceral adipose tissue


Very low-density lipoprotein


Waist circumference


Compliance with Ethical Standards

Conflict of Interest

Uchenna Agbim declares that she has no conflict of interest.

Rotonya M. Carr has served as a co-investigator on a study sponsored by Intercept Pharmaceuticals and has received salary support from Intercept Pharmaceuticals.

Octavia Pickett-Blakely declares that she has no conflict of interest.

Sam Dagogo-Jack has received research support through diabetes clinical trial contracts with the University of Tennessee unrelated to the content of this article from AstraZeneca and Boehringer Ingelheim and has received consultant honoraria for diabetes scientific advisory boards unrelated to the content of this article from Merck, Sanofi, AstraZeneca, Boehringer Ingelhim, and Janssen.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • N. C. D. Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96. This study uses population-based data to summarize worldwide changes in BMI and estimates risk of achieving the global obesity target.CrossRefGoogle Scholar
  2. 2.
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. Scholar
  3. 3.
    Stokes A, Preston SH. The contribution of rising adiposity to the increasing prevalence of diabetes in the United States. Prev Med. 2017;101:91–5. Scholar
  4. 4.
    Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the obesity Committee of the Council on nutrition, physical activity, and metabolism. Circulation. 2006;113(6):898–918. Scholar
  5. 5.
    • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment 28431.Of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. . This study is a meta-analysis of global prevalence of NAFLD and highlights areas of the world with high prevalence of NAFLD.
  6. 6.
    Carr RM, Oranu A, Khungar V. Nonalcoholic fatty liver disease: pathophysiology and management. Gastroenterol Clin N Am. 2016;45(4):639–52. Scholar
  7. 7.
    Cusi K. Role of insulin resistance and lipotoxicity in non-alcoholic steatohepatitis. Clin Liver Dis. 2009;13(4):545–63.
  8. 8.
    •• Trico D, Caprio S, Rosaria Umano G, Pierpont B, Nouws J, Galderisi A, et al. Metabolic features of nonalcoholic fatty liver (NAFL) in obese adolescents: findings from a multiethnic cohort. Hepatology (Baltimore, Md). 2018;68(4):1376–90. . The authors characterize metabolic phenotype, prevalence of NAFLD, and genotype analysis of common single nucleotide polymorphisms in a group of diverse adolescents.CrossRefGoogle Scholar
  9. 9.
    Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13. Scholar
  10. 10.
    Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39–48. Scholar
  11. 11.
    Liu J, Fox CS, Hickson D, Bidulescu A, Carr JJ, Taylor HA. Fatty liver, abdominal visceral fat, and cardiometabolic risk factors: the Jackson Heart Study. Arterioscler Thromb Vasc Biol. 2011;31(11):2715–22. Scholar
  12. 12.
    Guerrero R, Vega GL, Grundy SM, Browning JD. Ethnic differences in hepatic steatosis: an insulin resistance paradox? Hepatology (Baltimore, Md). 2009;49(3):791–801. Scholar
  13. 13.
    van der Poorten D, Milner KL, Hui J, Hodge A, Trenell MI, Kench JG, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology (Baltimore, Md). 2008;48(2):449–57. Scholar
  14. 14.
    Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80.
  15. 15.
    Garg SK, Lin F, Kandula N, Ding J, Carr J, Allison M, et al. Ectopic fat depots and coronary artery calcium in South Asians compared with other racial/ethnic groups. J Am Heart Assoc. 2016;5(11).
  16. 16.
    Hanley C, Matthews KA, Brooks MM, Janssen I, Budoff MJ, Sekikawa A, et al. Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study. Menopause (New York, NY). 2018;25(1):38–45. Scholar
  17. 17.
    Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, Pierson RN Jr. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994;60(1):23–8. Scholar
  18. 18.
    Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, et al. A better index of body adiposity. Obesity (Silver Spring, Md). 2011;19(5):1083–9. Scholar
  19. 19.
    Dugas LR, Cao G, Luke AH, Durazo-Arvizu RA. Adiposity is not equal in a multi-race/ethnic adolescent population: NHANES 1999-2004. Obesity (Silver Spring, Md). 2011;19(10):2099–101. Scholar
  20. 20.
    Katzmarzyk PT, Mire E, Bray GA, Greenway FL, Heymsfield SB, Bouchard C. Anthropometric markers of obesity and mortality in white and African American adults: the pennington center longitudinal study. Obesity (Silver Spring, Md). 2013;21(5):1070–5. Scholar
  21. 21.
    Fabbrini E, Conte C, Magkos F. Methods for assessing intrahepatic fat content and steatosis. Current opinion in clinical nutrition and metabolic care. 2009;12(5):474–81. Scholar
  22. 22.
    Camhi SM, Must A, Gona PN, Hankinson A, Odegaard A, Reis J, et al. Duration and stability of metabolically healthy obesity over 30 years. International journal of obesity (2005). 2018.
  23. 23.
    Lomonaco R, Ortiz-Lopez C, Orsak B, Webb A, Hardies J, Darland C, et al. Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease. Hepatology (Baltimore, Md). 2012;55(5):1389–97. Scholar
  24. 24.
    • Chang Y, Jung HS, Cho J, Zhang Y, Yun KE, Lazo M, et al. Metabolically healthy obesity and the development of nonalcoholic fatty liver disease. Am J Gastroenterol. 2016;111(8):1133–40. This study tracks the incidence and development of NAFLD among the MHO.CrossRefGoogle Scholar
  25. 25.
    • Hwang YC, Hayashi T, Fujimoto WY, Kahn SE, Leonetti DL, McNeely MJ, et al. Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype. International journal of obesity (2005). 2015;39(9):1365–70. In this study, the authors note the association of VAT in the transition of the MHO to MUO.CrossRefGoogle Scholar
  26. 26.
    Caleyachetty R, Thomas GN, Toulis KA, Mohammed N, Gokhale KM, Balachandran K, et al. Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. J Am Coll Cardiol. 2017;70(12):1429–37. Scholar
  27. 27.
    Hagstrom H, Nasr P, Ekstedt M, Hammar U, Stal P, Hultcrantz R, et al. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: a long-term follow-up study. Hepatology communications. 2018;2(1):48–57. Scholar
  28. 28.
    • Wei JL, Leung JC, Loong TC, Wong GL, Yeung DK, Chan RS, et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using proton-magnetic resonance spectroscopy. Am J Gastroenterol. 2015;110(9):1306–14 quiz 15. doi:10.1038/ajg.2015.235. The authors characterize NAFLD among subjects with lean NAFLD.CrossRefGoogle Scholar
  29. 29.
    Kim D, Kim WR. Nonobese fatty liver disease. Clin Gastroenterol Hepatol. 2017;15(4):474–85.
  30. 30.
    Owei I, Umekwe N, Provo C, Wan J, Dagogo-Jack S. Insulin-sensitive and insulin-resistant obese and non-obese phenotypes: role in prediction of incident pre-diabetes in a longitudinal biracial cohort. BMJ Open Diabetes Res Care. 2017;5(1):e000415. Scholar
  31. 31.
    Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”. Am J Hum Genet. 1962;14:353–62.Google Scholar
  32. 32.
    Neel JV. The “thrifty genotype” in 1998. Nutr Rev. 1999;57(5 Pt 2):S2–9.Google Scholar
  33. 33.
    Speakman JR. Thrifty genes for obesity, an attractive but flawed idea, and an alternative perspective: the ‘drifty gene’ hypothesis. International journal of obesity (2005). 2008;32(11):1611–7. CrossRefGoogle Scholar
  34. 34.
    Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40(12):1461–5. Scholar
  35. 35.
    Lotta LA, Wittemans LBL, Zuber V, Stewart ID, Sharp SJ, Luan J, et al. Association of genetic variants related to gluteofemoral vs abdominal fat distribution with type 2 diabetes, coronary disease, and cardiovascular risk factors. Jama. 2018;320(24):2553–63. Scholar
  36. 36.
    Hernaez R, McLean J, Lazo M, Brancati FL, Hirschhorn JN, Borecki IB, et al. Association between variants in or near PNPLA3, GCKR, and PPP1R3B with ultrasound-defined steatosis based on data from the third National Health and Nutrition Examination Survey. Clin Gastroenterol Hepatol. 2013;11(9):1183–90 e2.
  37. 37.
    Palmer ND, Musani SK, Yerges-Armstrong LM, Feitosa MF, Bielak LF, Hernaez R, et al. Characterization of European ancestry nonalcoholic fatty liver disease-associated variants in individuals of African and Hispanic descent. Hepatology (Baltimore, Md). 2013;58(3):966–75. Scholar
  38. 38.
    Schwimmer JB, Celedon MA, Lavine JE, Salem R, Campbell N, Schork NJ, et al. Heritability of nonalcoholic fatty liver disease. Gastroenterology. 2009;136(5):1585–92. Scholar
  39. 39.
    Wagenknecht LE, Palmer ND, Bowden DW, Rotter JI, Norris JM, Ziegler J, et al. Association of PNPLA3 with non-alcoholic fatty liver disease in a minority cohort: the Insulin Resistance Atherosclerosis Family Study. Liver Int. 2011;31(3):412–6.
  40. 40.
    Abul-Husn NS, Cheng X, Li AH, Xin Y, Schurmann C, Stevis P, et al. A protein-truncating HSD17B13 variant and protection from chronic liver disease. N Engl J Med. 2018;378(12):1096–106. Scholar
  41. 41.
    Yang TC, South SJ. Neighborhood effects on body mass: temporal and spatial dimensions. Social science & medicine (1982). 2018;217:45–54. Scholar
  42. 42.
    Hales CM, Fryar CD, Carroll MD, Freedman DS, Aoki Y, Ogden CL. Differences in obesity prevalence by demographic characteristics and urbanization level among adults in the United States, 2013-2016. Jama. 2018;319(23):2419–29. Scholar
  43. 43.
    Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS data brief. 2010;2010(50):1–8.Google Scholar
  44. 44.
    Liu J, Coady S, Carr JJ, Hoffmann U, Taylor HA, Fox CS. Differential associations of abdominal visceral, subcutaneous adipose tissue with cardiometabolic risk factors between African and European Americans. Obesity (Silver Spring, Md). 2014;22(3):811–8. Scholar
  45. 45.
    •• Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS data brief. 2017;288:1–8 Using NHANES data, the authors report the prevalence of obesity among youth and adults stratified by sex and race/ethnicity.Google Scholar
  46. 46.
    Mongraw-Chaffin ML, Anderson CA, Allison MA, Ouyang P, Szklo M, Vaidya D, et al. Association between sex hormones and adiposity: qualitative differences in women and men in the multi-ethnic study of atherosclerosis. J Clin Endocrinol Metab. 2015;100(4):E596–600. Scholar
  47. 47.
    Jiang Y, Owei I, Wan J, Ebenibo S, Dagogo-Jack S. Adiponectin levels predict prediabetes risk: the Pathobiology of Prediabetes in A Biracial Cohort (POP-ABC) study. BMJ Open Diabetes Res Care. 2016;4(1):e000194. Scholar
  48. 48.
    Wong RJ, Chou C, Sinha SR, Kamal A, Ahmed A. Ethnic disparities in the association of body mass index with the risk of hypertension and diabetes. J Community Health. 2014;39(3):437–45. Scholar
  49. 49.
    Deurenberg-Yap M, Deurenberg P. Is a re-evaluation of WHO body mass index cut-off values needed? The case of Asians in Singapore. Nutr Rev. 2003;61(5 Pt 2):S80–7.CrossRefGoogle Scholar
  50. 50.
    Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM, et al. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology (Baltimore, Md). 2005;41(2):372–9. Scholar
  51. 51.
    Jih J, Mukherjea A, Vittinghoff E, Nguyen TT, Tsoh JY, Fukuoka Y, et al. Using appropriate body mass index cut points for overweight and obesity among Asian Americans. Prev Med. 2014;65:1–6.
  52. 52.
    Expert Consultation WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. Scholar
  53. 53.
    Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38(1):150–8. Scholar
  54. 54.
    Conway JM, Yanovski SZ, Avila NA, Hubbard VS. Visceral adipose tissue differences in black and white women. Am J Clin Nutr. 1995;61(4):765–71. Scholar
  55. 55.
    Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9. Scholar
  56. 56.
    Katzmarzyk PT, Bray GA, Greenway FL, Johnson WD, Newton RL Jr, Ravussin E, et al. Racial differences in abdominal depot-specific adiposity in white and African American adults. Am J Clin Nutr. 2010;91(1):7–15. Scholar
  57. 57.
    McClain J, Hsu F, Brown E, Burke G, Carr J, Harris T, et al. Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA). Obesity (Silver Spring, Md). 2013;21(5):1056–63. Scholar
  58. 58.
    Bambha K, Belt P, Abraham M, Wilson LA, Pabst M, Ferrell L, et al. Ethnicity and nonalcoholic fatty liver disease. Hepatology (Baltimore, Md). 2012;55(3):769–80. Scholar
  59. 59.
    Browning MG, Khoraki J, DeAntonio JH, Mazzini G, Mangino MJ, Siddiqui MS, et al. Protective effect of black relative to white race against non-alcoholic fatty liver disease in patients with severe obesity. independent of type 2 diabetes International journal of obesity (2005). 2018;42(4):926–9. CrossRefGoogle Scholar
  60. 60.
    Mohanty SR, Troy TN, Huo D, O'Brien BL, Jensen DM, Hart J. Influence of ethnicity on histological differences in non-alcoholic fatty liver disease. J Hepatol. 2009;50(4):797–804. Scholar
  61. 61.
    Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice. journal of the American Gastroenterological Association. 2018;16(2):198–210 e2. Scholar
  62. 62.
    Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Stal P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology (Baltimore, Md). 2015;61(5):1547–54. Scholar
  63. 63.
    Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology (Baltimore, Md). 2004;40(6):1387–95. Scholar
  64. 64.
    Garcia AE, Kasim N, Tamboli RA, Gonzalez RS, Antoun J, Eckert EA, et al. Lipoprotein profiles in class III obese Caucasian and African American women with nonalcoholic fatty liver disease. PLoS One. 2015;10(11):e0142676. Scholar
  65. 65.
    Lee S, Kuk JL. Visceral fat is associated with the racial differences in liver fat between black and white adolescent boys with obesity. Pediatr Diabetes. 2017;18(7):660–3. Scholar
  66. 66.
    Lomonaco R, Ortiz-Lopez C, Orsak B, Finch J, Webb A, Bril F, et al. Role of ethnicity in overweight and obese patients with nonalcoholic steatohepatitis. Hepatology (Baltimore, Md). 2011;54(3):837–45. Scholar
  67. 67.
    Bril F, Portillo-Sanchez P, Liu IC, Kalavalapalli S, Dayton K, Cusi K. Clinical and histologic characterization of nonalcoholic steatohepatitis in African American patients. Diabetes Care. 2018;41(1):187–92. Scholar
  68. 68.
    Shen J, Wong GL, Chan HL, Chan HY, Yeung DK, Chan RS, et al. PNPLA3 gene polymorphism accounts for fatty liver in community subjects without metabolic syndrome. Aliment Pharmacol Ther. 2014;39(5):532–9. Scholar
  69. 69.
    Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, 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(1):124–31. Scholar
  70. 70.
    Ryu S, Chang Y, Jung HS, Yun KE, Kwon MJ, Choi Y, et al. Relationship of sitting time and physical activity with non-alcoholic fatty liver disease. J Hepatol. 2015;63(5):1229–37. Scholar
  71. 71.
    Rinella M, Charlton M. The globalization of nonalcoholic fatty liver disease: prevalence and impact on world health. Hepatology (Baltimore, Md). 2016;64(1):19–22. Scholar
  72. 72.
    Fleischman MW, Budoff M, Zeb I, Li D, Foster T. NAFLD prevalence differs among Hispanic subgroups: the Multi-Ethnic Study of Atherosclerosis. World J Gastroenterol : WJG. 2014;20(17):4987–93. Scholar
  73. 73.
    Chan WK, Treeprasertsuk S, Imajo K, Nakajima A, Seki Y, Kasama K, et al. Clinical features and treatment of nonalcoholic fatty liver disease across the Asia Pacific region-the GO ASIA initiative. Aliment Pharmacol Ther. 2018;47(6):816–25. Scholar
  74. 74.
    Merlotti C, Ceriani V, Morabito A, Pontiroli AE. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis. International journal of obesity (2005). 2017;41(5):672–82. CrossRefGoogle Scholar
  75. 75.
    Nyenwe EA, Ogwo CC, Owei I, Wan JY, Dagogo-Jack S. Parental history of type 2 diabetes is associated with lower resting energy expenditure in normoglycemic subjects. BMJ Open Diab Res Care. 2018;6:e000511. Scholar
  76. 76.
    DeLany JP, Jakicic JM, Lowery JB, Hames KC, Kelley DE, Goodpaster BH. African American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements. Int J Obes (Lond) (2005). 2014;38(9):1147–52.
  77. 77.
    Srivastava G, Apovian CM. Current pharmacotherapy for obesity. Nat Rev Endocrinol. 2018;14(1):12–24. Scholar
  78. 78.
    Admiraal WM, Celik F, Gerdes VE, Dallal RM, Hoekstra JB, Holleman F. Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care. 2012;35(9):1951–8. Scholar
  79. 79.
    Wee CC, Jones DB, Apovian C, Hess DT, Chiodi SN, Bourland AC, et al. Weight loss after bariatric surgery: do clinical and behavioral factors explain racial differences? Obes Surg. 2017;27(11):2873–84. Scholar
  80. 80.
    Valencia A, Garcia LC, Morton J. The impact of ethnicity on metabolic outcomes after bariatric surgery. J Surg Res. 2019;236:345–51. Scholar
  81. 81.
    Intercept announces positive topline results from pivotal phase 3 REGENERATE study of obeticholic acid in patients with liver fibrosis due to NASH. Accessed February 23 2019.
  82. 82.
    Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md). 2018;67(1):328–57. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Uchenna Agbim
    • 1
  • Rotonya M. Carr
    • 2
  • Octavia Pickett-Blakely
    • 2
  • Sam Dagogo-Jack
    • 3
    Email author
  1. 1.Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant InstituteUniversity of Tennessee Health Science CenterMemphisUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of Internal MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Endocrinology, Diabetes and Metabolism, Department of Internal MedicineUniversity of Tennessee Health Science CenterMemphisUSA

Personalised recommendations