Ethnic heterogeneity in steatosis-driven liver injury among MASLD patients: Han Chinese vs. Caucasian

Aim of the study: Despite the increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) worldwide, the ethnic differences in clinical features remain unknown.We aimed to compare steatosis-associated liver severity differences between Han Chinese vs. Caucasian patients with MASLD.Material and methods: This was a cross-sectional study comparing Han Chinese MASLD patients from four University-affiliated Medical Centers of fatty liver in south China from January 2015 to January 2023 and Caucasian MASLD patients from the UK Biobank database.All patients were measured for anthropometric parameters, biochemistry markers, metabolic tests and liver fat content (LFC) determined with the magnetic resonance imaging proton density fat fraction (MRI-PDFF).Results: Han Chinese MASLD patients (n = 620) had higher proportions of moderate and severe grades of steatosis than Caucasian MASLD patients (n = 829) (26.5% vs. 16.4%,p < 0.001).There was a linear positive correlation between serum alanine aminotransferase (ALT) levels and the average LFC in Han Chinese MASLD patients but not in Caucasian patients.Multivariate linear regression analysis demonstrated that such positive correlations between ALT levels and LFC remained (' = 0.192, p < 0.001 in male patients; ' = 0.229, p < 0.001 in female patients).Furthermore, liver biopsies confirmed that Han Chinese patients showed higher liver histological severity -measured by SAF (Steatosis, Activity and Fibrosis) scores -as LFC increased (r = 0.632, p < 0.001).Conclusions: Han Chinese MASLD patients tended to suffer from higher risk of high liver fat content associated liver injuries than Caucasian patients, suggesting that higher hepatic lipotoxicity sensitivity compared to Caucasians might be one of the ethnic distinctions of Chinese populations.