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HEALTHY
EATING

Hispanics and

Liver Disease

By Rita Lepe, MD

According to the 2019 U.S. Census, His-
panics make up 18.5% of the U.S. population
(60 million). In Texas, 39.7% of the popula-
tion is Hispanic (11.5 million) and they pri-
marily live in large urban cities, including San
Antonio (63.2%), Dallas (42.4%), Austin
(35.1%) and Fort Worth (35%). Hispanics,
by definition, are a heterogenous group de-
scending from countries related to Spain,
Spanish language and culture. Hispanics can
be of any race, although the majority are clas-
sified as White, thus the distinction in the
Census as Non-Hispanic Whites (NHW)
for the Caucasian population.
Chronic liver diseases are very prevalent in
the Hispanic population and are a leading which is currently the most common pedi- orthotopic liver transplant survival compared
cause of death. In 2018, chronic liver disease atric liver disease. If not addressed early, these to NHW and AA. Hispanics with end-stage
ranked 7th as a leading cause of overall mor- children will go on to develop early onset of liver disease (ESLD) should be promptly re-
tality in Hispanics and the 4th leading cause DM type 2, hypercholesterolemia and meta- ferred to transplant programs for evaluation.
of death in Hispanic men ages 55-64. The bolic syndrome at an early age. Chronic liver disease disproportionately af-
most prevalent liver diseases are non-alco- Data from NHANES III reported that 2% fects Hispanics of all ages. Obesity is also af-
holic fatty liver disease (NAFLD), chronic of Hispanics have chronic hepatitis C. In His- fecting Hispanics at an alarming rate,
hepatitis C, alcoholic liver disease, cirrhosis panics, cure rates of less than 95% are compa- suggesting that higher rates of NASH and
and liver cancer. Health care disparities exist rable to NHW and other races. Advanced liver liver cancer will lead to higher rates of mortal-
that are responsible for the increased mortal- disease due to alcohol abuse has a prevalence of ity. Early intervention addressing the risk fac-
ity. It is important to address them to im- 16% higher than that of other ethnic groups. tors for chronic liver disease in Hispanics and
prove long-term health outcomes. Death due to alcohol-related chronic liver dis- prevention, especially in the pediatric popula-
Obesity affects 43% of Hispanics in the ease is two times higher than in NHW men. tion, is of extreme importance. Programs need
U.S. Obesity can lead to the development of Rates for hepatocellular carcinoma and to be developed at the public health level.
NAFLD/NASH which can progress to cir- cholangiocarcinoma are 1.9/100,000 in His-
rhosis and liver cancer. Metabolic syndrome panics compared to 0.7 for NHW. The death Rita Lepe, MD is a Hepatologist
affects 35% of U.S. Hispanics and is a risk fac- rate is twice as high for Hispanics than with the Texas Liver Institute and is
tor for NAFLD/non-alcoholic steatohepati- NHW due to the fact that Hispanics tend to a member of many medical societies
tis (NASH). present with more advanced stage disease and including the American Association for the
A concerning fact is that Hispanic chil- are less likely to receive curative treatments. Study of Liver Diseases (AASLD), American
dren have the highest rates of obesity at Many studies have looked at the effect of Gastroenterology Association (AGA), Ameri-
25.8% compared to 22% of African Ameri- race/ethnicity on graft and patient outcomes can Society of Transplantation (AST) and the
can (AA) children and 14% of NHW chil- in patients undergoing liver transplants. His- North Texas Latin American Physician Asso-
dren. Children can also develop fatty liver, panics have equivalent or improved graft and ciation (NTLAPA).

22 SAN ANTONIO MEDICINE • May 2021