RT Journal Article SR Electronic T1 Non-invasive markers of liver fibrosis in fatty liver disease are unreliable in people of South Asian descent JF Frontline Gastroenterology JO Frontline Gastroenterol FD BMJ Publishing Group Ltd SP flgastro-2017-100865 DO 10.1136/flgastro-2017-100865 A1 Sampath De Silva A1 Wenhao Li A1 Polychronis Kemos A1 James H Brindley A1 Jibran Mecci A1 Salma Samsuddin A1 Joanne Chin-Aleong A1 Roger M Feakins A1 Graham R Foster A1 Wing-Kin Syn A1 William Alazawi YR 2017 UL http://fg.bmj.com/content/early/2017/11/16/flgastro-2017-100865.abstract AB Objective Liver biopsy is the most accurate method for determining stage and grade of injury in non-alcoholic fatty liver disease (NAFLD). Given risks and limitations of biopsy, non-invasive tests such as NAFLD fibrosis score, aspartate transaminase (AST) to platelet ratio index, Fib-4, AST/alanine transaminase ratio and BARD are used. Prevalence and severity of NAFLD and metabolic syndrome vary by ethnicity, yet tests have been developed in largely white populations. We tested our hypothesis that non-invasive tests that include metabolic parameters are less accurate in South Asian compared with white patients.Design Retrospective cross-sectional.Setting Specialist liver centre.Patients Patients with histologically confirmed NAFLD.Interventions Scores calculated using clinical data taken within 1 week and compared with histology (Kleiner).Main outcome measures Diagnostic test characteristics.Results 175 patients were identified. South Asians (n=90) were younger, had lower body mass index and lower proportion of obesity compared with white patients (n=79), with comparable rates of diabetes and liver injury. Tests are less sensitive at detecting advanced fibrosis in South Asian compared with white patients. Relative risk of correct diagnosis in white patients compared with South Asians is 1.86 (95% CI 1.4 to 2.6). In binary logistic regression models, ethnicity and platelet count predicted accuracy. Transient elastography was equally and highly accurate in both ethnicities.Conclusions Blood test-based non-invasive scores are less accurate in South Asian patients, irrespective of metabolic parameters. Ethnicity should be considered when devising risk-stratification algorithms for NAFLD.