Liver Disease and Why It’s a Concern for Asian Americans and Pacific Islanders

Chronic liver disease and liver cancer are surging in the United States, but no group is more affected than Asian Americans and Pacific Islanders (AAPI). Though only 6% of the U.S. population, people of Asian descent account for 60% of liver cancer cases in the nation. 

In response to these statistics, Columbia surgeon Tomoaki Kato, MD, decided to personally tackle liver disease by creating the Columbia Liver Asian Outreach Office, a branch of the Asian Liver Health Initiative of NewYork-Presbyterian. The outreach office, based in Flushing, Queens, serves a diverse population of Asian patients and sets a standard for culturally responsive care.  

We spoke with Kato to find out more.  

Why does liver disease affect many Asian Americans and Pacific Islanders? 

Nearly half of liver cancer cases are caused by chronic infection with the hepatitis B virus, a type of liver infection that is usually asymptomatic. The virus has been prevalent in China, some parts of Southeast Asia, East Asia (including Indonesia, Japan, Korea, Taiwan, and the Philippines), and India.  

Most people are infected with hepatitis B when the virus is passed from mother to child during pregnancy. Many of these countries did not (or still do not) have maternal screening programs, so the virus is passed down through the generations. Almost all babies exposed to hepatitis B will become chronic carriers and will be at high risk of liver disease as adults. 

Many AAPI are immigrants from these countries, and it’s estimated that 1 in 10 AAPI has hepatitis B. However, most do not have information about prevention, transmission, or treatment options. Liver disease screening is the only way to find out if you have chronic hepatitis B. 

The good news is that American-born children of these immigrants are usually vaccinated at birth against hepatitis B, so hepatitis B is declining in the AAPI population. 

What does the Columbia Liver Asian Outreach Office do? 

The Asian Liver Health Initiative was created to raise awareness about liver disease in the community, to promote screening for liver disease and liver cancer, and to educate patients and providers about treatment options. The Columbia Liver Asian Outreach Office serves the local community and has diverse medical providers who can speak with patients in their native languages. 

The providers and staff have worked with the community to provide education by partnering with local student groups, the local business community, and NewYork-Presbyterian Queens. 

We’ve also worked with some New York City high schools to educate first and second-generation AAPI high school students, so the students would share their knowledge with their parents in the hope the parents would get screened. Educational campaigns like this have helped reduce spread and manage disease. 

Are other types of liver disease a danger for Asian Americans and Pacific Islanders? 

Non-alcoholic fatty liver disease, a dangerous buildup of fat in the liver not due to alcohol consumption, is expected to be the leading cause of liver transplantation by 2025. Its rise in the United States is largely due to obesity. But for unknown reasons, Asian people with a low body mass index are likely to develop the disease. 

Recurrent pyogenic cholangitis, a chronic infection, is a little understood disease caused by infection in the bile ducts. It’s found in people of Asian descent. The reasons why are unknown.  

How to prevent liver disease 

Hepatitis B is spread through blood, semen, or other body fluids but can be prevented by vaccination. (Vaccination cannot prevent disease if administered after infection with hepatitis B). 

Other types of liver disease can be prevented by: 

• Avoiding or reducing alcohol consumption 
• Avoiding food and drink made with trans fats or high-fructose corn syrup 
• Limiting consumption of processed meat  
• Limiting use of medications like acetaminophen (Tylenol)

What does the liver do? 

To help the digestive system function, the liver separates necessary nutrients from waste and carries toxins out of the body. The liver also helps the immune system protect you from infection.