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Factors that make treating NASH and NAFLD a unique challenge for non-Hispanic Black Americans range from Social Determinants of Health (SDOH) to omics suggesting that the disease in Black Americans may be different than in Caucasians or a range of behavioral elements (for example, smoking) that are more closely associated with Black Americans.

This conversation begins with Stephen Harrison noting that a combination of lower incidence of Fatty Liver disease within this population and an historically appropriate trust deficit that non-Hispanic Black Americans feel toward medical trials leads to study samples without enough sample to tell us whether a given diagnostic or course of therapy works better or worse in a non-Hispanic Black American population. As a result, he notes, we do not know how negative health behaviors like smoking or alcohol, genomic patterns and comorbidities affect liver health in this population. Later on, Zaki Sherif notes that in omics work in HCC, he and colleagues identified metabolites that upregulated in Caucasians and down-regulated in Blacks. All this culminated in Donna Cryer's point that this is an historic moment to enrich non-Hispanic Black American populations in these trials so that from the moment we begin using these drugs in the general population, we will know how these drugs work among Blacks instead of simply "assuming" they work as they do with other racial groups, only to lear 5-10 years later than this is wrong.