A Retrospective Study of Hospitalizations in the USA: Proportion of Hospitalizations With Non-Alcoholic Fatty Liver Disease in Non-Obese Population

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD), one of the leading causes of end-stage liver disease, is known to be associated with obesity. However, only a few studies in the United States (US) have described non-obese NAFLD, most of which were on the outpatient population. AimWe aimed to investigate the proportion of hospitalizations in the US with a diagnosis code that included NAFLD in the non-obese population. MethodsWe analyzed adult discharges from the Nationwide Inpatient Sample with a diagnosis of NAFLD from January 2010 to December 2014. We created two groups: obese (overweight or obese) and non-obese (normal or underweight) groups. Basic demographic and clinical characteristics were compared using the chi-square test and Student's t-test. ResultsA total of 194,787 hospitalizations with NAFLD were identified over the five-year period. It was observed that the prevalence of non-obese NAFLD hospitalizations increased yearly. Non-obese NAFLD hospitalizations had a higher mean age (57.5 vs 51.5 years, p < 0.0001) and a higher proportion of males (43.3% vs 36.1%, p < 0.0001) than obese NAFLD hospitalizations. With univariate analysis, non-obese NAFLD hospitalizations had lower odds of hypertension (OR 0.74, p < 0.0001), diabetes mellitus (OR 0.65, p < 0.0001). Non-obese hospitalizations had higher odds of cirrhosis (OR 1.30, p < 0.001) and decompensated cirrhosis (OR 1.30, p < 0.001) after adjusting for age, sex, race, diabetes mellitus, and dyslipidemia. Hospitalizations with non-obese NAFLD had higher odds of death (OR 1.49, p < 0.001) after adjusting for age, gender, race, co-morbidities, cirrhosis, and liver decompensation. ConclusionThere is a continued rise in the proportion of non-obese NAFLD among hospitalizations in the US. Nonobese NAFLD hospitalizations were less likely to have hypertension and diabetes, but more likely to have decompensated liver disease. Further studies are needed to better characterize these patients to enable early detection, treatment, and reduction in complications of liver disease.

Differential Mortality Outcomes in Real-world Patients with Lean, Nonobese, and Obese Nonalcoholic Fatty Liver Disease

“…6,21 In fact, a recent study investigated the hospitalization trends for those with lean/nonobese NAFLD compared to obese NAFLD using the US National Inpatient Sample database. 22 They determined that over the 5-year span of their study, the hospitalization rate increased yearly among the lean/nonobese as compared to the obese NAFLD population. The lean NAFLD population was also older and had fewer metabolic comorbidities but were more likely to have cirrhosis, decompensated cirrhosis, and die.…”

Prevalence and Risk Factors of Non-Alcoholic Fatty Liver Disease (NAFLD) in Non-Obese Patients with Schizophrenia: A Retrospective Study

“…23 Studies have found that despite the absence of obesity, non-obese NAFLD subjects had a higher risk of death. 24 Furthermore, patients with NAFLD have been found to be independently associated with an increased risk for diabetes in non-obese subjects. 25 We found that NAFLD was common in non-obese patients with schizophrenia.…”