Lean Indian patients with non-alcoholic fatty liver disease (NAFLD) have less metabolic risk factors but similar liver disease severity as non-lean patients with NAFLD

Abstract

IntroductionAlthough most patients with NAFLD are obese or overweight, some are lean with normal BMI. Our aim was to assess differences in clinicopathological pro le and liver disease severity among lean and nonlean NAFLD. Methods Data of 1040 NAFLD patients over last 10 years was analysed. BMI <23kg/m 2 categorised lean patients. Non-invasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP) while brosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with signi cant brosis. Histology was reported using NASH-CRN system. Results 149 (14.3%) patients were lean while 891 (85.7%) patients were non-lean. Diabetes mellitus [25 (16.7%) vs 152 (17.05%), p>0.99], elevated triglycerides [81 (54.3%) vs 525 (58.9%), p=0.33] and low HDL [71(47.6%) vs 479(53.7%),p=0.18] were observed in a similar proportion. Lean patients were less likely to have central obesity [72 (48.3%) vs 788 (88.4%),p<0.001], hypertension [16 (10.7%) vs 239(26.8%),p<0.001] and metabolic syndrome [21 (14.09%) vs 290 (32.5%),p<0.001]. No difference in steatosis assessment was noted using ultrasound (p=0.55) or CAP (0.11).

Associations of PNPLA3 and LEP genetic polymorphisms with metabolic-associated fatty liver disease in Thai people living with human immunodeficiency virus

“…When examining the sexes separately, some studies reported a high prevalence of lean NAFLD in males[ 40 , 41 , 45 , 46 , 59 , 61 ], while others indicated a higher prevalence in females[ 7 , 50 , 58 , 62 ]. Nevertheless, there are studies reporting no significant differences in prevalence between females and males[ 42 , 51 , 52 , 57 , 60 , 63 ].…”

“…When comparing lean patients with NAFLD and overweight/obese patients with NAFLD, studies reported that lean NAFLD patients have a lower prevalence of T2DM[ 7 , 37 , 50 , 58 , 60 - 62 , 66 ], dyslipidemia[ 7 , 50 , 58 , 60 ] , HTN[ 7 , 49 , 50 , 52 , 56 - 58 , 60 , 63 , 66 , 67 ], MetS[ 49 , 52 , 62 , 66 ], cardiovascular disease[ 60 ], and cirrhosis[ 60 , 62 ]. Laboratory values were compared, indicating lower levels of aspartate aminotransferase (AST)[ 7 , 53 , 57 , 59 , 62 , 63 , 67 ], alanine aminotransferase (ALT)[ 7 , 53 , 57 , 59 , 62 , 63 , 67 ], platelet count[ 7 , 66 ], FBG[ 53 , 58 , 63 ], TG[ 53 , 57 , 58 , 61 , 62 ], homeostatic model assessment for insulin resistance (HOMA-IR)[ 57 , 63 , 68 ], and total cholesterol[ 57 , 58 , 61 - 63 ], as well as higher levels of high density lipoproteins (HDL)[ 56 , 61 - 63 , 66 , 6...…”

“…Laboratory values were compared, indicating lower levels of aspartate aminotransferase (AST)[ 7 , 53 , 57 , 59 , 62 , 63 , 67 ], alanine aminotransferase (ALT)[ 7 , 53 , 57 , 59 , 62 , 63 , 67 ], platelet count[ 7 , 66 ], FBG[ 53 , 58 , 63 ], TG[ 53 , 57 , 58 , 61 , 62 ], homeostatic model assessment for insulin resistance (HOMA-IR)[ 57 , 63 , 68 ], and total cholesterol[ 57 , 58 , 61 - 63 ], as well as higher levels of high density lipoproteins (HDL)[ 56 , 61 - 63 , 66 , 69 ]. Regarding anthropometric measurements, the studies reported lower WC[ 52 , 56 , 63 , 66 ], BMI[ 63 , 70 ], and waist-to-hip ratio (WHR)[ 63 , 70 ] in lean NAFLD compared to overweight/obese counterparts.…”

Glutamine prevents high-fat diet-induced hepatic lipid accumulation in mice by modulating lipolysis and oxidative stress

“…NAFLD has become a public health problem that threatens a quarter of the global population [3]. Based on its histology, this disease includes simple hepatic steatosis, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis [4,5]. NAFLD is associated with several metabolic diseases, including diabetes, obesity, and hypertension [6,7].…”