Risk of cardiovascular disease in lean patients with nonalcoholic fatty liver disease

Abstract

Background:Patients with nonalcoholic fatty liver disease (NAFLD) are highly at risk for cardiovascular disease (CVD). However, the risk of developing CVD in patients with lean NAFLD is not yet fully understood. Therefore, this study aimed to compare the CVD incidence in Japanese patients with lean NAFLD and those with non-lean NAFLD. Methods: A total of 581 patients with NAFLD (219 with lean and 362 with non-lean NAFLD) were recruited. All patients underwent annual health checkups for at least 3 years, and CVD incidence was investigated during follow-up. The primary end-point was CVD incidence at 3 years. Results: The 3-year new CVD incidence rates in patients with lean and non-lean NAFLD were 2.3% and 3.9%, respectively, and there was no significant difference between two groups (p = 0.3). Multivariable analysis adjusted for age, sex, hypertension, diabetes, and lean NAFLD/non-lean NAFLD revealed that age (every 10 years) as an independent factor associated with CVD incidence with an odds ratio (OR) of 2.0 (95% confidence interval [CI]: 1.3–3.2), whereas lean NAFLD was not associated with CVD incidence (OR: 0.6; 95% CI: 0.2–1.6). Conclusions: CVD incidence was comparable between patients with lean NAFLD and those with non-lean NAFLD. Therefore, CVD prevention is needed even in patients with lean NAFLD.

Impact of nomenclature as metabolic associated steatotic liver disease on steatotic liver disease prevalence and screening: a prospective population survey in Asians

“…A study from India that recruited 149 NAFLD patients with liver biopsy showed that lean NAFLD patients had a similar degree of NASH ( 16 Moreover, a 3-yearfollow-up study indicated that "lean" is not an independent protective factor for cardiovascular disease in NAFLD patients. 17 Although a previous study using data from the Third National Health and Nutrition Examination Survey reported that NAFLD non-MAFLD patients did not have a higher risk of all-cause mortality than patients without liver disease, 18 there was a risk new-onset metabolic disorders like type 2 diabetes in the near future. 19,20 We also found that HOMA-IR was independent risk factor and tea consumption was protective factor for moderateto-severe steatosis in MASLD non-MAFLD patients, indicating that they require lifestyle and diet interventions rather than purely pharmaceutical interventions.…”

Mortality, Hepatic Decompensation, and Cardiovascular- and Renal-Related Outcomes in Lean Versus Non-lean Patients Hospitalized With Metabolic Dysfunction-Associated Steatohepatitis (MASH)

“…Despite these severe implications, lean patients with MASH might not present with an elevated risk of developing cardiovascular disease, although their mortality rates from cardiovascular complications remain high [9,10]. This discrepancy points to a complex interplay of genetic, metabolic, and environmental factors that influence disease progression in lean MASH patients [11].…”