Lean NAFLD patients fare better than overweight peers

For individuals with nonalcoholic fatty liver disease (NAFLD), being lean equates to less complications, with a recent study reporting that lean patients are less likely to have cirrhosis, cardiovascular disease (CVD), and metabolic abnormalities compared with their overweight or obese peers.

Researchers looked at 3,386 NAFLD patients enrolled in TARGET-NASH. Of these, 433 were lean (12.8 percent; body mass index [BMI] >18.5–25 kg/m²), 917 were overweight (27.1 percent; BMI >25–30 kg/m²), 896 had class I obesity (26.5 percent; BMI >30-35 kg/m²), and 1,140 had class II or III obesity (33.7 percent; BMI >35 kg/m²).

Asians accounted for 48.7 percent of lean patients, and the proportions decreased as BMI categories increased (p<0.0001). Lean patients were also older than those with higher BMIs (median age 60 vs 58 years; p=0.0073), but there was no difference in sex.

Fewer patients in the lean vs higher BMI categories had cirrhosis (22.6 percent vs 40.2 percent), CVD history (9.0 percent vs 14.8 percent), diabetes (32.6 percent vs 53.5 percent), hypertension (47.8 percent vs 67.4 percent), and dyslipidaemia (54.0 percent vs 64.1 percent). Notably, Asians were less likely to have these complications compared with patients of other races or ethnicities, regardless of BMI.

On logistic regression analysis, lean Asians had lower odds of having NAFLD-associated cirrhosis compared with non-Asians who were also lean (odds ratio, 0.47, 95 percent confidence interval, 0.29–0.77).

According to the researchers, additional investigation is needed to shed light on the mechanisms responsible for the development of NAFLD in lean individuals, the reasons for the differences in NAFLD prevalence among lean individuals of different races/ethnicities, and the long-term clinical implications of NAFLD in lean persons.