Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This ...Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.展开更多
Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese subjects;however,it is not rare among lean individuals.Given the absence of traditional risk factors,it tends to remain under-recognised.The met...Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese subjects;however,it is not rare among lean individuals.Given the absence of traditional risk factors,it tends to remain under-recognised.The metabolic profiles of lean NAFLD patients are frequently comparable to those of obese NAFLD patients.Though results from several studies have been mixed,it has been generally revealed that lean subjects with NAFLD have minor insulin resistance compared to that in obese NAFLD.Several genetic variants are associated with NAFLD without insulin resistance.Some data suggest that the prevalence of steatohepatitis and advanced fibrosis do not differ significantly between lean and obese NAFLD;however,the former tend to have less severe disease at presentation.The underlying pathophysiology of lean NAFLD may be quite different.Genetic predispositions,fructose-and cholesterol-rich diet,visceral adiposity and dyslipidaemia have potential roles in the pathogenic underpinnings.Lean NAFLD may pose a risk for metabolic disturbances,cardiovascular morbidity or overall mortality.Secondary causes of hepatic steatosis are also needed to be ruled out in lean subjects with NAFLD.The effectiveness of various treatment modalities,such as exercise and pharmacotherapy,on lean NAFLD is not known.Weight loss is expected to help lean NAFLD patients who have visceral obesity.Further investigation is needed for many aspects of lean NAFLD,including mechanistic pathogenesis,risk assessment,natural history and therapeutic approach.展开更多
文摘Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.
文摘Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese subjects;however,it is not rare among lean individuals.Given the absence of traditional risk factors,it tends to remain under-recognised.The metabolic profiles of lean NAFLD patients are frequently comparable to those of obese NAFLD patients.Though results from several studies have been mixed,it has been generally revealed that lean subjects with NAFLD have minor insulin resistance compared to that in obese NAFLD.Several genetic variants are associated with NAFLD without insulin resistance.Some data suggest that the prevalence of steatohepatitis and advanced fibrosis do not differ significantly between lean and obese NAFLD;however,the former tend to have less severe disease at presentation.The underlying pathophysiology of lean NAFLD may be quite different.Genetic predispositions,fructose-and cholesterol-rich diet,visceral adiposity and dyslipidaemia have potential roles in the pathogenic underpinnings.Lean NAFLD may pose a risk for metabolic disturbances,cardiovascular morbidity or overall mortality.Secondary causes of hepatic steatosis are also needed to be ruled out in lean subjects with NAFLD.The effectiveness of various treatment modalities,such as exercise and pharmacotherapy,on lean NAFLD is not known.Weight loss is expected to help lean NAFLD patients who have visceral obesity.Further investigation is needed for many aspects of lean NAFLD,including mechanistic pathogenesis,risk assessment,natural history and therapeutic approach.
