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Clinical Research

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

International Journal of Obesity volume 47, pages 986–992 (2023)Cite this article

Subjects

Abstract

Introduction

Although most patients with NAFLD are obese or overweight, some are lean with normal BMI. Our aim was to assess differences in clinicopathological profile and liver disease severity among lean and non-lean NAFLD.

Methods

Data of 1040 NAFLD patients over last 10 years was analysed. BMI < 23 kg/m2 categorised lean patients. Non-invasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP) while fibrosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with significant fibrosis. 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). FAST [0.38 (0.18–0.66) vs 0.39 (0.27–0.73), p = 0.53], FIB-4 [1.08 (0.65–1.91) vs 1.09 (0.66–1.94), p = 0.94] and LSM [6.1 (4.8-7.9) vs 6.2 (4.7–8.6), p = 0.19) were similar.

Liver biopsy was available in 149 patients [lean: 19 (12.7%), non-lean: 130 (87.3%)]. There was no difference in the number of patients with NASH [4 (21.05%) vs 20 (15.3%), p = 0.51], significant fibrosis [2 (10.5%) vs 32 (24.6%), p = 0.25] or advanced fibrosis [1 (5.26%) vs 18 (13.84%), p = 0.47].

Conclusion

Although metabolic co-morbidities are less common, there is no difference in liver disease severity among both groups.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Part of the manuscript was presented as poster at the annual conference of the Indian National Association for Study of the Liver (INASL) 2022.

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Authors and Affiliations

  1. Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Arka De, Manu Mehta, Priya Singh, Naveen Bhagat & Ajay Duseja

  2. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Suvradeep Mitra & Ashim Das

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Contributions

ArD: conceptualisation, patient recruitment, data analysis and manuscript writing; MM: data collection and analysis; PS: data collection; NB: manuscript writing; SM: data collection; AsD: histopathology assessment; AD: conceptualisation, patient recruitment, data curation and critical revision.

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Correspondence to Ajay Duseja.

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De, A., Mehta, M., Singh, P. et al. 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. Int J Obes 47, 986–992 (2023). https://doi.org/10.1038/s41366-023-01346-w

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