Background & Aims: Non-alcoholic fatty liver disease (NAFLD) can develop in individuals who are not overweight. Whether lean persons with NAFLD have lower mortality and lower incidence of cirrhosis, cardiovascular diseases (CVD), diabetes mellitus (DM) and cancer than overweight/obese persons with NAFLD remains inconclusive. We compared mortality and incidence of cirrhosis, CVD, DM and cancer between lean versus non-lean persons with NAFLD.Methods: This is a retrospective study of adults with NAFLD in a single centre from 2012 to 2021. Primary outcomes were mortality and new diagnosis of cirrhosis, CVD, DM and cancer. Outcomes were modelled using competing risk analysis and Cox proportional hazards regression analysis.Results: A total of 18,594 and 13,420 patients were identified for cross-sectional and longitudinal analysis respectively: approximately 11% lean, 25% overweight, 28% class 1 obesity and 35% class 2-3 obesity. The median age was 51.0 years, 54.6% were women. The median follow-up was 49.3 months. Lean patients had lower prevalence of metabolic diseases at baseline and lower incidence of cirrhosis and DM than non-lean patients and no difference in CVD, any cancer or obesity-related cancer during follow-up. However, lean patients had significantly higher mortality with incidence per 1000 person-years of 16.67, 10.11, 7.37 and 8.99, respectively, in lean, overweight, obesity class 1 and obesity class 2-3 groups respectively.Conclusions: Lean patients with NAFLD had higher mortality despite lower incidence of cirrhosis and DM, and similar incidence of CVD and cancer and merit similar if not more attention as non-lean patients with NAFLD.| 1015 WIJARNPREECHA et al. | INTRODUC TI ONNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, affecting 25% of the population worldwide, and its clinical burden is expected to rise. 1 NAFLD is strongly associated with obesity and its comorbidities but can also develop in individuals who are not overweight ('lean NAFLD'). 2 The prevalence of NAFLD among lean individuals in the general population is 10%-20% with most studies reported from Asian countries, and the highest prevalence reported in Mexico (37%). [3][4][5][6] NAFLD is associated with a wide spectrum of extrahepatic diseases, such as cardiovascular diseases (CVD), metabolic diseases (diabetes mellitus [DM], hypertension, dyslipidaemia), chronic kidney diseases (CKD) or cancers. 7,8 Several cross-sectional studies have evaluated prevalence of hepatic and extra-hepatic diseases among lean versus obese individuals with NAFLD. A cross-sectional analysis of the TARGET-NASH study cohort with 3386 NAFLD patients in the United States found a lower prevalence of cirrhosis, DM and CVD in lean individuals compared to overweight/obese individuals. 2 Another study from Austria with 4091 NAFLD participants had similar findings with lower prevalence of metabolic diseases (DM, metabolic syndrome, hypertension, dyslipidaemia) and lower Framingham risk score for CVD but no significant differen...

SummaryBackgroundSocial determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.AimTo assess whether SDOH impact fibrosis progression in patients who already have MASLD.MethodsThis was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.ResultsWe included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.DiscussionNeighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.

1170] Figure 1. Forest plots for rate of (A) portal vein thrombosis (PVT) recanalization, (B) bleeding events, and (C) all-cause mortality following use of anticoagulation as therapy for PVT in the setting of cirrhosis.

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