Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease

Gutiérrez-Grobe, Ylse; Juárez-Hernández, Eva; Sánchez-Jiménez, Beatriz A; Uribe-Ramos, Martha H; Ramos-Ostos, Martha Helena; Uribe, Misael; Chávez-Tapia, Norberto C.

doi:10.1016/j.diabet.2017.02.007

Cited by 28 publications

(16 citation statements)

References 41 publications

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“…Another Korean study found that the 68% and 3.8% of healthy obese patients showed steatosis and significant fibrosis, respectively, while these percentages raised to 85% and 8.7% in unhealthy obese individuals . In Mexican population, about 10%‐15% of healthy obese patients showed advanced fibrosis, while this percentage increased to 25% in obese patients with adverse metabolic conditions . A Korean longitudinal study was designed to establish the temporal association between NAFLD and metabolic phenotypes.…”

Section: Discussionmentioning

confidence: 99%

“…27 In Mexican population, about 10%-15% of healthy obese patients showed advanced fibrosis, while this percentage increased to 25% in obese patients with adverse metabolic conditions. 28 A Korean longitudinal study was designed to establish the temporal association between NAFLD and metabolic phenotypes. It observed that the risk for developing NAFLD was higher in subjects who were metabolically unhealthy both at baseline and after 4 years compared with subjects who were consistently metabolically healthy.…”

Section: Discussionmentioning

confidence: 99%

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The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Ampuero¹,

Aller²,

Gallego‐Durán³

et al. 2018

Aliment Pharmacol Ther

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Summary Background Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non‐alcoholic fatty liver disease (NAFLD)‐related outcomes compared with non‐obese subjects with a few metabolic risks. Aim To define the impact of the metabolic status on the NAFLD‐related outcomes, beyond the presence of obesity. Methods We designed a multicentre cross‐sectional study, including 1058 biopsy‐proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non‐alcoholic steatohepatitis (NASH) and significant fibrosis (F2‐F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. Results Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non‐obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non‐obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non‐obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. Conclusions Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Ampuero¹,

Aller²,

Gallego‐Durán³

et al. 2018

Aliment Pharmacol Ther

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“…The association between obesity and liver disease is considered to be driven largely by associated metabolic abnormalities, primarily insulin resistance (Ampuero et al, ; Gutierrez‐Grobe et al, ).…”

Section: Interaction Between Hazardous Alcohol Use and Other Metabolimentioning

confidence: 99%

Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Åberg

Färkkilä

Männistö

2020

Alcoholism Clin & Exp Res

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Coexistence of alcohol use and metabolic risk-the 2 commonest population risk factors for nonviral chronic liver disease-is a growing concern. Clinical evidence and mechanistic evidence point to considerable supraadditive interaction effects for the development and progression of chronic liver disease between hazardous alcohol use and metabolic abnormalities including obesity, diabetes, and the metabolic syndrome (MetS). Intermittent binge drinking once monthly or more often seems to be associated with progression of liver disease even when average alcohol intake is within the currently allowed limits for a diagnosis of nonalcoholic fatty liver disease (NAFLD), and supraadditive interaction between binge drinking and the MetS has been reported. There are contradictory findings regarding the association between low alcohol use and liver steatosis, but, clearly, the mechanisms of alcoholic hepatotoxicity extend beyond simple fat accumulation. The presence of liver steatosis seems to amplify alcoholic hepatotoxicity. Recent longitudinal studies of NAFLD subjects report low alcohol use associated with both increased fibrosis progression and an elevated risk for liver cancer and severe liver disease. There is no clear safe limit of alcohol intake in the presence of NAFLD or metabolic risk. The interaction effects between alcohol and metabolic dysfunction merit increased attention in public health policy, individual counseling, and risk stratification. Based on current evidence, a strict dichotomization of liver disease into either pure alcoholic or nonalcoholic may be inappropriate.

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“…Although obesity is a risk factor for a series of metabolic complications, the presence of the phenotype known as Metabolically Healthy (MH) has suggested that individuals that are classified as metabolically healthy obese (MHO) seem to be more protected from complications related to the severity of Non-Alcoholic Fatty Liver Disease (NAFLD), insulin resistance (IR), alterations in lipid profile and in inflammation markers, unlike those classified as Metabolically Unhealthy Obese (MUHO) [10,11]. The role of the MHO phenotype has been widely debated, although the lack of standardization for its classification plays an important role in the differences observed between the available studies that have reported controversial and conflicting results [12,13].…”

Section: Introductionmentioning

confidence: 99%

Does the Metabolically Healthy Obese Phenotype Protect Adults with Class III Obesity from Biochemical Alterations Related to Bone Metabolism?

Loureiro

Lessa²,

Mendes

et al. 2019

Nutrients

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Obesity negatively affects the relationship between markers and micronutrients of bone metabolism. Testing the hypothesis that the metabolically healthy obese phenotype might be protected by those alterations was the aim of this study. A cross-sectional study was carried out in adults with class III obesity classified in Metabolically Healthy Obese (MHO) and Metabolically Unhealthy Obese (MUHO), according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria. Anthropometric, biochemical, and clinical variables were analyzed for sample characterization. To evaluate bone metabolism, markers (alkaline phosphatase and parathyroid hormone—PTH) and related nutrients (vitamin D, vitamin B12, calcium, phosphorus, magnesium, potassium and zinc) were analyzed. A total of 223 adults with class III obesity aged 41.20 ± 10.15 years were included. The MHO phenotype was identified in 32.73% of the sample. After logistic regression, it was observed that inadequacies of calcium (OR: 4.11; 95% CI: 2.33–6.66), phosphorus (OR: 3.03; 95% CI: 1.98–5.79), vitamin D (OR: 5.01; 95% CI: 2.92–6.71) and PTH (OR: 5.45; 95% CI: 4.49–6.74) were significantly higher in the MUHO group compared to the MHO Group. This study showed that the MHO phenotype does not protect adults from alterations in markers and micronutrients of bone metabolism. However, the MUHO phenotype presents a higher risk for alterations related to bone metabolism, which can favor the emergence of metabolic bone diseases.

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Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease

Cited by 28 publications

References 41 publications

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Does the Metabolically Healthy Obese Phenotype Protect Adults with Class III Obesity from Biochemical Alterations Related to Bone Metabolism?

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