Adiponectin–leptin ratio for the early detection of lean non-alcoholic fatty liver disease independent of insulin resistance

What Is New in Metabolic Dysfunction-Associated Steatotic Liver Disease in Lean Individuals: From Bench to Bedside

“…Lean individuals with MASLD have a “more favorable” metabolic risk profile than their non-lean counterparts. Despite having a BMI below the overweight cut-off, lean individuals with MASLD had a higher BMI and WC than lean individuals without MASLD [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Further, visceral adiposity is higher in lean individuals with MASLD than in lean individuals without MASLD, though visceral adiposity is still lower in lean MASLD than in high-BMI MASLD [ 12 , 29 , 40 , 43 ].…”

“…In contrast, both TG and HDL are the highest and lowest in high-BMI patients with MASLD, respectively. The difference in TC and LDL levels between all groups was still inconclusive [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. In contrast, TG and HDL levels increased stepwise from lean individuals without MASLD to those with MASLD and overweight/obese individuals without MASLD to those with MASLD [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

“…The difference in TC and LDL levels between all groups was still inconclusive [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. In contrast, TG and HDL levels increased stepwise from lean individuals without MASLD to those with MASLD and overweight/obese individuals without MASLD to those with MASLD [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Collectively, visceral obesity, as evaluated by increased WC, could contribute to the pathogenesis of MASLD in lean individuals.…”

“…Dysregulated glucose metabolism or insulin resistance—designated by an increased level of either fasting blood sugar (FBS), hemoglobin A1c (HbA1c), or resting insulin—is also a critical factor involved in metabolic dysregulation [ 53 , 54 ]. Of note, impaired FBS (prediabetes) and homeostasis model assessment of insulin resistance (HOMA-IR) were highest in non-lean individuals with MASLD, followed by lean individuals with MASLD and lean individuals without MASLD, respectively [ 24 , 26 , 27 , 28 , 29 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 52 ]. Nevertheless, the resting insulin and HbA1c levels varied and were inconclusive between lean and non-lean individuals with or without MASLD [ 24 , 25 , 27 , 30 , 42 , 43 , 46 , 47 , 49 , 50 , 51 ].…”

“…Of note, impaired FBS (prediabetes) and homeostasis model assessment of insulin resistance (HOMA-IR) were highest in non-lean individuals with MASLD, followed by lean individuals with MASLD and lean individuals without MASLD, respectively [ 24 , 26 , 27 , 28 , 29 , 31 , 32 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 52 ]. Nevertheless, the resting insulin and HbA1c levels varied and were inconclusive between lean and non-lean individuals with or without MASLD [ 24 , 25 , 27 , 30 , 42 , 43 , 46 , 47 , 49 , 50 , 51 ]. Thus, further addressing whether there are changes in levels of resting insulin and HbA1c in lean individuals with MASLD compared to the other groups, especially lean individuals without MASLD, is required.…”