Epidemiology and prevalence of lean nonalcoholic fatty liver disease and associated cirrhosis, hepatocellular carcinoma, and cardiovascular outcomes in the United States: a population‐based study and review of literature

Abstract

Backgrounds: Nonalcoholic fatty liver disease (NAFLD) is linked to obesity and metabolic syndrome conditions. However, a subset of NAFLD patients express a normal or low body mass index (lean NAFLD [L-NAFLD]). Our aim is to compare the prevalence of L-NAFLD to the obesity-associated NAFLD in the United States by assessing prevalence, potential risk factors, liver-related complications, and coronary artery disease outcomes. Methodology: A multicenter database (Explorys Inc.) of >70 million patients across the United States was screened. A cohort of patients with "nonalcoholic fatty liver" between 1999 and 2021 was identified. Two sub-cohorts of NAFLD patients were identified: those with a body mass index (BMI) < 25 kg/m 2 (L-NAFLD) and those with a BMI > 30 kg/m 2 (obesity-associated NAFLD). We excluded patients with age <18 and those who have viral hepatitis, hemochromatosis, Wilson's disease, biliary cirrhosis, alcoholic liver disease, cystic fibrosis, alpha-1-antitrypsin deficiency, and autoimmune hepatitis. Multivariate analysis was performed to adjust for confounders. Results: 68 892 260 individuals were screened. NAFLD prevalence was four per 100 000, and L-NAFLD prevalence was 0.6 per 100 000. Compared with those without, patients with L-NAFLD tended to be older (OR 2.16), females (OR 1.28), and smokers (OR 4.67) and of Asian race (OR 2.12). L-NAFLD patients were more likely to have acute coronary syndromes (OR 30.00) and metabolic syndrome (OR 2.31) despite the normal/low BMI. Esophageal varices and hepatocellular carcinoma risks were high in both cirrhosis patients. Conclusion: This is the largest study to assess L-NAFLD prevalence in the United States. L-NAFLD are at a significantly higher risk for acute coronary syndromes, esophageal varices, and hepatocellular carcinoma. with NAFLD, which is known as lean NAFLD (L-NAFLD).

Steatotic liver disease among lean and non-lean individuals in Southern Lao PDR: a cross-sectional study of risk factors

“…The higher prevalence of SLD in both lean and non-lean women, even after adjusting for other covariates is noteworthy. A recent review points to the various female gender related aspects that have the potential to influence SLD risk over the life course, including age at menarche, age at menopause, as well as other hormone related factors [ 43 ].…”

Prevalence of autoimmune, cholestatic and nonalcoholic fatty liver disease in celiac disease

“…Plausible explanations include underdiagnosis of these diseases and failure to accurately record them during inpatient admissions. This, however, should not affect the results of our study as previous studies from this database have been published and validated against studies from other databases [24,25,49]. Certain risk factors such as HLA haplotypes (especially for AIH, PBC and PSC cohorts), family history and the impact of pharmacological interventions (such as corticosteroid use in case of NAFLD) could not be assessed.…”

Cirrhotic patients on proton pump inhibitors are at a twofold risk of spontaneous bacterial peritonitis independently of gastrointestinal bleeding: a population-based retrospective study

“…Access to the database is granted to participating healthcare systems. The use of the Explorys platform has been validated in multiple fields, including gastroenterology and endocrinology [ 24 , 25 ].…”