Hepatic Steatosis in Lean Patients: Risk Factors and Impact on Mortality

Abstract

Background The prognostic impact of liver steatosis in obese patients is well established. Limited data on the risk factors for and impact of hepatic steatosis in lean patients are available. Aims Assess risk factors for liver steatosis in lean patients and investigate its impact on survival. Methods Patients without viral hepatitis and with a BMI ≤ 25 kg/m 2 undergoing liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) by transient elastography were retrospectively identified. Clinical characteristics and laboratory test results were obtained at the time of LSM/CAP measurement. National death registry data were obtained in order to assess survival. Results Among n = 218 lean patients, n = 97 (34.5%) showed significant liver steatosis (CAP ≥ 268 dB/m), while n = 184 (65.5%) had no or just mild steatosis (CAP < 268 dB/m). Patients with steatosis had higher GGT (238.0(± 450.3) vs. 112.1(± 180.0) IU/mL; p = 0.013), AST (63(± 67.4) vs. 38.5(± 32.9) IU/mL; p = 0.001), ALT (59.1(± 58.8) vs. 44.3(± 52.7) IU/mL; p = 0.048) and triglyceride levels (120.1(± 80.3) vs. 96.1(± 58.2) mg/dL; p = 0.014), and showed a trend toward more severe fibrosis (LSM 15.6(± 19.5) vs. 12.0(± 15.7) kPa; p = 0.115). In multivariate binary logistic regression analysis, only serum uric acid levels were independently associated with liver steatosis (odds ratio 1.43 per unit mg/dL; 95% CI 1.001-2.054; p = 0.049). During a mean follow-up of 38.9(± 10.6) months, n = 14 patients (5.0%) died. In the absence of advanced fibrosis, survival after 1 year was similar in patients without (98.7%) and with (98.6%) significant steatosis. Patients with advanced fibrosis had worse 1-year survival without concomitant significant steatosis (84.8%) than patients with steatosis (95.8%; log-rank p < 0.001). Conclusions High serum uric acid levels increase the risk of liver steatosis in lean patients. Liver fibrosis but not hepatic steatosis is a risk factor for impaired survival in lean patients.

Optimum non-invasive predictive indicators for metabolic dysfunction-associated fatty liver disease and its subgroups in the Chinese population: A retrospective case-control study

“…As the gold standard for diagnosis of MAFLD, the application of liver biopsy is limited because it is expensive and invasive with up to 1% risk of serious complications ( 5 ). Until now, abdominal ultrasound has been recommended as the preferred diagnostic method for fatty liver disease (FLD), which is still inconvenient for large populations ( 6 ).…”

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area

“…This result could be a consequence of the current pandemic, so the authors suggest larger trials with more intensive weight-loss interventions [ 49 ]. It is important to emphasize that in the lean patients with significant LS (S ≥ 2), the survival of these patients is not influenced as much by the LS grade as it is by its consequence, LF [ 50 ].…”

Individualized treatment options for patients with non-cirrhotic and cirrhotic liver disease

“…Even lower rates of sustained weight loss (about 5%) can decrease steatosis[ 52 ], liver enzymes[ 53 ] and the risk of developing T2DM[ 54 ]. Remission of MAFLD due to lifestyle interventions has also been demonstrated in non-obese patients with MAFLD[ 55 ] despite the fact that the underlying causes of lean MAFLD are unclear[ 56 ]. Guidelines suggest that the lifestyle modifications recommended to patients with MAFLD should be structured and include prescribed physical activity including resistance training, a calory restricted “Mediterranean” diet, avoidance of high fructose foods and avoidance of excess alcohol consumption.…”