Metabolic dysfunction and nonalcoholic fatty liver disease risk in individuals with a normal body mass index

Abstract

Purpose of review Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity, but is also common in individuals with a normal body mass index (BMI), who also experience the hepatic inflammation, fibrosis, and decompensated cirrhosis associated with NAFLD progression. The clinical evaluation and treatment of NAFLD in this patient population are challenging for the gastroenterologist. A better understanding of the epidemiology, natural history, and outcomes of NAFLD in individuals with normal BMI is emerging. This review examines the relationship between metabolic dysfunction and clinical characteristics associated with NAFLD in normal-weight individuals. Recent findings Despite a more favorable metabolic profile, normal-weight NAFLD patients exhibit metabolic dysfunction. Visceral adiposity may be a critical risk factor for NAFLD in normal-weight individuals, and waist circumference may be better than BMI for assessing metabolic risk in these patients. Although screening for NAFLD is not presently recommended, recent guidelines may assist clinicians in the diagnosis, staging, and management of NAFLD in individuals with a normal BMI. Summary Individuals with a normal BMI likely develop NAFLD as a result of different etiologies. Subclinical metabolic dysfunction may be a key component of NAFLD in these patients, and efforts to better understand this relationship in this patient population are needed.

Prevalence and Risk Factors of MASLD and Liver Fibrosis amongst the Penitentiary Population in Catalonia: The PRISONAFLD Study

“…Nonetheless, in recent years, chronic non-communicable diseases have become the leading cause of death in prisons, mainly driven by cardiovascular and metabolic-related events, which are significantly more frequent in patients with concomitant advanced liver disease due to MASLD [35]. Our results confirmed the impact of metabolic disorders in the penitentiary population [36], putting the spotlight on the need for screening programs and targeted therapeutic interventions and reinforcing the role of abdominal circumference instead of body mass index as a marker of adiposity [37].…”

LASSO-derived model for the prediction of lean-non-alcoholic fatty liver disease in examinees attending a routine health check-up

“…Moreover, considering that lean individuals often have normal body size, but may have abnormalities in visceral fat, BMI cannot be used as the sole indicator to assess the severity and prognosis of NAFLD. One review article suggested visceral adiposity may be a critical risk factor for lean-NAFLD [ 15 ]. Furthermore, previous studies have shown that compared to BMI and WC, waist-hip ratio (WHR) is a superior predictor of visceral fat, which is strongly linked to fatty liver [ 16 , 17 ].…”