Mortality of NAFLD According to the Body Composition and Presence of Metabolic Abnormalities

Abstract

Although nonalcoholic fatty liver disease (NAFLD) is associated with obesity, it can also occur in lean and metabolically normal individuals. Our aim was to determine the effect of different combinations of abdominal adiposity and overall adiposity on the mortality of NAFLD. The Third National Health and Nutrition Examination Survey with mortality data from the National Death Index were used. NAFLD was defined as steatosis without other liver diseases. Body composition was categorized according to waist circumference (WC) and body mass index (BMI). Obesity pattern was defined according to BMI (lean, overweight, and obese) and WC (normal and obese) using accepted definitions. The "metabolically abnormal" group had visceral obesity, insulin resistance, type 2 diabetes, hypertension, or hyperlipidemia. Of the 9,341 study individuals (47.9% male; 76.8% white), NAFLD was present in 3,140 (33.6%), of whom 0.6% had lean BMI and normal WC, and 1.7% had lean BMI and obese WC. The prevalence of metabolically normal NAFLD was 3.26% (95% confidence interval [CI]: 2.62%-3.90%), with most of these subjects having lean BMI (79.2%). During an average follow-up of 22.4 years, 24.1% of the subjects died from all causes. Among these deceased individuals, 41.7% had NAFLD at baseline. Causes of death were cardiovascular disease (24.8%), cancer-related (24.3%), type 2 diabetes-related (4.4%), and liver-related (1.7%). Individuals with NAFLD who were lean by BMI but obese by WC had higher risk of all-cause mortality. Individuals with NAFLD with normal BMI but obese WC had a higher risk of cardiovascular mortality (hazard ratio 2.63 [95% CI: 1.15-6.01]) as compared with overweight (by BMI) NAFLD with normal WC. Conclusion: The risk of mortality in NAFLD can be affected by the presence of visceral obesity, especially in the lean BMI group. These data have important management implications for patients with NAFLD.

Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma

“…J o u r n a l P r e -p r o o f 8 (24,25,(46)(47)(48)(49)(50) The most important risk factors for HCC include the presence of diabetes and insulin resistance, obesity, older age, and male sex (25,(46)(47)(48)(49)(50). In the United States, ethnicity has been associated with development of HCC; Mexican-Americans have been found to be at higher risk (25). In addition, less physically active persons, with more metabolic components, are also at increased risk (24,25).…”

“…(20)(21)(22)(23) Although NAFLD is associated with metabolic risk factors, up to 40% of patients with NAFLD may not be obese but still can be considered metabolically unhealthy. (8,(24)(25)(26) In the recent past it has become increasingly clear that NAFLD is rapidly becoming the most common cause of chronic liver disease and cirrhosis (2,27). In addition, NASH is the secondmost common indication for liver transplantation in the United States (28,29).…”

“… [19] , [20] , [21] , [22] Although NAFLD is associated with metabolic risk factors, up to 40% of patients with NAFLD may not be obese but can still be considered metabolically unhealthy. 8 , [23] , [24] , [25] …”

Cardiovascular Risk is Elevated in Lean Subjects With Non Alcoholic Fatty Liver Disease

“…Unlike the prognosis and complications of overall NAFLD, the data on lean NAFLD are scarce. Two studies have reported a higher mortality rate for lean compared to obese NAFLD (38,39). Moreover, cardiovascular disease accounted for approximately one quarter of the causes of death (38).…”

Lean non-alcoholic fatty liver disease: Is there a place for novel antidiabetics in the therapeutic management of this underappreciated “enemy”?

“…Of note, another subanalysis of data from the NHANES III database demonstrated that presence of visceral obesity, especially among lean NAFLD patients, has significant prognostic implications regarding all-cause mortality and can be a determinant of selected therapeutic intervention. 6 Novel antidiabetics, namely glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors have attracted scientific interest during the last decade Lean non-alcoholic fatty liver disease: Is there a place for novel antidiabetics in the therapeutic management of this underappreciated "enemy"?…”