Natural History of Nonalcoholic Fatty Liver Disease With Normal Body Mass Index: A Population-Based Study

Ahmed, Omar T.; Gidener, Tolga; Mara, Kristin C.; Larson, Joseph J.; Therneau, Terry M.; Allen, Alina M.

doi:10.1016/j.cgh.2021.07.016

Cited by 51 publications

(70 citation statements)

References 27 publications

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“…Several studies have reported that the incidence of advanced fibrosis and liver-related events in these patients is similar to or worse than that in patients with fatty liver who are overweight/obese [ 51 - 53 ]. In addition, a higher risk for ASCVD and higher all-cause mortality has been reported in patients with fatty liver in the context of normal weight than that in patients who are overweight/obese [ 53 - 55 ].…”

Section: Validity Of the Mafld Definition For People Who Are Lean/nor...mentioning

confidence: 99%

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

et al. 2022

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Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.

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Section: Validity Of the Mafld Definition For People Who Are Lean/nor...mentioning

confidence: 99%

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

et al. 2022

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“…2,3 Although NAFLD is observed predominantly in persons with obesity and/or type 2 diabetes mellitus (T2DM), an estimated 7%-20% of individuals with NAFLD have lean body habitus. 1,[4][5][6][7] Although similar NASH pathogenesis may be observed in lean patients with NAFLD, rates of disease progression, associated conditions, and diagnostic and management approaches differ for lean vs nonlean patients with NAFLD. There is a major unmet need to provide clear guidance to clinicians regarding the evaluation and management of NAFLD among lean patients.…”

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confidence: 99%

AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review

2022

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“…But since most of the NAFLD with non-obese patients were asymptomatic and prone to the possibility of underdiagnosis, their prevalence may be higher than actual ( 15 ). In addition, compared to the obese population with NAFLD, the non-obese population with NAFLD had a higher risk of prostate hyperplasia ( 16 ), diabetes mellitus ( 17 , 18 ), and also had a similar risk of CVD and malignancy ( 19 ). However, for the non-obese population, the incidence and severity of dyslipidemia were lower than those of the obese population.…”

Section: Discussionmentioning

confidence: 99%

Association between the atherogenic index of plasma and new-onset non-alcoholic fatty liver disease in non-obese participants

Cheng

et al. 2022

Front. Endocrinol.

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IntroductionNon-alcoholic fatty liver disease (NAFLD) in the non-obese population accounts for a large proportion of NAFLD. Atherogenic index of plasma (AIP, defined as the logarithm of the triglyceride/high-density lipoprotein cholesterol ratio.) can provide a stronger reflection of dyslipidemia and studies on the longitudinal association between AIP and NAFLD were limited in non-obese participants, especially in different BMI groups.MethodsWe performed a post-hoc analysis of data obtained from the Dryad data repository (Dryad is a nonprofit open database of medicine.) and explored the predictive value of AIP on the risk of NAFLD among non-obese participants.ResultsThis study included 16173 participants with AIP, of which 2322(14.4%) non-obese participants developed into individuals with NAFLD with the 5-year follow-up examination. The difference between AIP quartiles in the cumulative estimation of new-onset NAFLD was significant, and with increased AIP, the cumulative new-onset NAFLD gradually increased. Participants in higher AIP quartiles had a significantly increased risk of NAFLD. In the fully adjusted model 3, hazard ratios of the new-onset NAFLD for subjects in Q2, Q3, and Q4 of AIP were 2.00 (1.59, 2.53), 2.61 (2.09, 3.72), and 4.49 (3.62, 5.57) respectively. Meanwhile, the trend test for the association between AIP quartiles and the new-onset NAFLD presented that AIP quartile was positively and strongly associated with the new-onset NAFLD (adjusted hazard ratio (95%CI) in Model 3: 1.59 (1.51, 1.67), P<0.001). We found that AIP was also positively and strongly associated with new-onset NAFLD in different sex groups and different age groups in female patients. Moreover, the predictive ability of AIP was no significant difference in different sex groups and different age groups in female patients. In the subgroup analysis, we found that in the low BMI population, the predictive effect of AIP for new-onset NAFLD was expanded by 2-3 times for each quality increase of AIP.ConclusionThis study found that AIP was a strong independent risk factor for new-onset NAFLD among non-obese individuals especially in the low BMI participants, and screening for AIP in this population can be used to prevent future NAFLD.

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Natural History of Nonalcoholic Fatty Liver Disease With Normal Body Mass Index: A Population-Based Study

Cited by 51 publications

References 27 publications

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review

Association between the atherogenic index of plasma and new-onset non-alcoholic fatty liver disease in non-obese participants

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