Nonalcoholic Fatty Liver Disease in Lean/Nonobese and Obese Individuals: A Comprehensive Review on Prevalence, Pathogenesis, Clinical Outcomes, and Treatment

Patel, Apar S.; Peddu, Dhiraj; Amin, Sahil; Elsaid, Mohamed I.; Minacapelli, Carlos D.; Chandler, Toni-Marie; Catalano, Carolyn; Rustgi, Vinod K.

doi:10.14218/jcth.2022.00204

Cited by 11 publications

(13 citation statements)

References 171 publications

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“…This contrasted with results in lean NAFLD patients, where the FLI emerged as a more reliable marker for hepatic steatosis with a cutoff value of >16.5, while WHtR performed suboptimally. This discrepancy highlights the complexity of diagnosing NAFLD and the potential need for different diagnostic criteria based on body composition (19,20). Interestingly, the percentage of fatty liver in the lean population was higher than typically seen in Western populations.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Both Lean and Obese Patients Utilizing the Waist to Height Ratio (WHR) and Fatty Liver Index (FLI)

Rasool,

Balouch,

Khan

et al. 2024

JHRR

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Background: Non-alcoholic fatty liver disease (NAFLD) is a burgeoning health issue with a global prevalence that mirrors the rise in obesity and metabolic syndrome. Non-invasive diagnostic indices like the Waist to Height Ratio (WHtR) and the Fatty Liver Index (FLI) are crucial for early detection and management, offering an alternative to the invasive liver biopsy. These indices are particularly pertinent for populations with distinctive body compositions, such as those seen in Asian countries, where traditional measures like Body Mass Index (BMI) may not accurately reflect metabolic risk. Objective: To evaluate the efficacy of WHtR and FLI as non-invasive diagnostic tools for NAFLD in both lean and obese populations, and to identify the most reliable indicator for predicting the presence of fatty liver disease across different body compositions. Methods: This cross-sectional study was approved by the Ethical Review Board (ERC-771) and conducted at the Sindh Institute of Urology and Transplantation. It included 757 participants aged 18-70 years, with 559 lean and 298 obese individuals based on BMI classifications. Exclusion criteria included other forms of hepatitis, use of steatogenic medication, and significant gastrointestinal disorders. Diagnostic measures included abdominal ultrasonography performed by an expert radiologist and calculation of WHtR and FLI. Statistical analyses were performed using SPSS version 25, and diagnostic accuracy was assessed through sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Area Under the Receiver Operating Characteristic (AUROC) curves. Results: Fatty liver was detected in 49% of obese patients and 33% of lean patients. The obese cohort demonstrated a WHtR >0.63 with a diagnostic accuracy of 94.63%, whereas the FLI had a diagnostic accuracy of 83.6% for a cutoff >74. In lean patients, FLI >16.5 was more predictive of NAFLD with a diagnostic accuracy of 96.96%, as opposed to WHtR, which was less effective. The AUROC for WHtR and FLI in obese patients was 0.847 and 0.704, respectively, while in lean patients, the AUROC for FLI was 0.875, suggesting superior diagnostic performance over WHtR. Conclusion: The study confirms that WHtR and FLI are valuable non-invasive tools for predicting NAFLD, with WHtR being more effective in obese patients and FLI showing greater reliability in lean patients. These findings highlight the need for tailored approaches in diagnosing NAFLD according to body composition. Further large-scale, multicentric research is needed to generalize these diagnostic cut-offs.

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Section: Discussionmentioning

confidence: 99%

Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Both Lean and Obese Patients Utilizing the Waist to Height Ratio (WHR) and Fatty Liver Index (FLI)

Rasool,

Balouch,

Khan

et al. 2024

JHRR

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“…(ii) Diet is an important factor in NAFLD. Studies have found that lean individuals tend to consume more fructose and cholesterol, which will promote the occurrence of NAFLD [ 43 , 44 ]. (iii) Other factors such as metabolic syndrome, disrupted gut microbiota, and decreased skeletal muscle mass and function have also been implicated in the formation of non-obese NAFLD [ 42 – 44 ].…”

Section: Discussionmentioning

confidence: 99%

Association between weight-adjusted waist index and non-alcoholic fatty liver disease: a population-based study

Yu,

He,

Kuang

et al. 2024

BMC Endocr Disord

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Background Obesity is the most important driver of non-alcoholic fatty liver disease (NAFLD); nevertheless, the relationship of weight-adjusted waist index (WWI), a new obesity index, with NAFLD is unclear. Methods This retrospective study used data from the NAGALA project from 1994 to 2016. WWI values were calculated using waist circumference (WC) and weight measurements of the participants. Three stepwise adjusted logistic regression models were developed to assess the relationship of WWI with NAFLD in the whole population and in both sexes. Additionally, we also conducted a series of exploratory analysis to test the potential impact of body mass index (BMI), age, smoking status and exercise habits on the association of WWI with NAFLD. Receiver operating characteristic (ROC) curves were used to estimate cut-off points for identifying NAFLD in the entire population and in both sexes. Results The current study included a population of 11,805 individuals who participated in health screenings, including 6,451 men and 5,354 women. After adjusting for all non-collinear variables in the multivariable logistic regression model, we found a significant positive correlation of WWI with NAFLD. For each unit increase in WWI, the risk of NAFLD increased by 72% in the entire population, by 84% in men, and by 63% in women. Furthermore, subgroup analyses revealed no significant discrepancies in the correlation of WWI with NAFLD across individuals with varying ages, exercise habits, and smoking status (all P-interaction > 0.05), except for different BMI groups (P-interaction < 0.05). Specifically, compared to the overweight/obese group, the relationship of WWI with NAFLD was significantly stronger in the non-obese group, especially in non-obese men. Finally, based on the results of ROC analysis, we determined that the WWI cut-off point used to identify NAFLD was 9.7675 in men and 9.9987 in women. Conclusions This study is the first to establish a positive correlation between WWI and NAFLD. Moreover, assessing the influence of WWI on NAFLD in individuals without obesity may yield more valuable insights compared to those who are overweight or obese.

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“…Due to obesity-induced insulin resistance's primary function in promoting hepatic steatosis, MASLD is the most common hepatic manifestation of Metabolic Syndrome (MetS) [4,7,[11][12][13][14]. MetS comprises a group of metabolic abnormalities associated with an increased risk of insulin resistance and cardiovascular disease (CVD).…”

Section: Introductionmentioning

confidence: 99%

The impact of metabolic syndrome severity on racial and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease

Elsaid,

Bridges,

Mumtaz

et al. 2024

PLoS ONE

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Background & aims Previous studies have examined the effects of metabolic syndrome (MetS) rather than its severity on race and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). We used the MetS severity score, a validated sex-race-ethnicity-specific severity measure, to examine the effects of race/ethnicity on the association between MetS severity and MASLD. Methods This study included 10,605 adult participants from the Third National Health and Nutrition Examination Survey. The MASLD diagnosis was based on ultrasound findings in patients without excessive alcohol intake or other liver diseases. MetS severity Z-scores were calculated and stratified into four categories low (1st-50th), moderate (>50th-75th), high (>75th-90th), and very high (>90th+)]. Multivariable adjusted logistic regression models with complex survey methods were used to test the effect of MetS severity on MASLD. Results The age-adjusted MASLD prevalence was 17.4%, 25.7%, 42.5, and 54.9% in adults with mild, moderate, high, and very high MetS severities, respectively (P-trend <0.001). MetS severity was significantly higher in patients with MASLD than in those without [mean percentile 60th vs. 44th, P<0.001]. Among patients with MASLD, Mexican-American and Black non-Hispanic females had significantly higher age-adjusted MetS severity (68th and 61st, respectively) than White non-Hispanic females 54th, while Black non-Hispanic males had significantly lower MetS severity (56th) than White non-Hispanic males (70th) (P-Interaction = 0.02). Adults with high and very high MetS severity had 2.27 (95% CI:1.70 to 3.03) and 3.12 (95% CI:2.20 to 4.42), respectively, higher adjusted odds of MASLD than those with mild MetS severity. Conclusions Racial/ethnic disparities in MetS severity play a pivotal role in the risk of MASLD. Our findings highlight the potential clinical utility of the MetS severity score in identifying at-risk individuals, which will help guide targeted prevention and tailoring management strategies to mitigate the MASLD burden.

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Nonalcoholic Fatty Liver Disease in Lean/Nonobese and Obese Individuals: A Comprehensive Review on Prevalence, Pathogenesis, Clinical Outcomes, and Treatment

Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most com

Cited by 11 publications

References 171 publications

Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Both Lean and Obese Patients Utilizing the Waist to Height Ratio (WHR) and Fatty Liver Index (FLI)

Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Both Lean and Obese Patients Utilizing the Waist to Height Ratio (WHR) and Fatty Liver Index (FLI)

Association between weight-adjusted waist index and non-alcoholic fatty liver disease: a population-based study

The impact of metabolic syndrome severity on racial and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease

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