Systematic review with meta‐analysis: the significance of histological disease severity in lean patients with nonalcoholic fatty liver disease

Sookoian, Silvia; Pirola, Carlos José

doi:10.1111/apt.14401

Cited by 89 publications

(86 citation statements)

References 35 publications

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“…Recent data showed the presence of NAFLD also in patients with normal BMI, defining the new concept of lean NAFLD . Some studies indicated that lean NAFLD had lower steatosis grade and fibrosis stage compared with overweight or obese NAFLD . On the contrary, lean NAFLD was reported to acquire higher risk of DM, HTN or MetS, increasing the risk of cardiovascular disease .…”

Section: Discussionmentioning

confidence: 99%

“…28 Some studies indicated that lean NAFLD had lower steatosis grade and fibrosis stage compared with overweight or obese NAFLD. 29 On the contrary, lean NAFLD was reported to acquire higher risk of DM, HTN or MetS, increasing the risk of cardiovascular disease. 30 32 the association between MetS and HCV infection could not be clearly identified without the data of HCV genotype.…”

Section: Factors Associated With Metabolic Syndrome In Lean Body Sumentioning

confidence: 99%

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Association between chronic viral hepatitis and metabolic syndrome in southern Taiwan: a large population‐based study

Kuo

Kee

Wang

et al. 2018

Aliment Pharmacol Ther

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Summary Background The impact of metabolic syndrome (MetS) on hepatitis is an interesting issue. Aim To evaluate the association of MetS and chronic viral hepatitis including hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in southern Taiwan. Methods From 2004 to 2013, a series of community‐based health screenings for residents aged 40 and older were held in Tainan city. MetS was defined according to the Joint Scientific Statement. Cut‐offs of body‐mass index measures of 24 kg/m2 and 27 kg/m2 were used to stratify lean, overweight and obese subjects. Results We enrolled 180 359 participants; the prevalence of MetS was 30.1%, which was significantly associated with advanced age and female sex. There were 18 726 (10.4%) HBV, 13 428 (7.4%) HCV, 1337 (0.7%) HBV plus HCV (B+C) and 146 868 (81.5%) non‐HBV non‐HCV participants (NBNC). Prevalence rates of MetS in subjects with HBV, HCV, B+C and NBNC were 25.2%, 31.5%, 28.9% and 30.7% respectively (P < 0.001). There were 18.8% lean body, 35.4% overweight and 45.8% obese participants among 54 361 MetS subjects. Lean MetS subjects were older, had more diabetes, and had higher metabolic component levels, but lower alanine transaminase and aspartate transaminase‐platelet ratio index levels compared with obese MetS subjects. HCV infection was positively associated with MetS (P < 0.001). However, HBV infection was inversely associated with MetS only among lean subjects (P = 0.002), but not among the general population. Conclusions This large population‐based study indicated that HCV infection was positively associated with MetS. However, HBV infection was inversely associated with MetS only among lean subjects.

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Section: Discussionmentioning

confidence: 99%

Section: Factors Associated With Metabolic Syndrome In Lean Body Sumentioning

confidence: 99%

Association between chronic viral hepatitis and metabolic syndrome in southern Taiwan: a large population‐based study

Kuo

Kee

Wang

et al. 2018

Aliment Pharmacol Ther

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“…4 NAFLD can also appear in non-obese subjects. 5,6 Many studies have described the deleterious effects of NAFLD, which range from liver damage to increased risk of cardiovascular 7,8 or kidney disease. 9 Despite NAFLD shares common risk factors with cardiovascular and chronic kidney disease, they seem to play an additional role in the pathogenesis of NAFLD.…”

Section: Introductionmentioning

confidence: 99%

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Ampuero¹,

Aller²,

Gallego‐Durán³

et al. 2018

Aliment Pharmacol Ther

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Summary Background Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non‐alcoholic fatty liver disease (NAFLD)‐related outcomes compared with non‐obese subjects with a few metabolic risks. Aim To define the impact of the metabolic status on the NAFLD‐related outcomes, beyond the presence of obesity. Methods We designed a multicentre cross‐sectional study, including 1058 biopsy‐proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non‐alcoholic steatohepatitis (NASH) and significant fibrosis (F2‐F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. Results Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non‐obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non‐obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non‐obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. Conclusions Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.

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“…Although new and efficient drugs that can safely cure hepatitis C with high rates of sustained virological response have been developed, fibrosis still progresses in some patients with a further risk of cirrhosis and HCC development, mainly in those with advanced fibrosis . Recently, liver steatosis has been described as an additional risk factor for fibrosis progression and HCC development in patients with and without hepatitis C . Hepatic steatosis is defined as excessive fat accumulation in the liver.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictive factors of moderate/severe liver steatosis in chronic hepatitis C (CHC) infected patients evaluated with controlled attenuation parameter (CAP)

Cardoso

Perez

Figueiredo-Mendes

et al. 2018

Journal of Viral Hepatitis

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A novel controlled attenuation parameter (CAP) using FibroScan has been developed for assessment of liver steatosis. The aim was to evaluate the frequency and associated factors for moderate/severe steatosis evaluated by CAP in CHC patients submitted to transient elastography (TE) by FibroScan . CHC patients underwent TE with CAP evaluation. The classification of steatosis was defined as: CAP < 222 dB/m = S0; CAP ≥ 222 dB/m and <233dB/m = S1; ≥233 dB/m < 290dB/m = S2 and >= 290 dB/m = S3. The prevalence of moderate/severe steatosis (CAP ≥ S2) and the related independent factors were identified by a logistic regression analysis. A significance level of 5% was adopted. 1104 CHC patients, 85% genotype-1 were included (mean age 55 ± 11 years; 46% male, mean BMI 25 ± 4 Kg/m ). Systemic arterial hypertension and type 2 diabetes mellitus prevalences were 39% and 17%, respectively. Liver stiffness measurement ≥ 9.5 kPa was observed in 39% of patients and steatosis was identified in 50% (S1 = 7%, S2 = 28% and S3 = 15%). The variables independently associated with moderate/severe steatosis were: male gender (OR=1.35; P = .037; 95% CI:1.01-1.81); systemic arterial hypertension (OR=1.57; P = .002; 95% CI:1.17-2.10) and BMI (OR=1.17; P < .01;95% CI:1.12-1.22). In conclusion, when CAP was adopted as a tool to detect steatosis, genotype 1 CHC patients presented a high prevalence of moderate/advanced steatosis. In these patients, liver steatosis was associated mostly to metabolic factors (arterial hypertension and high BMI).

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Systematic review with meta‐analysis: the significance of histological disease severity in lean patients with nonalcoholic fatty liver disease

Cited by 89 publications

References 35 publications

Association between chronic viral hepatitis and metabolic syndrome in southern Taiwan: a large population‐based study

Association between chronic viral hepatitis and metabolic syndrome in southern Taiwan: a large population‐based study

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Prevalence and predictive factors of moderate/severe liver steatosis in chronic hepatitis C (CHC) infected patients evaluated with controlled attenuation parameter (CAP)

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