An evaluation on the histological characteristics and clinical outcome of non-obese patients with nonalcoholic fatty liver disease

Abstract

Abstract: Objective To evaluate the histological features and clinical outcomes of non-obese patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 152 patients (81 males and 71 females) with an average age of (52.1±11.7) years old who were admitted from January 2015 to June 2021 were selected. According to their Body Mass Index (BMI), the NAFLD patients were divided into non-obese type (BMI<25 kg/m²) and obese type (BMI>25 kg/m²). The histological features and clinical outcomes of non-obese and obese NAFLD patients were compared. Results There were 36 cases of non-obese NAFLD patients and 116 cases of obese NAFLD patients. The BMI, waist circumference and diastolic blood pressure of non-obese NAFLD patients were 23.5 (22.4, 24.6) kg/m², (83.4±7.0) cm and 74 (60, 86) mmHg, respectively, which were significantly higher than those of [28.8 (26.5, 31.5) kg/m² and (99.2±11.2) cm and 86 (75, 98) mmHg, P<0.05] of the obese patients. The aspartate transaminase (AST) of non-obese and obese NAFLD patients was 25 (18, 31) U/L and 32 (21, 48) U/L, with statistical significant difference (P<0.05). There are 15 cases (41.7%) and 13 cases (36.1%) of non-obese NAFLD with hypertension and metabolic syndrome, respectively, which are significantly different from those of the obese NAFLD [68 cases (58.6%) and 77 cases (66.4%), P<0.05]. The non-obese NAFLD steatosis, NAFLD activity score, hepatocyte ballooning, liver fibrosis stage and liver fibrosis were 35 (16, 52) %, (3.2±1.2) points, 19 cases (52.8%), (1.4±0.6) stage and 20 cases (55.6%), which are significantly different from those of [50 (30, 68) %, (3.8±1.3) points, 85 cases (73.3%), (1.9±0.8) stage and 92 cases (79.3%) of the obese NAFLD patients (P<0.05]. The LSM of non-obese and obese NAFLD patients was 6.2(4.6, 8.3) kPa and 8.4(6.0, 12.8) kPa, with statistical significance (P<0.05). There were no death patients during following-up. The cardiovascular events in non-obese and obese NAFLD patients were 1 case (2.8%) and 18 cases (15.5%), respectively, with statistically significant difference (P<0.05). The liver-related events were 1 case (2.8%) and 4 cases (3.4%), respectively, without statistically significant difference (P>0.05). Conclusion Compared with obese NAFLD patients, non-obese NAFLD patients have lighter histological abnormalities and better clinical outcome, but the long-term prognosis of these patients warrants further studies.

Key words: Nonalcoholic fatty liver disease, Staging of liver fibrosis, Cardiovascular event

WANG Wei, GE Liang, YU Ning, XIONG Xiao-yun. An evaluation on the histological characteristics and clinical outcome of non-obese patients with nonalcoholic fatty liver disease[J]. Chinese Hepatolgy, 2023, 28(3): 360-363.

References

[1] Ozturk A, Grajo JR, Gee MS, et al. Quantitative hepatic fat quantification in non-alcoholic fatty liver disease using ultrasound-based techniques: a review of literature and their diagnostic performance. Ultrasound Med Biol, 2018, 44(12):2461-2475.
[2] Loomba R, Wong R, Fraysse J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther, 2020, 51(11):1149-1159.
[3] Alkhouri N. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): prevalence, therapeutic innovations, and stumbling blocks for clinical development. Expert Opin Investig Drugs, 2020, 29(2):115-116.
[4] Taheri H, Malek M, Ismail-Beigi F, et al. Effect of empagliflozin on liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease without diabetes: a randomized, double-blind, placebo-controlled trial. Adv Ther, 2020, 37(11):4697-4708.
[5] Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology, 2002, 35(2):373-379.
[6] Wong VW, Hui AY, Tsang SW, et al. Metabolic and adipokine profile of Chinese patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 2006, 4(9):1154-1161.
[7] Younes R, Govaere O, Petta S, et al. Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: time for reappraisal of BMI-driven approach? Gut, 2021, gutjnl-2020-322564.
[8] Niriella MA, Kasturiratne A, Pathmeswaran A, et al. Lean non-alcoholic fatty liver disease (lean NAFLD): characteristics, metabolic outcomes and risk factors from a 7-year prospective, community cohort study from Sri Lanka. Hepatol Int, 2019, 13(3):314-322.
[9] 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南(2010年修订版). 中华肝脏病杂志, 2010, 18(3):163-166.
[10] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版). 中华肝脏病杂志, 2019, 27(12)?: 938-961.
[11] Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 2020, 5(8):739-752.
[12] Chang Y, Ryu S, Sung KC, et al. Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: evidence from the Kangbuk Samsung Health Study. Gut, 2019, 68(9):1667-1675.
[13] Dela Cruz AC, Bugianesi E, George J, et al. Characteristics and long-term prognosis of lean patients with nonalcoholic fatty liver disease. Gastroenterology, 2014, 146:S-909.
[14] Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology, 2019, 156(6):1717-1730.
[15] Wong VW, Wong GL, Yip GW, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut, 2011, 60:1721-1727.