Lean people with non-alcoholic fatty liver disease (NAFLD) may be at greater risk for liver-related death compared to those with excess weight or obesity, but other outcomes, including cardiovascular mortality and liver cancer, were similar, according to study findings published in Clinical Gastroenterology and Hepatology.
Arising from the accumulation of fat in the liver, NAFLD and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for an increasing proportion of advanced liver disease worldwide. As a result of inflammation, NAFLD can lead to liver fibrosis, cirrhosis and even liver cancer. With no effective approved medical therapies, disease management is dependent on lifestyle changes such as weight loss and exercise.
Fatty liver disease is a growing cause of liver complications, coinciding with a global rise in obesity, but as many as 40% of people with NAFLD do not have overweight or obesity. Less is known about clinical outcomes for lean people with the condition.
Raffi Karagozian, MD, of Tufts Medical Center in Boston, and colleagues performed a systematic review and meta-analysis of the risk of death and adverse outcomes in lean people with fatty liver disease. They searched the PubMed, Embase, and Cochrane Library databases for studies on the risk of mortality and cirrhosis in people with NAFLD. Altogether, they analyzed 10 cohort studies involving 109,151 people with NAFLD; of these, 42,112 were lean and 67,039 people had excess weight or obesity.
Lean and non-lean people with NAFLD had similar risks for all-cause mortality and cardiovascular mortality as well as liver-related adverse outcomes, such as decompensated cirrhosis and hepatocellular carcinoma, the most common type of primary liver cancer. But the risk of liver-related death was significantly higher among lean people with NAFLD.
“This study highlights a higher risk of liver-related mortality in patients with lean NAFLD than those with non-lean NAFLD,” wrote the researchers. “This finding indicates that further understanding of the pathophysiology, risk factors of adverse outcomes, and genetic and ethnic variabilities of lean NAFLD phenotype is warranted for individualized treatment strategies in lean NAFLD patients.”
Click here to read the study abstract in the journal Clinical Gastroenterology and Hepatology.
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