Predictors of Nonalcoholic Steatohepatitis and Significant Fibrosis in Non-Obese Nonalcoholic Fatty Liver Disease. Liver international : official journal of the International Association for the Study of the Liver Kim, D., Kim, W., Joo, S. K., Kim, J. H., Harrison, S. A., Younossi, Z. M., Ahmed, A. 2018


AIMS: We compared (1) demographic and clinical characteristics, and (2) determinants of nonalcoholic steatohepatitis (NASH) and significant fibrosis in non-obese and obese NAFLD.METHODS: A cross-sectional study of 664 Asian subjects (mean age 53.1 years; men 50.3%) with biopsy-proven NAFLD and controls was conducted. Subjects were divided by their body mass index (BMI) into obese (BMI =25 kg/m2 ) and non-obese (BMI <25 kg/m2 ).RESULTS: Observations in subjects with non-obese NAFLD were in between non-obese controls and obese NAFLD subjects for BMI, sagittal abdominal diameter (SAD), aminotransferase levels, insulin resistance, and abdominal visceral adipose tissue (VAT) area. There was no significant difference in histology between non-obese and obese subjects with NAFLD except for lower grade of hepatic steatosis in non-obese NAFLD and higher severity of hepatic fibrosis in non-obese NASH. Predictors of NASH in non-obese subjects included females (odds ratio [OR] 2.49), higher alanine aminotransferase (OR 1.03), lower high density lipoprotein-cholesterol (OR 0.96), higher prevalence of diabetes (OR 3.65) and higher VAT area (OR 1.63 per SD increase of VAT), while age (OR 1.04), higher aspartate aminotransferase (OR 1.02), diabetes (OR 2.76,), and higher VAT area (OR 1.57 per SD increase) were associated with significant fibrosis in the non-obese. SAD was independently associated with NASH or significant fibrosis among non-obese NAFLD subjects.CONCLUSION: While there were a few phenotypic differences from obese subjects, non-obese subjects with NAFLD displayed a similar severity of histological liver damage. Potential factor(s) beyond obesity may play a role as non-obese NAFLD advances to more severe disease. This article is protected by copyright. All rights reserved.

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