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Characteristics of non‐alcoholic steatohepatitis among lean patients in Japan: Not uncommon and not always benign
Author(s) -
Tobari Maki,
Hashimoto Estuko,
Taniai Makiko,
Ikarashi Yuuichi,
Kodama Kazuhisa,
Kogiso Tomomi,
Tokushige Katsutoshi,
Takayoshi Nishino,
Hashimoto Naotake
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14585
Subject(s) - medicine , steatohepatitis , fatty liver , gastroenterology , steatosis , bioelectrical impedance analysis , insulin resistance , body mass index , obesity , metabolic syndrome , disease
Background and Aim To elucidate features of nonobese non‐alcoholic fatty liver disease (NAFLD), we assessed Japanese patients with NAFLD stratified by body mass index (BMI) and by sex. Methods Biopsy‐proven 762 NAFLD patients (404 men) were classified into three groups by the Japanese criteria: nonobese group (BMI < 25 kg/m 2 ), obese group (25 to 30), and severely obese group (≥ 30). Clinicopathological features and single nucleotide polymorphism of patatin‐like phospholipase 3 ( PNPLA3 ) rs738409 were investigated, and body composition analysis was performed by bioelectrical impedance analysis and computed tomography. Results Over 25% of men and almost 40% of women were nonobese, but most of them had visceral fat obesity and/or insulin resistance. The median age (years) of the nonobese, obese, and severely obese men was 49.9, 46.8, and 40.5 ( P < 0.01), respectively, while those of women was 60.2, 59.6, and 48.5 ( P < 0.01), respectively. The prevalence of metabolic comorbidities and PNPLA3 risk alleles did not differ among these groups in both sexes. Also, the prevalence of non‐alcoholic steatohepatitis was not significantly different in both sexes, although nonobese patients had a higher prevalence of mild steatosis. Advanced fibrosis showed a marked difference between men and women. Advanced fibrosis was significantly more frequent among severely obese men (nonobese: 31.0%, obese: 41.6%, severely obese: 60.9%; P < 0.01), but it was lower among severely obese women (51.4%, 62.9%, 33.7%; P < 0.01). Skeletal muscle mass was significantly lower in nonobese patients. Conclusions Non‐alcoholic fatty liver disease was not milder in nonobese patients. Histological steatosis was associated with BMI, but advanced fibrosis was not and showed a significant sex difference.