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Clinical profile of non‐alcoholic fatty liver disease in nonobese patients
Author(s) -
Lum Johnathan Huey Ming,
Cheah Mark Chang Chuen,
Leow Wei Qiang,
Wan Wei Keat,
Lim Tony Kiat Hon,
Chow Wan Cheng,
Chang Jason Pik Eu,
Goh George Boon Bee
Publication year - 2021
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.15154
Subject(s) - medicine , steatohepatitis , gastroenterology , fatty liver , body mass index , metabolic syndrome , fibrosis , liver biopsy , diabetes mellitus , cohort , waist , obesity , biopsy , disease , endocrinology
Background and Aim Non‐alcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome. Worryingly, it has been increasingly reported among nonobese patients. This study aims to analyse patient characteristics of biopsy‐proven NAFLD in an Asian cohort and explore differences stratified by body mass index (BMI). Methods Clinical, laboratory, and histological data were collected from 263 adults with biopsy‐proven NAFLD. Patients with and without obesity (BMI cut‐off 25) were compared. The ability to predict advanced liver fibrosis with three non‐invasive scores, the NAFLD Fibrosis score (NFS), Fibrosis‐4 (FIB4), and the aspartate aminotransferase to platelet ratio index (APRI), was compared. Results Obese subjects had a lower mean age (49.5 ± 12.5 vs 54.0 ± 12.9 years, P = 0.017), a higher prevalence of diabetes (52.4% vs 36.8%, P = 0.037), and a higher waist circumference (113.9 ± 16.0 cm vs 87.0 ± 18.4 cm, P = 0.022). The prevalence of dyslipidaemia (68.0% vs 61.4%, P = 0.353) and hypertension (61.7% vs 49.1%, P = 0.190) was comparable between the two groups. The distribution of non‐alcoholic steatohepatitis (NASH) (63.1% versus 61.4%, P = 0.710) and advanced fibrosis (31.6% versus 26.3%, P = 0.447) were also similar in both groups. All three non‐invasive scores (NFS, FIB4, and APRI) performed poorly in predicting advanced fibrosis in nonobese patients with NAFLD. The FIB4 was the most accurate non‐invasive score in predicting advanced fibrosis in the obese group. Conclusions Obese and nonobese patients are equally at risk of NASH and advanced fibrosis. While the FIB4 is the most accurate non‐invasive score in predicting advanced fibrosis among obese individuals, further research is warranted to develop a nonobese specific score to correctly identify nonobese NAFLD patients with advanced fibrosis.