Higher mortality among lean patients with non‐alcoholic fatty liver disease despite fewer metabolic comorbidities

Author:

Wijarnpreecha Karn12ORCID,Li Fang3ORCID,Lundin Sori K.4ORCID,Suresh Deepika5,Song Michael W.5,Tao Cui3ORCID,Chen Vincent L.1ORCID,Lok Anna S. F.1ORCID

Affiliation:

1. Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Michigan Health System Ann Arbor Michigan USA

2. Division of Gastroenterology and Hepatology, Department of Medicine University of Arizona College of Medicine Phoenix Arizona USA

3. School of Biomedical Informatics The University of Texas Health Science Center at Houston Houston Texas USA

4. School of Public Health The University of Texas Health Science Center at Houston Houston Texas USA

5. Department of Internal Medicine University of Michigan Health System Ann Arbor Michigan USA

Abstract

SummaryBackground & AimsNon‐alcoholic fatty liver disease (NAFLD) can develop in individuals who are not overweight. Whether lean persons with NAFLD have lower mortality and lower incidence of cirrhosis, cardiovascular diseases (CVD), diabetes mellitus (DM) and cancer than overweight/obese persons with NAFLD remains inconclusive. We compared mortality and incidence of cirrhosis, CVD, DM and cancer between lean versus non‐lean persons with NAFLD.MethodsThis is a retrospective study of adults with NAFLD in a single centre from 2012 to 2021. Primary outcomes were mortality and new diagnosis of cirrhosis, CVD, DM and cancer. Outcomes were modelled using competing risk analysis and Cox proportional hazards regression analysis.ResultsA total of 18,594 and 13,420 patients were identified for cross‐sectional and longitudinal analysis respectively: approximately 11% lean, 25% overweight, 28% class 1 obesity and 35% class 2–3 obesity. The median age was 51.0 years, 54.6% were women. The median follow‐up was 49.3 months. Lean patients had lower prevalence of metabolic diseases at baseline and lower incidence of cirrhosis and DM than non‐lean patients and no difference in CVD, any cancer or obesity‐related cancer during follow‐up. However, lean patients had significantly higher mortality with incidence per 1000 person‐years of 16.67, 10.11, 7.37 and 8.99, respectively, in lean, overweight, obesity class 1 and obesity class 2–3 groups respectively.ConclusionsLean patients with NAFLD had higher mortality despite lower incidence of cirrhosis and DM, and similar incidence of CVD and cancer and merit similar if not more attention as non‐lean patients with NAFLD.

Funder

American Association for the Study of Liver Diseases

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Wiley

Subject

Pharmacology (medical),Gastroenterology,Hepatology

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