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Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study

Tan EX 1 , Lee JW 1 , Jumat NH 2 , Chan WK 3 , Treeprasertsuk S 4 , Goh GB 5 Show all authors , Fan JG 6 , Song MJ 7 , Charatcharoenwitthaya P 8 , Duseja A 9 , Imajo K 10 , Nakajima A 10 , Seki Y 11 , Kasama K 11 , Kakizaki S 12 , Lesmana LA 13 , Zheng KI 14 , Zheng MH 14 , Koh CJ 1 , Ho KY 1 , Goh KL 3 , Wong VW 15 , Dan YY 16

Affiliations 

  • 1 Division of Gastroenterology and Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 3 University of Malaya, Kuala Lumpur, Malaysia
  • 4 Chulalongkorn University, Bangkok, Thailand
  • 5 Singapore General Hospital, Singapore
  • 6 Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 7 The Catholic University Korea, Republic of Korea
  • 8 Mahidol University, Bangkok, Thailand
  • 9 Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 10 Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • 11 Yotsuya Medical Cube, Tokyo, Japan
  • 12 Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
  • 13 Medistra Hospital, Jakarta, Indonesia
  • 14 NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 15 The Chinese University of Hong Kong, Hong Kong
  • 16 Division of Gastroenterology and Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: mdcdyy@nus.edu.sg
Metabolism, 2022 01;126:154911.
PMID: 34648769 DOI: 10.1016/j.metabol.2021.154911

Abstract

BACKGROUND: A significant proportion of the non-alcoholic fatty liver disease (NAFLD) population is non-obese. Prior studies reporting the severity of NAFLD amongst non-obese patients were heterogenous. Our study, using data from the largest biopsy-proven NAFLD international registry within Asia, aims to characterize the demographic, metabolic and histological differences between non-obese and obese NAFLD patients.

METHODS: 1812 biopsy-proven NAFLD patients across nine countries in Asia assessed between 2006 and 2019 were pooled into a curated clinical registry. Demographic, metabolic and histological differences between non-obese and obese NAFLD patients were evaluated. The performance of Fibrosis-4 index for liver fibrosis (FIB-4) and NAFLD fibrosis score (NFS) to identify advanced liver disease across the varying obesity subgroups was compared. A random forest analysis was performed to identify novel predictors of fibrosis and steatohepatitis in non-obese patients.

FINDINGS: One-fifth (21.6%) of NAFLD patients were non-obese. Non-obese NAFLD patients had lower proportions of NASH (50.5% vs 56.5%, p = 0.033) and advanced fibrosis (14.0% vs 18.7%, p = 0.033). Metabolic syndrome in non-obese individuals was associated with NASH (OR 1.59, 95% CI 1.01-2.54, p = 0.047) and advanced fibrosis (OR 1.88, 95% CI 0.99-3.54, p = 0.051). FIB-4 performed better than the NFS score (AUROC 81.5% vs 73.7%, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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