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Comparative Study
. 2019 Aug;34(8):1404-1410.
doi: 10.1111/jgh.14585. Epub 2019 Jan 15.

Characteristics of non-alcoholic steatohepatitis among lean patients in Japan: Not uncommon and not always benign

Maki Tobari  1 , Etsuko Hashimoto  2 , Makiko Taniai  2 , Yuuichi Ikarashi  2 , Kazuhisa Kodama  2 , Tomomi Kogiso  2 , Katsutoshi Tokushige  2 , Nishino Takayoshi  1 , Naotake Hashimoto  3
Affiliations
Comparative Study

Characteristics of non-alcoholic steatohepatitis among lean patients in Japan: Not uncommon and not always benign

Maki Tobari et al. J Gastroenterol Hepatol. 2019 Aug.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] J Gastroenterol Hepatol. 2020 Mar;35(3):516. doi: 10.1111/jgh.15015. J Gastroenterol Hepatol. 2020. PMID: 32162385 No abstract available.

Abstract

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/m2 ), 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.

Keywords: NAFLD; NASH; gender difference; histology; nonobese patients.

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References

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