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Review
. 2022 Mar 24;14(1):45.
doi: 10.1186/s13098-022-00814-z.

NAFLD in normal weight individuals

Johanna K DiStefano  1 , Glenn S Gerhard  2
Affiliations
Review

NAFLD in normal weight individuals

Johanna K DiStefano et al. Diabetol Metab Syndr. .

Abstract

Nonalcoholic fatty liver disease (NAFLD) can develop in lean individuals. Despite a better metabolic profile, the risk of disease progression to hepatic inflammation, fibrosis, and decompensated cirrhosis in the lean is similar to that in obesity-related NAFLD and lean individuals may experience more severe hepatic consequences and higher mortality relative to those with a higher body mass index (BMI). In the absence of early symptoms and abnormal laboratory findings, lean individuals are not likely to be screened for NAFLD or related comorbidities; however, given the progressive nature of the disease and the increased risk of morbidity and mortality, a clearer understanding of the natural history of NAFLD in lean individuals, as well as efforts to raise awareness of the potential health risks of NAFLD in lean individuals, are warranted. In this review, we summarize available data on NAFLD prevalence, clinical characteristics, outcomes, and mortality in lean individuals and discuss factors that may contribute to the development of NAFLD in this population, including links between dietary and genetic factors, menopausal status, and ethnicity. We also highlight the need for greater representation of lean individuals in NAFLD-related clinical trials, as well as more studies to better characterize lean NAFLD, develop improved screening algorithms, and determine specific treatment strategies based on underlying etiology.

Keywords: BMI; Choline deficiency; Clinical outcomes; Genetic variation; Lean; Menopause; Metabolic syndrome; NAFLD; NASH; Nonobese; Prevalence.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Potential contributors to NAFLD in lean individuals. Despite the same pathological findings in the liver, the factors that contribute to NAFLD and subsequent progression NASH in lean individuals are not yet well-characterized relative to those with obesity-related NAFLD. However, a number of factors that likely influence risk of NAFLD development and progression, even in the absence of excess adiposity, have been postulated in the recent literature. The majority of these risk factors fall into environmental, endocrine, genetic, and metabolic origins. Most of these factors are also expected to interact with one another, as well as other, as-yet-undefined factors, to further modulate NAFLD risk
See this image and copyright information in PMC

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