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. 2020:6:72.
doi: 10.20517/2394-5079.2020.73. Epub 2020 Oct 12.

The transcontinental variability of nonalcoholic fatty liver disease

Claudia P Oliveira  1   2 , Angelo Paredes  3 , Mohammed Siddiqui  4 , Lawrence Serfaty  5 , Abhijit Chowdhury  6   7 , Jose Tadeu Stefano  2 , Denise Siqueira Vanni  2 , Sherry Boyett  4 , Arun J Sanyal  4
Affiliations

The transcontinental variability of nonalcoholic fatty liver disease

Claudia P Oliveira et al. Hepatoma Res. 2020.

Abstract

Aim: To compare the phenotype of lean versus overweight (OW) and obese (OB) subjects with non-alcoholic fatty liver disease (NAFLD) across multiple continents.

Methods: A retrospective study of histologically defined subjects from a single center each in France (Fr), Brazil (Br), India (In) and United States (US) was performed.

Results: A total of 70 lean [body mass index (BMI) < 25 kg/m2] subjects (Fr:Br:In:US: 16:19:22:13) with NAFLD were compared to 136 OW (BMI > 25 kg/m2, BMI < 29 kg/m2) (n = 28:33:52:23) and 224 OB subjects (BMI > 29 kg/m2) (n = 81:11:22:103). Lean French subjects had the lowest incidence of type 2 diabetes while those from Brazil (P < 0.01) had the highest. Lean subjects had similar low-density lipoprotein-cholesterol, but higher high-density lipoprotein-cholesterol compared to obese subjects in all regions. In both lean and obese subjects, there were both insulin-sensitive and insulin-resistant subjects. Lean French subjects were most insulin-sensitive while those from Brazil were mostly insulin-resistant. For each weight category, subjects from India were more insulin-sensitive than those from other regions. Disease activity increased from lean to overweight to obese in France but was similar across weight categories in other regions.

Conclusion: The phenotype of NAFLD in lean subjects varies by region. Some obese subjects with NAFLD are insulin-sensitive. We hypothesize that genetics and region-specific disease modifiers account for these differences.

Keywords: Non-alcoholic fatty liver disease; demographics; epidemiology; phenotype.

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Conflict of interest statement

Conflicts of interest All authors declared that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Comorbidities of lean vs. overweight vs. obese subjects with nonalcoholic fatty liver disease. A: type 2 diabetes mellitus (T2DM); B: LDL cholesterol; C: HDL cholesterol; D: triglycerides. LDL: low-density lipoprotein cholesterol; HDL: high-density lipoprotein cholesterol
Figure 2.
Figure 2.
Insulin resistance and insulin sensitivity in nonalcoholic fatty liver disease lean subjects vs. overweight vs. obese across regions. A: lean subjects; B: overweight subjects; C: obese subjects
Figure 3.
Figure 3.
The histological spectrum of nonalcoholic fatty liver disease in lean vs. overweight vs. obese across regions. A: steatosis grade; B: lobular inflammation grade; C: hepatocellular ballooning; D: fibrosis stage
See this image and copyright information in PMC

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References

    1. Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology 2017;65:1557–65. - PMC - PubMed
    1. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015;148:547–55. - PubMed
    1. Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int 2009;29:113–9. - PubMed
    1. Ercin CN, Dogru T, Genc H, Celebi G, Aslan F, et al. Insulin resistance but not visceral adiposity index is associated with liver fibrosis in nondiabetic subjects with nonalcoholic fatty liver disease. Metab Syndr Relat Disord 2015;13:319–25. - PubMed
    1. Dumas ME, Kinross J, Nicholson JK. Metabolic phenotyping and systems biology approaches to understanding metabolic syndrome and fatty liver disease. Gastroenterology 2014;146:46–62. - PubMed

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