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. 2023 May;57(9):1014-1027.
doi: 10.1111/apt.17424. Epub 2023 Feb 23.

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

Karn Wijarnpreecha  1   2 , Fang Li  3 , Sori K Lundin  4 , Deepika Suresh  5 , Michael W Song  5 , Cui Tao  3 , Vincent L Chen  1 , Anna S F Lok  1
Affiliations

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

Karn Wijarnpreecha et al. Aliment Pharmacol Ther. 2023 May.

Abstract

Background & aims: Non-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.

Methods: This 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.

Results: A 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.

Conclusions: Lean 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.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Vincent Chen receives research grant funding from KOWA and Astra Zeneca. Anna Lok receives research grant funding from KOWA, Astra Zeneca and TARGET, and serves on Data and Safety Monitoring Board for Novo Nordisk.

Figures

FIGURE 1
FIGURE 1
Study flow chart.
FIGURE 2
FIGURE 2
Cumulative incidence of death and diseases among NAFLD by BMI category. (A) Cumulative incidence of death by BMI category. (B) Cumulative incidence of type 2 diabetes mellitus by BMI category. (C) Cumulative incidence of any cardiovascular disease by BMI category. (D) Cumulative incidence of cirrhosis by BMI category. (E) Cumulative incidence of any cancer by BMI category. (F) Cumulative incidence of obesity-related cancer by BMI category. *(B–F) Used competing risk analysis.
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