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Adverse metabolic profile more impactful on NASH than obesity

Adverse metabolic conditions showed a greater impact on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, significant fibrosis, kidney dysfunction and atherogenic profile compared with “healthy” obesity, according to a recently published study.

“Obesity is a strong risk factor for a lot of entities, including NAFLD,” Javier Ampuero, MD, PhD, from the University Hospital Virgen del Rocío in Spain, and colleagues wrote. “However, some obese people do not suffer from the common metabolic disturbances related to obesity, adopting the concept of metabolically healthy obesity (MHO). The concept of MHO could represent an unfavorable type of body fat distribution with a low but relevant subclinical inflammation.”

To define the impact of the metabolic status on the NAFLD-related outcomes with or without concomitant obesity, Ampuero and colleagues enrolled 1,058 patients with biopsy-confirmed NAFLD, 52.2% of whom had NASH. The researchers distributed patients into categories of healthy non-obesity (11.2%), healthy obesity (11.2%), unhealthy non-obesity (21.4%) and unhealthy obesity (56.2%).

Both the prevalence of NASH and fibrosis progressively increased according to the number of metabolic risk factors present (P < .0001).

In multivariate analysis, the healthy obesity (OR = 1.88; 95% CI, 1-3.66), unhealthy non-obesity (OR = 3.7; 95% CI, 2.116.46) and unhealthy obesity categories (OR = 3.47; 95% CI, 2.055.87) were linked to an increased risk for NASH, together with homeostatic model assessment (OR = 1.07; 95% CI, 1.021.11), platelets (OR = 0.99; 95% CI, 0.991) and aspartate aminotransferase (OR = 1.01; 95% CI, 1-1.02).

Similarly, the unhealthy obesity (OR = 3.89; 95% CI, 1.579.61) and unhealthy non-obesity categories (OR = 3.92; 95% CI, 1.639.44) were linked to significant fibrosis in addition to platelets (OR = 0.99; 95% CI, 0.980.99), albumin (OR = 0.56; 95% CI, 0.330.94), AST (OR = 1.01; 95% CI, 1-1.02), HOMA (OR = 1.1; 95% CI, 1.051.15) and age (OR = 1.04; 95% CI, 1.021.06).

The prevalence of chronic kidney disease was more common in patients with metabolically unhealthy than healthy status (5.7% vs. 2%; P = .028) and increased depending on the metabolic health and obesity phenotypes from 2.1% in healthy non-obese and 1.9% in healthy obesity to 3.5% in unhealthy nonobesity and 6.5% in unhealthy obesity (P = .05).

Finally, atherogenic index of plasma (AIP) of 2 or more was less common in the healthy non-obesity (38.1%) and obesity categories (48.7%) than the unhealthy non-obesity (78.2%) and obesity categories (79.8%; P < .0001). AIP also increased depending on the number of metabolic risk factors.

“The impact of metabolic status was more important than obesity on NAFLD-related histological outcomes, and they were progressively affected according to the number of metabolic risk factors,” the researchers wrote. “This finding emphasizes the importance of early intervention, besides simple weight loss, in metabolically unhealthy subjects.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.