Asian, lean patients with NAFLD have lower prevalence of cirrhosis, CVD

Lean Asian patients with nonalcoholic fatty liver disease had significantly lower prevalence of cirrhosis, cardiovascular disease and metabolic abnormalities than lean non-Asian patients.

“Everyone knows that NAFLD is very common and everyone knows obesity is an important risk factor. But not everyone knows that patients can look skinny and normal and still have fatty liver disease,” Anna S. Lok, MD, professor of internal medicine and director of clinical hepatology at University of Michigan, told Healio Gastroenterology. “That is something we want people to be aware of, think about it.”

Lok and colleagues used data from the Target-nonalcoholic steatohepatitis (TARGET-NASH) study to determine prevalence of cirrhosis, cardiovascular disease (CVD) and metabolic abnormalities in patients within all BMI groups. They identified 3,386 patients with NAFLD.

“We were not surprised by the results,” Lok said. “We know that there are patients with NAFLD who are lean. But we didn’t know how common it was among Asian patients compared with white patients. We found that Asians were over-represented among those with normal BMI and NAFLD.”

Data showed 12.8% of study patients were lean, 27.1% were overweight, 26.5% had class 1 obesity and 33.7% had class 2 or 3 obesity.

Asian patients accounted for 48.7% of lean patients and the proportion of patients being Asian decreased as BMI increased (P < .0001). Lean patients had lower risk for cirrhosis, diabetes, hypertension or dyslipidemia, overall, when compared to those who were overweight or obese; and Asian patients, compared with non-Asian patients, had lower cirrhosis prevalence, history of CVD, cardiovascular events and diabetes, independent of BMI. The odds for NAFLD-related cirrhosis in Asian patients who were lean was almost half that of lean non-Asian patients, after adjusting for age, sex, center type and site (OR = 0.47; 95% CI, 0.29–0.77).

“We hope that over time, with a longer duration of follow-up, we can determine whether lean patients have slower rate of progression of liver, cardiovascular, and metabolic diseases than those who are overweight or obese, and whether the rate of progression among lean Asians is slower than that of lean non-Asians. We do not know the cause of these differences but there could be differences in genetics and environmental factors that could be contributing to this.”