Daily Dose: NAFLD Associated with Adverse Outcomes Regardless of BMI

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the Journal of Clinical and Translational Hepatology that examined the long-term outcomes of patients with nonalcoholic fatty liver disease (NAFLD) who were considered lean, overweight, or obese by body mass index (BMI).

The study

Researchers compared long-term outcomes in consecutive patients with imaging-confirmed NAFLD considered lean, overweight, and obese who presented at any clinic at Stanford Healthcare between March 1, 1995, and December 31, 2021. Investigators followed participants from first presentation with confirmed NAFLD to death, loss to follow-up, or end of the study period. Among exclusion criteria were significant alcohol use, viral hepatitis, autoimmune or other metabolic liver diseases.

The primary outcomes were NASH incidence, cirrhosis incidence, and overall mortality. Investigators additionally performed subgroup analysis for liver-related and nonliver-related death and used uni- and multivariable logistic regression to identify factors associated with lean NAFLD.

The research team identified and enrolled a final cohort of 9061 participants with confirmed NAFLD and available BMI data.

The findings

More than half the study cohort had obesity (58.1%); slightly less than one-third were categorized as overweight (31.7%); and 10.2% were classified as lean.

When the team evaluated risk of NASH and cirrhosis by weight category, they found no statistically significant differences among the groups (NASH, P=.20; cirrhosis, P=.22).

Mortality among the overweight and obese subgroups was similar for overall and liver-specific causes of death. The group of participants with lean NAFLD, however, had higher mortality rates both overall (P=.01) and for nonliver-related causes (P=.02) compared to the overweight and obese groups, although not for liver-related causes (P=.71).

Authors' comment

"Lean NAFLD had fewer metabolic comorbidities but similar adverse or worse outcomes, suggesting that it is not benign. Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD."

Click here for more details.