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Comparison of clinical and metabolic profiles of lean versus non-lean nonalcoholic fatty liver disease

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Abstract

Background

Data on nonalcoholic fatty liver disease (NAFLD) in the Philippines are scarce. We aimed to compare the clinical and biochemical profiles of lean (BMI<23) vs. non-lean (BMI≥23) NAFLD patients.

Methods

Consecutive patients diagnosed with NAFLD on ultrasound in two outpatient hepatology clinics from February 2007-January 2017 were included. Patients with significant alcohol intake, alternative causes of steatosis, and incomplete data were excluded.

Results

A total of 663 patients (57.9% male) were included. Most patients were non-lean (88.1%) and had an elevated alanine aminotransferase (ALT) (63%). Cirrhosis or hepatocellular carcinoma (HCC) were already present in 8.4% on initial consultation. Concomitant hepatitis B was equally common in patients with and without cirrhosis (20.7% vs. 17.5%; p=0.660) or HCC (17.9% vs. 12.8%; p=0.415). Independent factors associated with HCC/cirrhosis on initial consultation were older age (OR=1.038), low albumin (OR=0.428), high BARD score (BMI, AST/ALT ratio, T2 diabetes mellitus; OR=2.548) and the presence of symptoms (OR=1.808). Compared to lean NAFLD patients, non-lean patients were more likely to be younger (51.5±14.4 vs. 55±14.3; p=0.003), have DM (47.9% vs. 29.1%; p=0.002), hypertension (57.5% vs. 38%; p=0.001), dyslipidemia (73.1% vs. 54.4%; p=0.001) and metabolic syndrome (60.3% vs. 30.4%; p<0.0001), abnormal metabolic parameters (LDL-C, HDL-C, triglycerides, uric acid and FBS), and with elevated ALT (65.2% vs. 46.8%; p=0.002) and AST (41.1±29.6 vs. 35.3±28.3; p=0.008).

Conclusions

The proportion of lean NAFLD was 11.9%. Although metabolic derangements and its clinical consequences were present in about a third of lean patients, these were still more common in non-lean NAFLD. Cirrhosis or HCC were already present in a significant proportion (8.4%) of NAFLD patients on initial presentation.

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Authors and Affiliations

  1. Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines

    Ann Margaret C. Navarroza & Stephen N. Wong

  2. Section of Gastroenterology, Chinese General Hospital and Medical Center, Manila, Philippines

    Stephen N. Wong

Authors
  1. Ann Margaret C. Navarroza
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  2. Stephen N. Wong
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ann Margaret Navarroza and Stephen Wong. The first draft of the manuscript was written by Ann Margaret Navarroza and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephen N. Wong.

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Conflict of interest

AMCN, and SNW declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Navarroza, A.M.C., Wong, S.N. Comparison of clinical and metabolic profiles of lean versus non-lean nonalcoholic fatty liver disease. Indian J Gastroenterol 40, 380–388 (2021). https://doi.org/10.1007/s12664-021-01184-6

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  • DOI: https://doi.org/10.1007/s12664-021-01184-6

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