Liver and Bile

Gut. 2022;71(2):382–90

Younes R, Govaere O, Petta S, Miele L, Tiniakos D, Burt A, David E, Vecchio FM, Maggioni M, Cabibi D, McLeod D, Pareja MJ, Fracanzani AL, Aller R, Rosso C, Ampuero J, Gallego-Durán R, Armandi A, Caviglia GP, Zaki MYW, Liguori A, Francione P, Pennisi G, Grieco A, Birolo G, Fariselli P, Eslam M, Valenti L, George J, Romero-Gómez M, Anstee QM, Bugianesi E

Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: Time for reappraisal of BMI-driven approach?

Objective: The full phenotypic expression of non-alcoholic fatty liver disease (NAFLD) in lean subjects is incompletely characterized. The authors aimed to investigate prevalence, characteristics and long-term prognosis of Caucasian lean subjects with NAFLD.
Design: The study cohort comprises 1339 biopsy-proven NAFLD subjects from 4 countries (Italy, UK, Spain and Australia), stratified into lean and non-lean (body mass index [BMI] 10,483 person-years), 4.7% of lean versus 7.7% of non-lean patients reported liver-related events (p = 0.37). No difference in survival was observed compared with non-lean NAFLD (p = 0.069).

Conclusions: Caucasian lean subjects with non-alcoholic fatty liver disease (NAFLD) may progress to advanced liver disease, develop metabolic comorbidities and experience cardiovascular disease as well as liver-related mortality, independent of longitudinal progression to obesity and PNPLA3 genotype. These patients represent one end of a wide spectrum of phenotypic expression of NAFLD where the disease manifests at lower overall body mass index thresholds.

DOI: DOI: 10.1136/gutjnl-2020-322564