Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study
1
Issued Date
2022-01-01
Resource Type
ISSN
00260495
eISSN
15328600
Scopus ID
2-s2.0-85118626694
Pubmed ID
34648769
Journal Title
Metabolism: Clinical and Experimental
Volume
126
Rights Holder(s)
SCOPUS
Bibliographic Citation
Metabolism: Clinical and Experimental Vol.126 (2022)
Suggested Citation
Tan E.X.X., Lee J.W.J., Jumat N.H., Chan W.K., Treeprasertsuk S., Goh G.B.B., Fan J.G., Song M.J., Charatcharoenwitthaya P., Duseja A., Imajo K., Nakajima A., Seki Y., Kasama K., Kakizaki S., Lesmana L.A., Zheng K.I., Zheng M.H., Koh C.J., Ho K.Y., Goh K.L., Wong V.W.S., Dan Y.Y. Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study. Metabolism: Clinical and Experimental Vol.126 (2022). doi:10.1016/j.metabol.2021.154911 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/83944
Title
Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study
Author's Affiliation
Graduate School of Medicine
Graduate School of Medicine
The First Affiliated Hospital of Wenzhou Medical University
National University Health System
Shanghai Jiao Tong University School of Medicine
Universiti Malaya
Chulalongkorn University
NUS Yong Loo Lin School of Medicine
Singapore General Hospital
Mahidol University
The Catholic University of Korea
Chinese University of Hong Kong
Postgraduate Institute of Medical Education & Research, Chandigarh
Yotsuya Medical Cube
Medistra Hospital
Graduate School of Medicine
The First Affiliated Hospital of Wenzhou Medical University
National University Health System
Shanghai Jiao Tong University School of Medicine
Universiti Malaya
Chulalongkorn University
NUS Yong Loo Lin School of Medicine
Singapore General Hospital
Mahidol University
The Catholic University of Korea
Chinese University of Hong Kong
Postgraduate Institute of Medical Education & Research, Chandigarh
Yotsuya Medical Cube
Medistra Hospital
Other Contributor(s)
Abstract
Background: A significant proportion of the non-alcoholic fatty liver disease (NAFLD) population is non-obese. Prior studies reporting the severity of NAFLD amongst non-obese patients were heterogenous. Our study, using data from the largest biopsy-proven NAFLD international registry within Asia, aims to characterize the demographic, metabolic and histological differences between non-obese and obese NAFLD patients. Methods: 1812 biopsy-proven NAFLD patients across nine countries in Asia assessed between 2006 and 2019 were pooled into a curated clinical registry. Demographic, metabolic and histological differences between non-obese and obese NAFLD patients were evaluated. The performance of Fibrosis-4 index for liver fibrosis (FIB-4) and NAFLD fibrosis score (NFS) to identify advanced liver disease across the varying obesity subgroups was compared. A random forest analysis was performed to identify novel predictors of fibrosis and steatohepatitis in non-obese patients. Findings: One-fifth (21.6%) of NAFLD patients were non-obese. Non-obese NAFLD patients had lower proportions of NASH (50.5% vs 56.5%, p = 0.033) and advanced fibrosis (14.0% vs 18.7%, p = 0.033). Metabolic syndrome in non-obese individuals was associated with NASH (OR 1.59, 95% CI 1.01–2.54, p = 0.047) and advanced fibrosis (OR 1.88, 95% CI 0.99–3.54, p = 0.051). FIB-4 performed better than the NFS score (AUROC 81.5% vs 73.7%, p < 0.001) when classifying patients with F2–4 fibrosis amongst non-obese NAFLD patients. Haemoglobin, GGT, waist circumference and cholesterol are additional variables found on random forest analysis useful for identifying non-obese NAFLD patients with advanced liver disease. Conclusion: A substantial proportion of non-obese NAFLD patients has NASH or advanced fibrosis. FIB-4, compared to NFS better identifies non-obese NAFLD patients with advanced liver disease. Serum GGT, cholesterol, haemoglobin and waist circumference, which are neither components of NFS nor FIB-4, are important biomarkers for advanced liver disease in non-obese patients.