Comparative Burden of Metabolic Dysfunction in Lean NAFLD vs Non-lean NAFLD - A Systematic Review and Meta-analysis

Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunctio...

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Published inClinical gastroenterology and hepatology Vol. 21; no. 7; pp. 1750 - 1760.e12
Main Authors Tang, Ansel, Ng, Cheng Han, Phang, Poh Hui, Chan, Kai En, Chin, Yip Han, Fu, Clarissa Elysia, Zeng, Rebecca Wenling, Xiao, Jieling, Tan, Darren Jun Hao, Quek, Jingxuan, Lim, Wen Hui, Mak, Lung Yi, Wang, Jiong-wei, Chew, Nicholas W.S., Syn, Nicholas, Huang, Daniel Q., Siddiqui, Mohammad Shadab, Sanyal, Arun, Muthiah, Mark, Noureddin, Mazen
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2023
Subjects
Comorbidity
Diabetes Mellitus - epidemiology
Gastroenterology and Hepatology
Humans
MAFLD
Metabolic Associated Fatty Liver Disease Definition
NAFLD
NAFLD in obese
Non-alcoholic Fatty Liver Disease - complications
Non-alcoholic Fatty Liver Disease - epidemiology
Obesity - complications
Obesity - epidemiology
Overweight - complications
Overweight - epidemiology
SBP
NAFLD
CI
FBG
Metabolic Associated Fatty Liver Disease Definition
NAFLD in obese
MAFLD
HDL
HOMA-IR
DBP
TG
LDL
BMI
fasting blood glucose
body mass index
high-density lipoprotein
triglycerides
Homeostatic Model Assessment for Insulin Resistance
systolic blood pressure
low-density lipoprotein
nonalcoholic fatty liver disease
diastolic blood pressure
confidence interval
metabolic-associated fatty liver disease
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Abstract Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD. Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis. Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%–16.62%) of the global population and 14.55% (95% CI, 11.32%–18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%–24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%–56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese. The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD. [Display omitted]
AbstractList Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD. Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis. Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese. The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.
Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD. Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis. Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%–16.62%) of the global population and 14.55% (95% CI, 11.32%–18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%–24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%–56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese. The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD. [Display omitted]
Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD.BACKGROUND & AIMSNonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD.Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis.METHODSMedline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis.Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese.RESULTSEighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese.The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.CONCLUSIONThe current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.
Background & AimsNonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD. MethodsMedline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis. ResultsEighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%–16.62%) of the global population and 14.55% (95% CI, 11.32%–18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%–24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%–56.80%) of obese subjects with NAFLD had diabetes ( P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese. ConclusionThe current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.
Author Syn, Nicholas
Xiao, Jieling
Chew, Nicholas W.S.
Tang, Ansel
Quek, Jingxuan
Zeng, Rebecca Wenling
Huang, Daniel Q.
Ng, Cheng Han
Wang, Jiong-wei
Mak, Lung Yi
Muthiah, Mark
Siddiqui, Mohammad Shadab
Tan, Darren Jun Hao
Sanyal, Arun
Lim, Wen Hui
Phang, Poh Hui
Chan, Kai En
Chin, Yip Han
Noureddin, Mazen
Fu, Clarissa Elysia
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  organization: Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, California
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35863685$$D View this record in MEDLINE/PubMed
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ID FETCH-LOGICAL-c458t-4a5fbe49fa873978925de9a3a997c13ca69d1c944f41377e281a43bf3c6841553
ISSN 1542-3565
1542-7714
IngestDate Fri Jul 11 06:45:17 EDT 2025
Mon Jul 21 06:05:17 EDT 2025
Tue Jul 01 03:50:48 EDT 2025
Thu Apr 24 22:54:59 EDT 2025
Fri Feb 23 02:38:02 EST 2024
Tue Feb 25 20:04:39 EST 2025
Tue Aug 26 16:33:55 EDT 2025
IsPeerReviewed true
IsScholarly true
Issue 7
Keywords SBP
NAFLD
CI
FBG
Metabolic Associated Fatty Liver Disease Definition
NAFLD in obese
MAFLD
HDL
HOMA-IR
DBP
TG
LDL
BMI
fasting blood glucose
body mass index
high-density lipoprotein
triglycerides
Homeostatic Model Assessment for Insulin Resistance
systolic blood pressure
low-density lipoprotein
nonalcoholic fatty liver disease
diastolic blood pressure
confidence interval
metabolic-associated fatty liver disease
Language English
License Copyright © 2023 AGA Institute. All rights reserved.
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Snippet Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs...
Background & AimsNonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean,...
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SubjectTerms Comorbidity
Diabetes Mellitus - epidemiology
Gastroenterology and Hepatology
Humans
MAFLD
Metabolic Associated Fatty Liver Disease Definition
NAFLD
NAFLD in obese
Non-alcoholic Fatty Liver Disease - complications
Non-alcoholic Fatty Liver Disease - epidemiology
Obesity - complications
Obesity - epidemiology
Overweight - complications
Overweight - epidemiology
Title Comparative Burden of Metabolic Dysfunction in Lean NAFLD vs Non-lean NAFLD - A Systematic Review and Meta-analysis
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https://dx.doi.org/10.1016/j.cgh.2022.06.029
https://www.ncbi.nlm.nih.gov/pubmed/35863685
https://www.proquest.com/docview/2693777624
Volume 21
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