TY - JOUR
T1 - Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia
T2 - an international registry study
AU - Tan, Eunice Xiang Xuan
AU - Lee, Jonathan Wei Jie
AU - Jumat, Nur Halisah
AU - Chan, Wah Kheong
AU - Treeprasertsuk, Sombat
AU - Goh, George Boon Bee
AU - Fan, Jian Gao
AU - Song, Myeong Jun
AU - Charatcharoenwitthaya, Phunchai
AU - Duseja, Ajay
AU - Imajo, Kento
AU - Nakajima, Atsushi
AU - Seki, Yosuke
AU - Kasama, Kazunori
AU - Kakizaki, Satoru
AU - Lesmana, Laurentius A.
AU - Zheng, Kenneth I.
AU - Zheng, Ming Hua
AU - Koh, Calvin J.
AU - Ho, Khek Yu
AU - Goh, Khean Lee
AU - Wong, Vincent Wai Sun
AU - Dan, Yock Young
N1 - Funding Information:
Nil.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - Asian
KW - Fatty liver
KW - Fibrosis
KW - NAFLD
KW - Obesity
UR - http://www.scopus.com/inward/record.url?scp=85118626694&partnerID=8YFLogxK
U2 - 10.1016/j.metabol.2021.154911
DO - 10.1016/j.metabol.2021.154911
M3 - Article
C2 - 34648769
AN - SCOPUS:85118626694
SN - 0026-0495
VL - 126
JO - Metabolism: Clinical and Experimental
JF - Metabolism: Clinical and Experimental
M1 - 154911
ER -
