BARCELONA — New data presented during the International Liver Congress showed patients with nonalcoholic fatty liver disease and a large waist circumference, but without obesity, may be at increased risk for further complications compared with patients with NAFLD and obesity.
“While NAFLD is commonly associated with obesity, research has highlighted that a percentage of patients are not actually obese,” Rosa Lombardi, MD, unit of internal medicine, Policlinico Hospital, University of Milan, Italy, said during her presentation. “This is the first study to show that patients with lean-NAFLD who have increased levels of waist fat can, in fact, be at greater risk than obese patients with NAFLD.”
Lombardi and colleagues evaluated the parameters of lean-NAFLD (BMI less than 25kg/m2) in 334 patients with biopsy-proven NAFLD. Patients were divided according to BMI, waist circumference and abdominal fat. A total of 61 patients with lean-NAFLD were found.
“NAFLD was present in 20% of patients, despite normal BMI,” Lombardi said during her presentation.
In the overall multivariate analysis, increased waist circumference — greater than 88 cm (35 inches) in women and 102 cm (40 inches) in men — was significantly associated with metabolic syndrome (P = .001), significant fibrosis (P = .03), carotid plaques (P = .03), homeostasis model assessment of insulin resistance (HOMA-IR; P = .04) and triglycerides (P = .002). Age (P = .001) and HOMA-IR (P = .03) in patients with lean-NAFLD.
When patients with lean-NAFLD and overweight patients were divided according to waist circumference, lean-NAFLD with higher waist circumference had greater prevalence of metabolic syndrome, carotid plaques and significant fibrosis compared with patients who were overweight or had obesity.
Patients with lean-NAFLD overall showed lower prevalence of hypertension (20% vs. 42%; P = .001), diabetes (8% vs. 25%; P = .003) and metabolic syndrome (13% vs. 42%; P = .002) compared with the overweight patients or patients with obesity. Lipid parameters were not different between the groups.
In addition, carotid intima-media thickness (0.7 ± 0.1 vs. 0.8 ± 0.1; P = .0001), carotid plaques (13% vs. 33%; P = .007), cardiovascular risk (4.1 ± 6.6; P = .007), the prevalence of nonalcoholic steatohepatitis (37% vs. 62%; P = .0005) and prevalence of significant fibrosis (4% vs. 13%; P = .02) were all lower in patients with lean-NAFLD.
In univariate analysis, Lombardi stated that age, female gender, fasting glucose and diabetes were associated with increased waist circumference in patients with lean-NAFLD, noting that these data are “interesting” but preliminary and more data is needed with a larger cohort of patients.
“Increased visceral obesity, evaluated by waist circumference, is associated with more severe metabolic profile and vascular and liver damage,” Lombardi concluded “This occurs also in lean-NAFLD. … Thus, NAFLD patients need to be carefully examined for hepatic and extrahepatic complications independently of BMI.”
In a press release from EASL, Frank Tacke, MD, PhD, EASL governing board member, said, “This study has proven to us that the severity of nonalcoholic fatty liver disease is not necessarily linked to how obese an individual is, but instead how much fat build-up they have around the waist.” – by Melinda Stevens
Lombardi R, et al. Abstract PS110. Presented at International Liver Congress. April 13-17, 2016; Barcelona.
Disclosure: The researchers report no relevant financial disclosures.