Background & Aims

Nonalcoholic fatty liver disease (NAFLD) is typically associated with obesity. Little is known about the prevalence of cirrhosis in patients with NAFLD and a normal body mass index (BMI).

Methods

We determined prevalence of cirrhosis, cardiovascular disease (CVD), and metabolic abnormalities among participants in all BMI categories in the TARGET-NASH study. A total of 3386 patients with NAFLD were enrolled from August 2016 through March 2019. The odds ratios of cirrhosis, CVD, and metabolic abnormalities were estimated by age and race, adjusting for sex and center type.

Results

Based on standard BMI cutoff values, 12.8% of study subjects were lean, 27.1% were overweight, 26.5% had class 1 obesity, and 33.7% had class 2 or 3 obesity. Asians accounted for 48.7% of lean participants, and proportions decreased as BMI categories increased (P < .0001). Lower proportions of lean participants had cirrhosis (22.6% vs 40.2% of non-lean participants), CVD history (9.0% vs 14.8% of nonlean participants), diabetes (32.6% vs 53.5% of non-lean participants), hypertension (47.8% vs 67.4% of non-lean participants), or dyslipidemia (54.0% vs 64.1% of non-lean participants). Asian participants had a lower prevalence of cirrhosis, history of CVD, cardiovascular events, and diabetes compared with non-Asians, independent of BMI category. After we adjusted for age, sex, and center type and site, the odds of NAFLD-associated cirrhosis in Asians who were lean was almost half the odds of NAFLD-associated cirrhosis in non-Asians who were lean (odds ratio, 0.47; 95% CI, 0.29–0.77).

Conclusions

More than 10% participants in a cohort of persons with NAFLD in the United States are lean; Asians account for almost half of the lean persons with NAFLD. Lean participants had a lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-lean persons with NAFLD. Asian participants had a significantly lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-Asians in all BMI categories. ClinicalTrials.gov, Number: NCT02815891.

中文翻译：

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患有非酒精性脂肪肝的瘦美国人肝硬化和合并症的发生率较低

背景与目标

非酒精性脂肪性肝病 (NAFLD) 通常与肥胖有关。关于 NAFLD 和正常体重指数 (BMI) 患者的肝硬化患病率知之甚少。

方法

我们确定了 TARGET-NASH 研究中所有 BMI 类别参与者的肝硬化、心血管疾病 (CVD) 和代谢异常的患病率。从 2016 年 8 月到 2019 年 3 月，共有 3386 名 NAFLD 患者入组。肝硬化、心血管疾病和代谢异常的优势比根据年龄和种族进行估计，并根据性别和中心类型进行调整。

结果

根据标准 BMI 临界值，12.8% 的研究对象瘦，27.1% 超重，26.5% 有 1 级肥胖，33.7% 有 2 级或 3 级肥胖。亚洲人占精益参与者的 48.7%，随着 BMI 类别的增加，比例下降（P < .0001)。较低比例的精益参与者患有肝硬化（22.6% 与 40.2% 的非精益参与者）、CVD 病史（9.0% 与 14.8% 的非精益参与者）、糖尿病（32.6% 与 53.5% 的非精益参与者）、高血压（47.8 % vs 67.4% 的非精益参与者）或血脂异常（54.0% vs 64.1% 的非精益参与者）。与非亚洲人相比，亚洲参与者的肝硬化、心血管疾病病史、心血管事件和糖尿病患病率较低，与 BMI 类别无关。在我们对年龄、性别、中心类型和部位进行调整后，瘦亚洲人患 NAFLD 相关肝硬化的几率几乎是瘦非亚洲人患 NAFLD 相关肝硬化的几率的一半（优势比，0.47；95 % CI，0.29–0.77)。

结论

在美国的 NAFLD 患者队列中，超过 10% 的参与者是瘦的；亚洲人几乎占 NAFLD 瘦人的一半。与非瘦身的 NAFLD 患者相比，瘦身参与者的肝硬化、心血管疾病和代谢异常的患病率较低。在所有 BMI 类别中，亚洲参与者的肝硬化、心血管疾病和代谢异常的患病率显着低于非亚洲人。ClinicalTrials.gov，编号：NCT02815891。