Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: An inter-national registry study

Tan, Eunice Xiang-Xuan and Lee, Jonathan Wei-Jie and Jumat, Nur Halisah and Chan, Wah-Kheong and Treeprasertsuk, Sombat and Goh, George Boon-Bee and Fan, Jian-Gao and Song, Myeong Jun and Charatcharoenwitthaya, Phunchai and Duseja, Ajay and Imajo, Kento and Nakajima, Atsushi and Seki, Yosuke and Kasama, Kazunori and Kakizaki, Satoru and Lesmana, Laurentius A. and Zheng, Kenneth and Zheng, Ming-Hua and Koh, Calvin J. and Ho, Khek-Yu and Goh, Khean-Lee and Wong, Vincent Wai-Sun and Dan, Yock-Young (2022) Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: An inter-national registry study. Metabolism-Clinical And Experimental, 126. ISSN 0026-0495, DOI

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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, com-pared 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 bio-markers for advanced liver disease in non-obese patients. (c) 2021 Published by Elsevier Inc.

Item Type: Article
Funders: None
Uncontrolled Keywords: Fatty liver; Obesity; Asian; NAFLD; Fibrosis
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 19 Jul 2022 11:06
Last Modified: 19 Jul 2022 11:06

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