Abstract
Backgrounds
Non-obese nonalcoholic fatty liver disease (NAFLD) is paradoxically associated with
improved metabolic and pathological features at diagnosis but worse prognosis relative
to obese NAFLD.
Aim
To compare predictors of disease severity in NAFLD with different body mass index
(BMI) categories.
Methods
All 1509 consecutive NAFLD patients were classified as lean (20.2%), overweight (23.1%)
and obese (56.7%). Liver fat content (LFC) and fibrosis were estimated with magnetic
resonance imaging-based proton density fat fraction and shear wave elastography respectively.
Results
Lipid profiles and uric acid (UA) were significantly increased in parallel with BMI
categories (pairwise comparison P < 0.001), but insulin resistance (IR) was significantly different between the non-obese
and obese groups. For LFC ≥ 10%, increased waist circumference (WC) was an independent
predictor in all groups, while UA elevation (P = 0.02) was predictive in the overweight patients, but BMI ≥ 28 kg/m2 (P = 0.029) and IR (P = 0.026) were significant in the obese patients. For fibrosis, alanine aminotransferase
(ALT) > 40 U/L (P = 0.031), increased WC (P = 0.012) and BMI ≥ 28 kg/m2 (P < 0.001) plus ALT > 40 U/L (P = 0.007) were predictors in the lean, overweight and obese patients, respectively.
Conclusions
WC was strongly predictive of disease severity in all NAFLD, while UA and BMI plus
IR were additional predictors in the overweight and obese NAFLD respectively. Individualized
screening strategies should be established for NAFLD according to different BMIs.
Keywords
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Article info
Publication history
Published online: March 07, 2019
Accepted:
February 25,
2019
Received:
December 5,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
