Nonalcoholic Fatty Liver Disease in Lean Patients Linked With CVD Risk

Lean patients with non-alcoholic fatty liver disease (NAFLD) were more likely to have cardiovascular disease (CVD) than those who were overweight or obese, one researcher reported.

Among more than 18,000 of these patients, a logistic regression analysis—adjusted for demographics and clinical risk factors—showed that overweight or obese patients with NAFLD were associated with a significantly lower prevalence of any cardiovascular disease compared to lean patients, according to Karn Wijarnpreecha, MD, MPH, of the University of Michigan at Ann Arbor. Specifically:

  • Overweight: odds ratio 0.8, 95% CI 0.6-0.9
  • Class 1 obesity: OR 0.7, 95% CI 0.6-0.9
  • Obesity class 2-3: OR 0.7, 95% CI 0.6-0.8

While lean patients had a lower prevalence of cirrhosis, diabetes, dyslipidemia, hypertension, chronic kidney disease (CKD) and other metabolic diseases, they had a higher prevalence of stroke and of peripheral arterial disease, Wijarnpreecha said during a press briefing ahead of Digestive Disease Week.

“We think it could be due to a difference in lifestyle, diet, exercise, genetics, or even microbiota,” he said. “These are the factors that we did not consider in this current study and could explain why the lean group has the highest association or prevalence of cardiovascular disease.”

Multisystem NAFLD develops more frequently in obese patients and often presents without symptoms. NAFLD can lead to conditions unrelated to the liver such as metabolic disease, CKD, and CVD. However, about 10-20% of people with a normal BMI can still develop NAFLD. According to Wijarnpreecha and colleagues, there remains a lack of data on whether people with a normal BMI who develop NAFLD have less severe liver disease, CKD, or CVD than those with NAFLD. obesity.

“Our team expected to see that people with a normal BMI would have a lower prevalence of any metabolic or cardiovascular condition, so we were very surprised to find this link to cardiovascular disease,” Wijarnpreecha said. “Too often we overlook NAFLD patients with normal BMIs because we assume their risk of more serious diseases is lower than those of overweight people. But this way of thinking can put these patients at risk.”

The authors retrospectively reviewed electronic health record data of 18,594 adults diagnosed with NAFLD at the University of Michigan Hospital (n=10,220) from January 1, 2012 to February 28, 2021 and a Michigan NAFLD cohort ( n = 8,374; Wijarnpreecha did not specify the source of these data). Of these, 2,137 were underweight (BMI 18.5-24.9), 4,692 were overweight (BMI 25-29.9), 5,234 were class 1 obese (BMI 30-34.9) and 6,531 had class 2-3 obesity (BMI 35-<40), based on the BMI threshold recommendations for Asians and non-Asians provided by the World Health Organization.

Diagnoses of NAFLD were confirmed by liver biopsy, the presence of hepatic steatosis on imaging, or a controlled attenuation parameter greater than 250 db/m on transient vibration-controlled elastography. Patients with excessive alcohol consumption, alcohol-related disease and cancer, among others, were excluded. Multivariate analysis adjusted for age, sex, race, smoking, diabetes, dyslipidemia and hypertension.

Overall, more than half of patients in all weight categories were female, Caucasian (78% to 82%), and never smokers (56% to 57%), the most common comorbidities being hypertension (42% to 60%). , dyslipidemia (34%-52%) and any CVD (29%-33%). Obese patients tended to have a higher prevalence of cirrhosis (4.7%).

The current study was retrospective and performed at a single medical center. The authors concluded that “NAFLD in lean people is not a benign disease and that “attention to cardiac risk stratification and intervention is warranted for lean patients with NAFLD.”

“The results are interesting because the authors found a significantly increased prevalence of cardiovascular disease compared to overweight/obese people, even though the prevalence of risk factors for atherosclerotic disease and metabolic disease was lower,” said Andrew Talal. , MD, of the University at Buffalo in New York said MedPage today. “Primary care physicians, endocrinologists, hepatologists, and public health officials should consider screening for cardiovascular disease in lean people with NAFLD.”

“Future work is warranted to investigate the effect of modifying CVD risk factors in lean people with NAFLD,” said Talal, who was not involved in this study.

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

Wijarnpreecha and its co-authors have disclosed no relationship with the industry.

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