Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Department of Anatomical Pathology, Singapore General Hospital, Singapore.
J Gastroenterol Hepatol. 2021 Jan;36(1):257-261. doi: 10.1111/jgh.15154. Epub 2020 Jul 5.
Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome. Worryingly, it has been increasingly reported among nonobese patients. This study aims to analyse patient characteristics of biopsy-proven NAFLD in an Asian cohort and explore differences stratified by body mass index (BMI).
Clinical, laboratory, and histological data were collected from 263 adults with biopsy-proven NAFLD. Patients with and without obesity (BMI cut-off 25) were compared. The ability to predict advanced liver fibrosis with three non-invasive scores, the NAFLD Fibrosis score (NFS), Fibrosis-4 (FIB4), and the aspartate aminotransferase to platelet ratio index (APRI), was compared.
Obese subjects had a lower mean age (49.5 ± 12.5 vs 54.0 ± 12.9 years, P = 0.017), a higher prevalence of diabetes (52.4% vs 36.8%, P = 0.037), and a higher waist circumference (113.9 ± 16.0 cm vs 87.0 ± 18.4 cm, P = 0.022). The prevalence of dyslipidaemia (68.0% vs 61.4%, P = 0.353) and hypertension (61.7% vs 49.1%, P = 0.190) was comparable between the two groups. The distribution of non-alcoholic steatohepatitis (NASH) (63.1% versus 61.4%, P = 0.710) and advanced fibrosis (31.6% versus 26.3%, P = 0.447) were also similar in both groups. All three non-invasive scores (NFS, FIB4, and APRI) performed poorly in predicting advanced fibrosis in nonobese patients with NAFLD. The FIB4 was the most accurate non-invasive score in predicting advanced fibrosis in the obese group.
Obese and nonobese patients are equally at risk of NASH and advanced fibrosis. While the FIB4 is the most accurate non-invasive score in predicting advanced fibrosis among obese individuals, further research is warranted to develop a nonobese specific score to correctly identify nonobese NAFLD patients with advanced fibrosis.
非酒精性脂肪性肝病（NAFLD）与代谢综合征相关。令人担忧的是，越来越多的非肥胖患者也出现了这种情况。本研究旨在分析亚洲人群中经活检证实的 NAFLD 患者的特征，并探讨按体重指数（BMI）分层的差异。
从 263 名经活检证实的 NAFLD 成人患者中收集临床、实验室和组织学数据。比较有和无肥胖症（BMI 切点 25）的患者。比较三种非侵入性评分，即 NAFLD 纤维化评分（NFS）、纤维化 4 指数（FIB4）和天门冬氨酸氨基转移酶与血小板比值指数（APRI），预测晚期肝纤维化的能力。
肥胖组的平均年龄较低（49.5±12.5 岁 vs 54.0±12.9 岁，P=0.017），糖尿病患病率较高（52.4% vs 36.8%，P=0.037），腰围较大（113.9±16.0cm vs 87.0±18.4cm，P=0.022）。两组血脂异常（68.0% vs 61.4%，P=0.353）和高血压（61.7% vs 49.1%，P=0.190）的患病率相当。两组非酒精性脂肪性肝炎（NASH）（63.1% vs 61.4%，P=0.710）和晚期纤维化（31.6% vs 26.3%，P=0.447）的分布也相似。在非肥胖的 NAFLD 患者中，所有三种非侵入性评分（NFS、FIB4 和 APRI）预测晚期纤维化的效果均不佳。在肥胖组中，FIB4 是预测晚期纤维化最准确的非侵入性评分。
肥胖和非肥胖患者发生 NASH 和晚期纤维化的风险相同。虽然 FIB4 是预测肥胖患者晚期纤维化最准确的非侵入性评分，但需要进一步研究开发针对非肥胖人群的特异性评分，以正确识别非肥胖的 NAFLD 患者的晚期纤维化。
