First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece.
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
World J Gastroenterol. 2020 Nov 14;26(42):6514-6528. doi: 10.3748/wjg.v26.i42.6514.
Nonalcoholic fatty liver disease (NAFLD) accounts for most cases of chronic liver disease worldwide, with an estimated global prevalence of approximately 25% and ranges from simple steatosis to nonalcoholic steatohepatitis and cirrhosis. NAFLD is strongly connected to metabolic syndrome, and for many years, fatty liver was considered to be an exclusive feature of obese patients. However, recent studies have highlighted the presence of NAFLD in non-obese subjects, with or without increased visceral fat or even in lean subjects without increased waist circumference. "Lean NAFLD" is a relatively new concept and there is significant scientific interest in understanding the differences in pathophysiology, prognosis and management compared with NAFLD in overweight/obese patients. In the present editorial, we discuss the clinical and metabolic profiles and outcomes of lean NAFLD compared with both obese NAFLD and lean healthy individuals from Asian and Western countries. Moreover, we shed light to the challenging topic of management of NAFLD in lean subjects since there are no specific guidelines for this population. Finally, we discuss open questions and issues to be addressed in the future in order to categorize NAFLD patients into lean and non-lean cohorts.
非酒精性脂肪性肝病（NAFLD）占全球慢性肝病的大多数，其全球患病率约为 25%，范围从单纯性脂肪变性到非酒精性脂肪性肝炎和肝硬化。NAFLD 与代谢综合征密切相关，多年来，脂肪肝被认为是肥胖患者特有的特征。然而，最近的研究强调了非肥胖人群中存在 NAFLD，无论是否存在内脏脂肪增加，甚至在没有腰围增加的瘦人群体中也是如此。“瘦型 NAFLD”是一个相对较新的概念，科学界对其与超重/肥胖患者的 NAFLD 在病理生理学、预后和管理方面的差异非常感兴趣。在本期社论中，我们讨论了来自亚洲和西方国家的瘦型 NAFLD 与肥胖型 NAFLD 和瘦型健康个体的临床和代谢特征以及结局。此外，我们还探讨了瘦型人群中 NAFLD 管理这一具有挑战性的话题，因为针对这一人群尚无特定的指南。最后，我们讨论了一些悬而未决的问题和需要在未来解决的问题，以便将 NAFLD 患者分为瘦型和非瘦型队列。
