Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Department of Clinical Research Design and Evaluation, SAIHST.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e529-e534. doi: 10.1097/MEG.0000000000002158.
Obesity is a well-known risk factor for nonalcoholic fatty liver disease (NAFLD), and weight reduction is primarily recommended for managing the disease. However, some NAFLD patients have a normal weight (lean NAFLD), and whether weight reduction is also recommendable for lean NAFLD patients remains unclear.
We conducted a longitudinal study of 16 738 adults (average age, 50.5 years; lean NAFLD, 2383 participants) with NAFLD at baseline who underwent repeated health check-up examinations, including bodyweight measurements and abdominal ultrasonography from January 2003 through December 2013.
During 68 389 person-years of follow-up (median follow-up of 3.00 years), 5819 patients had a fatty liver resolution. Compared with participants who had no weight reduction or increased weight, the fully adjusted hazard ratios for fatty liver resolution in participants with 0-4.9, 5-9.9 and 10% or more weight reduction were 1.67 [95% confidence interval (CI), 1.57-1.77], 3.36 (95% CI, 3.09-3.65) and 5.50 (95% CI, 4.83-6.27), respectively. The association between weight reduction and the fatty liver resolution was stronger in overweight/obese NAFLD participants but was also evident in lean NAFLD participants in a dose-dependent manner. In spline regression models, the association between weight change and the fatty liver resolution was linear among participants with normal weight.
There was a dose-dependent association between weight reduction and fatty liver resolution in both lean and overweight/obese NAFLD patients. This finding suggests weight reduction as a primary recommendation for lean NAFLD patients as in overweight/obese NAFLD patients.
肥胖是众所周知的非酒精性脂肪性肝病（NAFLD）的危险因素，主要推荐减轻体重来治疗这种疾病。然而，一些 NAFLD 患者体重正常（瘦型 NAFLD），对于瘦型 NAFLD 患者是否也推荐减轻体重尚不清楚。
我们对 16738 名基线时患有 NAFLD 的成年人（平均年龄为 50.5 岁；瘦型 NAFLD 患者 2383 名）进行了一项纵向研究，这些患者在 2003 年 1 月至 2013 年 12 月期间接受了重复的健康检查，包括体重测量和腹部超声检查。
在 68389 人年的随访期间（中位随访时间为 3.00 年），5819 名患者的脂肪肝得到了缓解。与没有减轻体重或体重增加的参与者相比，体重减轻 0-4.9%、5-9.9%和 10%或更多的参与者，脂肪肝缓解的全调整风险比分别为 1.67（95%置信区间[CI]，1.57-1.77）、3.36（95%CI，3.09-3.65）和 5.50（95%CI，4.83-6.27）。体重减轻与脂肪肝缓解之间的关联在超重/肥胖的 NAFLD 患者中更强，但在瘦型 NAFLD 患者中也呈剂量依赖性。在样条回归模型中，在体重正常的参与者中，体重变化与脂肪肝缓解之间的关系呈线性。
在瘦型和超重/肥胖的 NAFLD 患者中，体重减轻与脂肪肝缓解之间存在剂量依赖性关联。这一发现表明，对于瘦型 NAFLD 患者，与超重/肥胖的 NAFLD 患者一样，减轻体重是主要推荐的治疗方法。
