Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Clin Gastroenterol Hepatol. 2023 Jul;21(7):1750-1760.e12. doi: 10.1016/j.cgh.2022.06.029. Epub 2022 Jul 19.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD.
Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis.
Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese.
The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.
非酒精性脂肪性肝病（NAFLD）传统上与肥胖相关。然而，有一种 NAFLD 的亚型，即非肥胖型 NAFLD，它在没有肥胖的情况下发生。然而，最近呼吁将 NAFLD 重新定义为代谢相关脂肪性肝病，重点关注肥胖和代谢功能障碍。有人批评说，过分强调全身性合并症可能对瘦人不利。本分析旨在量化非肥胖型 NAFLD 代谢功能障碍的程度，并与超重和肥胖型 NAFLD 以及非 NAFLD 进行比较。
从 2022 年 3 月 3 日起，在 Medline 和 Embase 数据库中进行了搜索。纳入标准是有基线代谢参数的非肥胖型 NAFLD 患者的文章。通过亚组分析进行了比较。
共有 85 篇文章纳入荟萃分析。非肥胖型 NAFLD 占全球人群的 13.11%（95%可信区间[CI]，10.26%-16.62%），亚洲人群的 14.55%（95% CI，11.32%-18.51%）。代谢功能障碍与体重有关，与超重的非肥胖型 NAFLD 患者相比，非肥胖型 NAFLD 患者的代谢功能障碍明显较轻。对于非肥胖型 NAFLD，只有 19.56%（95% CI，15.28%-24.69%）的患者患有糖尿病，而肥胖型 NAFLD 患者中则有 45.70%（95% CI，35.01%-56.80%）患有糖尿病（P<.01）。非肥胖型 NAFLD 患者的空腹血糖和收缩压及舒张压值明显低于超重和肥胖患者。
本分析强调了 NAFLD 代谢功能障碍与体重的关系。非肥胖型 NAFLD 患者的代谢健康状况明显好于肥胖和超重的 NAFLD 患者。过度依赖代谢功能障碍来定义脂肪肝将是一个缺陷，可能会排除以前定义的 NAFLD。
