Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Internal Medicine, Mayo Clinic, Rochester, MN 55092, United States.
Postgrad Med J. 2023 Sep 21;99(1176):1094-1103. doi: 10.1093/postmj/qgad035.
The relationship between body mass index (BMI) and outcomes in patients with nonalcoholic fatty liver disease (NAFLD) is not well defined. This study aimed to assess the presentations, outcomes, and development of liver-related events (LREs) and non-LREs in patients with NAFLD stratified by BMI.
Records of NAFLD patients from 2000-2022 were reviewed. Patients were categorized as lean (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (>25 kg/m2) based on BMI. Stage of steatosis, fibrosis, and NAFLD activity score were noted in the patients undergoing liver biopsy in each group.
Out of 1051 NAFLD patients, 127 (12.1%) had normal BMI, 177 (16.8%) and 747 (71.1%) were overweight and obese, respectively. Median [interquartile range] BMI was 21.9 [20.6-22.5], 24.2 [23.7-24.6], and 28.3 [26.6-30.6] kg/m2 in each group, respectively. Prevalence of metabolic syndrome and dyslipidemia were significantly higher in the obese. Obese patients had significantly higher median [interquartile range] liver stiffness (6.4 [4.9-9.4] kPa) than overweight and lean subjects. A higher proportion of obese patients had significant and advanced liver fibrosis. At follow-up, there were no significant differences in the progression of liver disease, new LREs, coronary artery disease, or hypertension across the BMI groups. Overweight and obese patients were more likely to develop new-onset diabetes by follow-up. The mortality rates in the three groups were comparable (0.47, 0.68, and 0.49 per 100 person-years, respectively), with similar causes of death (liver-related vs non-liver-related).
Patients with lean NAFLD have similar disease severity and rates of progression as the obese. BMI is not a reliable determinant of outcomes in NAFLD patients.
体质量指数（BMI）与非酒精性脂肪性肝病（NAFLD）患者结局之间的关系尚未明确。本研究旨在评估根据 BMI 分层的 NAFLD 患者的临床表现、结局以及与肝脏相关事件（LRE）和非 LRE 的发生情况。
回顾了 2000 年至 2022 年的 NAFLD 患者记录。根据 BMI 将患者分为消瘦（18.5-22.9kg/m2）、超重（23-24.9kg/m2）和肥胖（>25kg/m2）。在每组接受肝活检的患者中记录了脂肪变性、纤维化和 NAFLD 活动评分的分期。
在 1051 名 NAFLD 患者中，127 名（12.1%）的 BMI 正常，177 名（16.8%）和 747 名（71.1%）超重和肥胖。各组的 BMI 中位数[四分位数间距]分别为 21.9[20.6-22.5]、24.2[23.7-24.6]和 28.3[26.6-30.6]kg/m2。肥胖患者的代谢综合征和血脂异常患病率明显更高。肥胖患者的中位[四分位数间距]肝硬度（6.4[4.9-9.4]kPa）明显高于超重和消瘦患者。更高比例的肥胖患者存在显著且进展性的肝纤维化。在随访期间，各组的肝病进展、新发 LRE、冠心病或高血压无显著差异。超重和肥胖患者在随访期间更有可能新发糖尿病。三组的死亡率相当（0.47、0.68 和 0.49/100 人年），死亡原因相似（与肝脏相关与非肝脏相关）。
瘦型 NAFLD 患者的疾病严重程度和进展率与肥胖患者相似。BMI 不是 NAFLD 患者结局的可靠决定因素。
