Xu Mengyan, Gong Rui, Xie Jiao, Xu Sanping, Wang Shi
Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Nutr Metab (Lond). 2025 May 12;22(1):40. doi: 10.1186/s12986-025-00927-y.
Non-alcoholic fatty liver disease (NAFLD) affects more than a quarter of the global population and has become the world's number one chronic liver disease, seriously jeopardizing public life and health. Despite the new terminology of metabolic dysfunction-associated steatotic liver disease (MASLD) has been proposed, the mechanisms underlying the heterogeneity across BMI stratification in non-alcoholic fatty liver disease (NAFLD) remain unclear. The aim of this study was to reveal the differences in metabolic and fibrotic characteristics between lean (BMI < 23 kg/m) and non-lean NAFLD in an Asian population.
The current study collected NAFLD patients from the physical examination population. Patients were divided into two groups by BMI to compare their clinical parameters, including lean (BMI < 23 kg/m) and non-lean (BMI ≥ 23 kg/m) and fibrosis subgroups (with a threshold of LSM = 8 kPa) and analyzed for risk factors by logistic regression models.
Of the 11,577 NAFLD patients who participated in the study, there were 916 lean and 10,661 non-lean. The non-lean group was younger than the lean group (median age 50 vs. 52 years, P < 0.001) and had a significantly higher prevalence of hypertension (28.0% vs. 18.3%), diabetes mellitus (10.1% vs. 6.1%), and liver fibrosis (9.1% vs. 5.1%) (all P < 0.001). Analysis of metabolic indexes showed that TyG, TyG-BMI, TG/HDL-C and APRI were higher in the non-lean group (all P < 0.001). Gender stratification revealed that ALT was significantly higher in the male non-lean group, while HDL-C was lower in the female non-lean group (1.35 vs. 1.47 mmol/L). Multiple regression suggested that the risk of fibrosis was independently associated with CAP values and fasting glucose, BMI, direct bilirubin, globulin, and age in the non-lean group, whereas the risk was mainly driven by GGT and ALP in the lean group.
Non-lean NAFLD patients showed more significant metabolic disturbances and risk of liver fibrosis. Although metabolic indicators (TyG, FIB-4) have limited predictive value for liver fibrosis, they are strongly associated with metabolic risk in MASLD.
非酒精性脂肪性肝病（NAFLD）影响着全球超过四分之一的人口，已成为全球第一大慢性肝病，严重危害公众生活和健康。尽管已提出代谢功能障碍相关脂肪性肝病（MASLD）这一新术语，但非酒精性脂肪性肝病（NAFLD）中BMI分层间异质性的潜在机制仍不清楚。本研究的目的是揭示亚洲人群中瘦（BMI＜23kg/m²）与非瘦NAFLD患者在代谢和纤维化特征上的差异。
本研究从体检人群中收集NAFLD患者。根据BMI将患者分为两组，比较其临床参数，包括瘦（BMI＜23kg/m²）和非瘦（BMI≥23kg/m²）以及纤维化亚组（以LSM = 8kPa为阈值），并通过逻辑回归模型分析危险因素。
参与本研究的11577例NAFLD患者中，有916例瘦患者和10661例非瘦患者。非瘦组比瘦组年轻（中位年龄50岁对52岁，P＜0.001），高血压（28.0%对18.3%）、糖尿病（10.1%对6.1%）和肝纤维化（9.1%对5.1%）的患病率显著更高（均P＜0.001）。代谢指标分析显示，非瘦组的TyG、TyG-BMI、TG/HDL-C和APRI更高（均P＜0.001）。性别分层显示，男性非瘦组的ALT显著更高，而女性非瘦组的HDL-C更低（1.35对1.47mmol/L）。多元回归表明，非瘦组纤维化风险与CAP值、空腹血糖、BMI、直接胆红素、球蛋白和年龄独立相关，而瘦组的风险主要由GGT和ALP驱动。
非瘦NAFLD患者表现出更显著的代谢紊乱和肝纤维化风险。尽管代谢指标（TyG、FIB-4）对肝纤维化的预测价值有限，但它们与MASLD中的代谢风险密切相关。
