Mostafa Alaa M, Fouad Yasser, Gaber Yasmine, Alem Shereen Abdel, Pan Ziyan, Eslam Mohammed
Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Main Road, Minia, 11432, Egypt.
Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Clin Exp Med. 2025 Jun 18;25(1):211. doi: 10.1007/s10238-025-01749-1.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is often linked to overweight and obesity. However, a significant number of individuals with MAFLD are not obese, commonly referred to as lean MAFLD. This study aims to investigate the potential risk factors for fibrosis among lean individuals with MAFLD compared to those who are overweight or obese. The study included 7902 participants from the National Health and Nutrition Examination Survey (NHANES) data collected between 2017 and March 2020. MAFLD was defined in individuals with steatosis who were either overweight, diabetic, or lean and had at least two metabolic risk abnormalities. Demographic, anthropometric, and laboratory data, along with elastography results, were reported for each subject. Lean patients with MAFLD were significantly older (62.3 ± 13.8 years) compared to overweight or obese patients with MAFLD (51.7 ± 16.7 years; p < 0.001). Several factors were identified as predictors of significant fibrosis within the MAFLD population, including increasing age, BMI, ALT levels, alkaline phosphatase levels, lower platelet counts, lower HDL-cholesterol levels, and the presence of diabetes. In a multivariate logistic analysis of significant fibrosis (F > 2) in patients with obese MAFLD, female gender, diabetes, and hypertension were identified as risk factors. For lean individuals with MAFLD, older age, high AST levels, and lower platelet counts were found to be significant predictors of fibrosis. MAFLD among lean individuals is not a benign condition; those with metabolic dysfunction are at risk of developing fibrosis. The risk factors for fibrosis in these individuals may differ from those in their obese counterparts.
代谢功能障碍相关脂肪性肝病（MAFLD）常与超重和肥胖有关。然而，相当一部分MAFLD患者并不肥胖，通常被称为瘦型MAFLD。本研究旨在调查与超重或肥胖的MAFLD患者相比，瘦型MAFLD患者发生肝纤维化的潜在危险因素。该研究纳入了7902名参与者，数据来自2017年至2020年3月期间收集的美国国家健康与营养检查调查（NHANES）。MAFLD定义为存在脂肪变性，且超重、患有糖尿病或体型偏瘦，同时至少有两项代谢风险异常的个体。报告了每个受试者的人口统计学、人体测量学和实验室数据以及弹性成像结果。与超重或肥胖的MAFLD患者（51.7±16.7岁；p<0.001）相比，瘦型MAFLD患者的年龄显著更大（62.3±13.8岁）。在MAFLD人群中，有几个因素被确定为显著肝纤维化的预测因素，包括年龄增加、体重指数（BMI）、谷丙转氨酶（ALT）水平、碱性磷酸酶水平、血小板计数降低、高密度脂蛋白胆固醇水平降低以及糖尿病的存在。在对肥胖MAFLD患者显著肝纤维化（F>2）的多因素逻辑分析中，女性性别、糖尿病和高血压被确定为危险因素。对于瘦型MAFLD患者，年龄较大、天冬氨酸转氨酶（AST）水平较高和血小板计数较低被发现是肝纤维化的显著预测因素。瘦型个体中的MAFLD并非良性疾病；那些有代谢功能障碍的人有发生肝纤维化的风险。这些个体发生肝纤维化的危险因素可能与肥胖个体不同。
