Miao Ping, Shao Zhongyi, Jiang Ji
Ping Miao Traditional Chinese Medicine Diagnosis and Treatment Centre, Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang Province 315040, P.R. China.
Zhongyi Shao Department of Pharmacy, Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang Province 315040, P.R. China.
Pak J Med Sci. 2025 Jun;41(6):1845-1853. doi: 10.12669/pjms.41.6.12044.
To investigate the impact of lean status as per body mass index (BMI) on mortality in cases of non-alcoholic fatty liver disease (NAFLD).
A systematic search was conducted in PubMed, Embase, and Scopus to identify relevant studies published from the inception of each database up to July 31, 2024. Observational studies that reported data on the mortality outcomes of NAFLD patients with different BMI, and provided adjusted estimates were included. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Pooled effect sizes were reported as hazard ratio (HR) with 95% confidence intervals (CI).
Fourteen studies were included, of which majority were retrospective cohort studies (n=10). Objective assessment method for NAFLD i.e., imaging and/or biopsy was used in 10 studies. Compared to NAFLD patients with high BMI, lean patients had higher risk of all-cause mortality (HR 1.34, 95% CI: 1.23, 1.47), with no publication bias for any of the outcomes. Lean status correlated with elevated risk of liver disease-related mortality (HR 2.14, 95% CI: 1.18, 3.87) but had similar risk of cardiovascular (HR 0.92, 95% CI: 0.65, 1.30) and cancer-related mortality (HR 1.20, 95% CI: 0.90, 1.60).
Lean status of NAFLD patients correlates with higher risk of all-cause and liver disease-related mortality compared to patients with high BMI. There is a need for tailored interventions and further research to understand specific mortality risks in this subgroup of patients.
研究根据体重指数（BMI）划分的消瘦状态对非酒精性脂肪性肝病（NAFLD）患者死亡率的影响。
在PubMed、Embase和Scopus数据库中进行系统检索，以识别从各数据库建立至2024年7月31日发表的相关研究。纳入报告了不同BMI的NAFLD患者死亡率数据并提供校正估计值的观察性研究。采用纽卡斯尔-渥太华量表（NOS）进行质量评估。合并效应量以风险比（HR）及95%置信区间（CI）表示。
纳入14项研究，其中多数为回顾性队列研究（n = 10）。10项研究使用了NAFLD的客观评估方法，即影像学和/或活检。与高BMI的NAFLD患者相比，消瘦患者全因死亡风险更高（HR 1.34，95% CI：1.23，1.47），且各结局均无发表偏倚。消瘦状态与肝病相关死亡风险升高相关（HR 2.14，95% CI：1.18，3.87），但心血管疾病相关死亡风险（HR 0.92，95% CI：0.65，1.30）和癌症相关死亡风险（HR 1.20，95% CI：0.90，1.60）相似。
与高BMI的NAFLD患者相比，消瘦状态的NAFLD患者全因死亡和肝病相关死亡风险更高。需要进行针对性干预并开展进一步研究，以了解该亚组患者的特定死亡风险。
