title: The severity of histologic liver lesions is independent of body mass index in patients with nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is associated with obesity, but it may also be present in lean individuals. We evaluated the characteristics of NAFLD patients, focusing on those with normal body mass index (BMI).
  
  
  METHODS
  One hundred and sixty-two of 185 consecutive NAFLD patients were included. Demographic, clinical, somatometric, and laboratory characteristics were recorded. BMI<25 kg/m2 was considered to be normal.
  
  
  RESULTS
  Of the 162 patients, 12% had normal BMI. Patients with normal compared with those with increased BMI fulfilled more frequently no criterion of metabolic syndrome (43% vs. 2%; P<0.001) and had higher median alanine aminotransferase (92 vs. 62 IU/L; P=0.032) and aspartate aminotransferase levels (45 vs. 37 IU/L; P=0.036). Liver stiffness values by transient elastography were significantly lower in patients with normal than in those with increased BMI (5.0 ± 1.6 vs. 9.5 ± 8.7 kPa; P=0.003). In the 56 patients with liver biopsy, the prevalence of nonalcoholic steatohepatitis (50% vs. 68.8%; P=0.423) and the severity of inflammation and fibrosis did not significantly differ between cases with normal and those with increased BMI.
  
  
  CONCLUSIONS
  Approximately 1 of 8 NAFLD patients coming to a Greek tertiary liver center has normal BMI. On liver biopsy, normal BMI patients often have nonalcoholic steatohepatitis and histologic liver lesions of similar severity to the overweight or obese patients.
authors: Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece.
authors: Aikaterini
authors: A
authors: Margariti
authors: Melanie
authors: M
authors: Deutsch
authors: Spilios
authors: S
authors: Manolakopoulos
authors: Dina
authors: D
authors: Tiniakos
authors: George V
authors: GV
authors: Papatheodoridis
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015992:Body Mass Index; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006115:Greece; D006801:Humans; D056865:Ideal Body Weight; D007249:Inflammation / Q000453:epidemiology / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D015995:Prevalence; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase