title: Clinicopathological characteristics and metabolic profiles of non-alcoholic fatty liver disease in Indian patients with normal body mass index: Do they differ from obese or overweight non-alcoholic fatty liver disease?
abstract: BACKGROUND
  Obesity is an important risk factor for non-alcoholic fatty liver disease (NAFLD); however, NAFLD does occur in lean subjects. This study was aimed to evaluate the magnitude, clinical, pathological, and metabolic profiles of NAFLD in normal body mass index (BMI) subjects (defined as lean NAFLD) in comparison to overweight or obese NAFLD and lean healthy control.
  
  
  METHODS
  336 subjects (205 consecutive NAFLD, and 131 healthy controls) were studied.
  
  
  RESULTS
  Among 205 NAFLD patients, 27 (13.2%) were lean, while 141 (68.8%) and 37 (18%) patients were obese and overweight, respectively. The lean NAFLD compared to obese NAFLD had significantly lesser degree of fasting hyperinsulinemia (P < 0.001), homeostasis model assessment insulin resistance (HOMA-IR, P < 0.001), and lower prevalence of diabetes mellitus (P = 0.01) and metabolic syndrome (P < 0.001). The profiles of serum lipids were similar between all 3 BMI categories, and 89% of lean NAFLD were dyslipidemic. Compared to obese subjects, patients with lean NAFLD had less hepatic necro-inflammation (P = 0.05) and fibrosis (P < 0.001). However, the proportion of steatohepatitis and advanced fibrosis were similar between all BMI categories. The profiles of overweight NAFLD were similar to those of lean NAFLD, except for higher HOMA-IR, uric acids and male gender in overweight group. Despite being lean, the mean BMI of lean NAFLD were still higher than unselected lean healthy controls (P = 0.02).
  
  
  CONCLUSIONS
  Lean NAFLD patients have less severe disease, minor, or no insulin resistance, but are frequently dyslipidemic and have BMI higher than lean healthy control.
authors: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors: Ramesh
authors: R
authors: Kumar
authors: Archana
authors: A
authors: Rastogi
authors: Manoj Kumar
authors: MK
authors: Sharma
authors: Vikram
authors: V
authors: Bhatia
authors: Hitendra
authors: H
authors: Garg
authors: Chhagan
authors: C
authors: Bihari
authors: Shiv Kumar
authors: SK
authors: Sarin
keywords: Dyslipidemia; insulin resistance; lean non-alcoholic fatty liver disease
references: Ann Hepatol. 2007 Jul-Sep;6(3):161-3
references: 17786142
references: Hepatology. 2010 Nov;52(5):1836-46
references: 21038418
references: Diabetes. 2001 Aug;50(8):1844-50
references: 11473047
references: Indian J Med Res. 2009 Mar;129(3):285-92
references: 19491421
references: Aliment Pharmacol Ther. 2011 Oct;34(7):757-66
references: 21790685
references: N Engl J Med. 2010 May 6;362(18):1675-85
references: 20427778
references: Hepatology. 2009 Oct;50(4):1087-93
references: 19670459
references: J Lipid Res. 2004 May;45(5):941-7
references: 14967820
references: Diabetologia. 2005 Apr;48(4):634-42
references: 15747110
references: Dig Dis Sci. 2007 Sep;52(9):2368-74
references: 17420951
references: J Lipid Res. 2011 Apr;52(4):593-617
references: 21245030
references: J Assoc Physicians India. 2011 Jun;59:351-4
references: 21751587
references: Indian J Clin Biochem. 2011 Apr;26(2):202-9
references: 22468051
references: Diabetes Care. 2000 Jan;23(1):57-63
references: 10857969
references: Lancet. 2004 Jan 10;363(9403):157-63
references: 14726171
references: Hepatology. 2010 Feb;51(2):679-89
references: 20041406
references: World J Gastroenterol. 2006 Jun 7;12(21):3400-5
references: 16733858
references: Hepatology. 2005 Jun;41(6):1313-21
references: 15915461
references: Obesity (Silver Spring). 2008 Aug;16(8):1881-6
references: 18551117
references: J Assoc Physicians India. 2009 Mar;57:201-4
references: 19588647
references: Proc Natl Acad Sci U S A. 2006 Nov 28;103(48):18273-7
references: 17114290
references: J Gastroenterol Hepatol. 2007 Jun;22(6):788-93
references: 17565631
references: Arch Intern Med. 2004 Oct 25;164(19):2169-75
references: 15505132
references: Gastroenterology. 2007 May;132(6):2191-207
references: 17498512
references: Hepatology. 2010 May;51(5):1593-602
references: 20222092
references: Hepatology. 2003 Jun;37(6):1286-92
references: 12774006
references: Atherosclerosis. 2006 Jun;186(2):367-73
references: 16112123
references: J Hepatol. 2007 Nov;47(5):711-7
references: 17850914
references: J Clin Gastroenterol. 2006 Mar;40 Suppl 1:S17-29
references: 16540762
references: Hepatology. 2007 Apr;45(4):846-54
references: 17393509
references: Ann Intern Med. 2000 Jan 18;132(2):112-7
references: 10644271
references: Hepatology. 2003 Aug;38(2):518-26
references: 12883497
references: Hepatology. 2006 Jun;43(6):1317-25
references: 16729309
references: Hepatology. 2010 Oct;52(4):1281-90
references: 20803499