title: Clinical, anthropometric, biochemical, and histological characteristics of nonobese nonalcoholic fatty liver disease patients of Bangladesh.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is considered to be a disease of obese individuals, yet lean patients are increasingly susceptible to have NAFLD. The aim of this study was to evaluate the profile of nonobese patients by comparing with obese NAFLD patients.
  
  
  METHODS
  We have included 465 patients of NAFLD after exclusion of other diseases, and 220 with elevated alanine aminotransferase (ALT) were biopsied. Patients were biochemically and clinically evaluated: blood pressure, body mass index (BMI), and waist circumference (WC) were recorded for every patient. A BMI  ≥ 25 kg/m(2) was defined as obese, and those with a BMI of <25 kg/m(2) were labeled as nonobese. Histological activity was expressed with NAFLD activity score (NAS).
  
  
  RESULTS
  Of 465 cases, 119 (25.6 %) were nonobese. Diabetes was noted in 122 (26.2 %) and hypertension in 122 (26.2 %). Metabolic syndrome was present in 253 (59.7 %), low HDL cholesterol in 228 (64.8 %), hypertriglyceridemia in 297 (73.2 %), and WC above normal in 308 (70.2 %). Males were predominating in the nonobese compared to females in the obese (p = 0.001). Hypertriglyceridemia and low high-density lipoprotein was similar in the obese and nonobese (76.2 % vs. 72.3 %, p = 0.5 and 65.2 % vs. 64.6 %, p = 1.0, respectively). The grades of steatosis, lobular inflammation, ballooning, NAS, and the stage of fibrosis did not also significantly differ between obese and nonobese patients. Nonalcoholic steatohepatitis (NASH) was 53.1 % in nonobese.
  
  
  CONCLUSIONS
  Nonobese was 25.6 % among NAFLD patients of Bangladesh, and 53.1 % of nonobese NAFLD cases were NASH. Though they were nonobese by BMI grade, they were metabolically similar to obese. Males were predominant in the nonobese, whereas females in the obese. NASH and fibrosis were similar in the obese and nonobese.
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, shahinul67@yahoo.com.
authors.forename: Shahinul
authors.initials: S
authors.lastname: Alam
authors.forename: Utpal Das
authors.initials: UD
authors.lastname: Gupta
authors.forename: Mahbubul
authors.initials: M
authors.lastname: Alam
authors.forename: Jahangir
authors.initials: J
authors.lastname: Kabir
authors.forename: Ziaur Rahman
authors.initials: ZR
authors.lastname: Chowdhury
authors.forename: A K M Khorshed
authors.initials: AK
authors.lastname: Alam
mesh_terms: D000328:Adult; D001459:Bangladesh; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000209:etiology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D009765:Obesity / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D012723:Sex