title: Lean-non-alcoholic fatty liver disease increases risk for metabolic disorders in a normal weight Chinese population.
abstract: OBJECTIVE
  To study the prevalence and clinical biochemical, blood cell and metabolic features of lean-non-alcoholic fatty liver disease (lean-NAFLD) and its association with other diseases.
  
  
  METHODS
  Demographic, biochemical and blood examinations were conducted in all the subjects in this study. We classified the subjects into four groups according to their weight and NAFLD status: lean-control, lean-NAFLD [body mass index (BMI) < 24 kg/m(2)], overweight-obese control and overweight-obese NAFLD. One-way analysis of variance (ANOVA) was used to compare the means of continuous variables (age, BMI, blood pressure, glucose, lipid, insulin, liver enzymes and blood cell counts) and the χ (2) test was used to compare the differences in frequency of categorical variables (sex, education, physical activity, smoking, alcohol consumption and prevalence of hypertension, hyperlipidemia, diabetes, metabolic syndrome central obesity and obesity). Both univariate and multivariate logistic regression models were adopted to calculate odds ratios (ORs) and predict hyperlipidemia, hypertension, diabetes and metabolic syndrome when we respectively set all controls, lean-control and overweight-obese-control as references. In multivariate logistic regression models, we adjusted potential confounding factors, including age, sex, smoking, alcohol consumption and physical activity.
  
  
  RESULTS
  The prevalence of NAFLD was very high in China. NAFLD patients were older, had a higher BMI, waist circumference, blood pressure, fasting blood glucose, insulin, blood lipid, liver enzymes and uric acid than the controls. Although lean-NAFLD patients had lower BMI and waist circumstance, they had significantly higher visceral adiposity index than overweight-obese controls. Lean-NAFLD patients had comparable triglyceride, cholesterin and low-density lipoprotein cholesterin to overweight-obese NAFLD patients. In blood cell examination, both lean and overweight-obese NAFLD was companied by higher white blood cell count, red blood cell count, hemoglobin and hematocrit value. All NAFLD patients were at risk of hyperlipidemia, hypertension, diabetes and metabolic syndrome (MetS). Lean-NAFLD was more strongly associated with diabetes (OR = 2.47, 95%CI: 1.14-5.35), hypertension (OR = 1.72, 95%CI: 1.00-2.96) and MetS (OR = 3.19, 95%CI: 1.17-4.05) than overweight-obese-NAFLD (only OR for MetS was meaningful: OR = 1.89, 95%CI: 1.29-2.77). NAFLD patients were more likely to have central obesity (OR = 1.97, 95%CI: 1.38-2.80), especially in lean groups (OR = 2.17, 95%CI: 1.17-4.05).
  
  
  CONCLUSIONS
  Lean-NAFLD has unique results in demographic, biochemical and blood examinations, and adds significant risk for diabetes, hypertension and MetS in lean individuals.
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Ren-Nan
authors.initials: RN
authors.lastname: Feng
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Du
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Yan-Chuan
authors.initials: YC
authors.lastname: Li
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Liu
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Fu-Chuan
authors.initials: FC
authors.lastname: Guo
authors.affiliation: Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
authors.forename: Chang-Hao
authors.initials: CH
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000208:ethnology; D050171:Dyslipidemias / Q000208:ethnology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D056865:Ideal Body Weight / Q000208:ethnology*; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D009765:Obesity / Q000208:ethnology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D013851:Thinness / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Chinese; Diabetes; Lean-non-alcoholic fatty liver disease; Metabolic disorder; Risk