Lean NAFLD: An Underrecognized Outlier.
Nonalcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese or overweight individuals. However, lean individuals with NAFLD are not rare but represent one significant end of the phenotypic spectrum of NAFLD. Although initial observations between obese and lean NAFLD reveal some metabolic parallels, these associations vary widely given differences in study populations and metabolic parameters assessed. The role of body composition in risk assessment is significant and incompletely assessed during most clinical encounters. Recent multinational investigation reveals an increased mortality in lean individuals with NASH. Many aspects of lean NAFLD need further exploration including epidemiology, clinical risk assessment, histologic changes unique to lean NAFLD, genetic and pathophysiologic mechanisms predisposing at risk individuals, natural history and treatment strategies in this underrecognized population.
Center for Liver Disease and Transplantation, Columbia University Medical Center - New York Presbyterian Hospital.
Julia
J
Wattacheril
Virginia Commonwealth University, VCU Medical Center.
Arun J
AJ
Sanyal
lean; nonalcoholic fatty liver disease (NAFLD); nonalcoholic steatohepatitis (NASH); nonobese; normal weight
World J Gastroenterol. 2014 Dec 21;20(47):17932-40
25548491
Acta Gastroenterol Belg. 2011 Sep;74(3):389-94
22103042
Hepatology. 2009 Mar;49(3):791-801
19105205
Trop Gastroenterol. 2013 Jan-Mar;34(1):18-24
23923370
PLoS One. 2007 Aug 29;2(8):e812
17726542
Hepatol Int. 2013 Dec;7 Suppl 2:806-13
26202295
Hepatology. 2010 May;51(5):1593-602
20222092
Obesity (Silver Spring). 2011 Jun;19(6):1265-71
21183935
Medicine (Baltimore). 2012 Nov;91(6):319-27
23117851
J Clin Invest. 2004 Jun;113(11):1582-8
15173884
Proc Natl Acad Sci U S A. 2006 Nov 28;103(48):18273-7
17114290
J Gastroenterol. 2015 Jan;50(1):95-108
24619537
Eur J Clin Invest. 2015 Nov;45(11):1209-17
26291691
Ann Gastroenterol. 2012;25(1):45-51
24713801
Hepatology. 2007 Sep;46(3):716-22
17659597
Lancet. 2004 Jan 10;363(9403):157-63
14726171
J Clin Invest. 2007 Sep;117(9):2621-37
17717599
Nat Rev Endocrinol. 2015 Feb;11(2):90-100
25365922
Diabetes. 1993 Nov;42(11):1567-73
8405696
Arch Intern Med. 2004 Oct 25;164(19):2169-75
15505132
Hepatology. 2005 Nov;42(5):1175-83
16231364
Diabetes. 1999 Aug;48(8):1586-92
10426377