Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease.
OBJECTIVE
This cross-sectional study evaluated liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), and compared the characteristics of metabolically healthy obese (MHO) with metabolically unhealthy obese (MUHO) patients.


METHODS
The study was nested within a randomized clinical trial (RCT) and included obese patients with NAFLD, as determined by liver ultrasonography. Fibrosis was assessed by transient elastography, and AST-to-platelet ratio index (APRI) and NAFLD score. Patients were compared according to obesity phenotype using various accepted criteria.


RESULTS
The RCT included 1024 patients with NAFLD, of whom 428 (41.7%) were included in the present study. The prevalence of MHO ranged from 1.2% to 63%, depending on the criteria used. According to various criteria for metabolic health, obese patients had less liver fibrosis. MHO patients, as defined by all criteria, showed a significantly lower prevalence of advanced liver fibrosis (F3-F4) than MUHO on transient elastography (16.5% vs. 28%, respectively; P≤0.05).


CONCLUSIONS
MUHO patients are at higher risk of liver fibrosis and, therefore, the identification of obese patients with 'healthy' characteristics is imperative as their entire clinical work-ups are likely to differ.
Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
Y
Y
Gutiérrez-Grobe
Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
E
E
Juárez-Hernández
Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
B A
BA
Sánchez-Jiménez
Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
M H
MH
Uribe-Ramos
Diagnosis and Treatment Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
M H
MH
Ramos-Ostos
Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
M
M
Uribe
Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico; Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico. Electronic address: khavez@gmail.com.
N C
NC
Chávez-Tapia
D000328:Adult; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D009765:Obesity / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
Chronic liver disease; Fibrosis; Metabolic syndrome; Obesity; Prognosis