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Differential risk factors of fibrosis between lean and obese MAFLD
Alaa M Mostafa1, Yasser Fouad2, Yasmine Gaber3
1Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Main Road, Minia, 11432, Egypt. alaam.mostafa2022@gmail.com.
Abstract:
Metabolic dysfunction-associated fatty liver disease (MAFLD) is often linked to overweight and obesity. However, a significant number of individuals with MAFLD are not obese, commonly referred to as lean MAFLD. This study aims to investigate the potential risk factors for fibrosis among lean individuals with MAFLD compared to those who are overweight or obese. The study included 7902 participants from the National Health and Nutrition Examination Survey (NHANES) data collected between 2017 and March 2020. MAFLD was defined in individuals with steatosis who were either overweight, diabetic, or lean and had at least two metabolic risk abnormalities. Demographic, anthropometric, and laboratory data, along with elastography results, were reported for each subject. Lean patients with MAFLD were significantly older (62.3 ± 13.8 years) compared to overweight or obese patients with MAFLD (51.7 ± 16.7 years; p < 0.001). Several factors were identified as predictors of significant fibrosis within the MAFLD population, including increasing age, BMI, ALT levels, alkaline phosphatase levels, lower platelet counts, lower HDL-cholesterol levels, and the presence of diabetes. In a multivariate logistic analysis of significant fibrosis (F > 2) in patients with obese MAFLD, female gender, diabetes, and hypertension were identified as risk factors. For lean individuals with MAFLD, older age, high AST levels, and lower platelet counts were found to be significant predictors of fibrosis. MAFLD among lean individuals is not a benign condition; those with metabolic dysfunction are at risk of developing fibrosis. The risk factors for fibrosis in these individuals may differ from those in their obese counterparts.
Insights
Lean individuals with metabolic dysfunction-associated fatty liver disease (MAFLD) face fibrosis risks. Older age, high AST, and low platelets predict fibrosis in lean MAFLD patients, differing from obese counterparts.
Area of Science:
- Hepatology
- Metabolic Disorders
- Public Health
Background:
- Metabolic dysfunction-associated fatty liver disease (MAFLD) is commonly associated with overweight and obesity.
- A subset of MAFLD patients, termed lean MAFLD, present without obesity, posing unique clinical questions.
- Understanding fibrosis risk factors in lean MAFLD is crucial for targeted interventions.
Purpose of the Study:
- To investigate and compare the risk factors for liver fibrosis in lean individuals with MAFLD versus those who are overweight or obese.
- To identify specific predictors of significant fibrosis in the lean MAFLD population.
Main Methods:
- Analysis of 7902 participants from the National Health and Nutrition Examination Survey (NHANES) (2017-2020).
- MAFLD diagnosis based on steatosis plus overweight, diabetes, or lean status with metabolic abnormalities.
- Utilized demographic, anthropometric, laboratory, and elastography data to assess fibrosis predictors.
Main Results:
- Lean MAFLD patients were significantly older than their overweight/obese counterparts.
- Predictors of significant fibrosis in the overall MAFLD cohort included age, BMI, ALT, alkaline phosphatase, platelet count, HDL-cholesterol, and diabetes.
- In lean MAFLD, older age, elevated AST, and lower platelet counts were significant fibrosis predictors, contrasting with risk factors like female gender, diabetes, and hypertension in obese MAFLD.
Conclusions:
- Lean MAFLD is not a benign condition and carries a significant risk of fibrosis development.
- The risk factors for developing fibrosis in lean individuals with MAFLD differ from those observed in overweight or obese MAFLD patients.
- These findings highlight the need for tailored risk assessment and management strategies for lean MAFLD patients.
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