| Original Article |
Question: What is the risk of liver disease progression, non–liver-related outcomes, and mortality among normal, overweight, and obese people with Nonalcoholic fatty liver disease (NAFLD)?
Design/Method: A cohort study was done between 1996 and 2016. Subjects were divided on the basis of body mass index (BMI) at NAFLD diagnosis into 3 groups: normal, overweight, and obese. The probability of developing cirrhosis, decompensation, malignancies, cardiovascular events, or death among the 3 groups was estimated by using the Aalen-Johansen method, treating death as a competing risk. The impact of BMI categories on these outcomes was explored by using Cox proportional hazards regression analysis
Setting: The United States
Patient/ Study community: All adults with NAFLD
Results: NAFLD with normal BMI is associated with a healthier metabolic profile, a trend toward milder liver disease progression, but similar risk of cardiovascular disease and malignancy and worse survival than obese NAFLD
| Primary and Secondary Outcomes at End of Follow-up Period | |||
| Outcomes | Normal (N = 414) | Overweight (N =1189) | Obese (N = 3231) |
| NAFLD with cirrhosis patients | 6 | 36 | 124 |
| Compensated patients | 1 | 15 | 43 |
| Decompensated patients
*Ascites events *Bleeding varices events *Hepatic encephalopathy events *Jaundice events |
5
4 1 2 3 |
21
18 5 4 9 |
81
69 12 45 42 |
| Any CV event | 120 | 373 | 988 |
| Any cancer event
*Colon *Liver *Pancreatic *Stomach *Esophageal *Breast *Prostate *Uterine *Ovarian *Lung |
68
12 3 7 2 1 30 10 5 4 12 |
206
37 6 8 5 4 54 65 13 8 28 |
446
58 16 27 10 4 160 84 72 23 51 |
| Death | 74 | 148 | 347 |
Commentary:
| With normal, overweight, and obese BMIs, the natural course of NAFLD is not the same. The management of NAFLD with normal BMI is expected to differ from the typical lifestyle adjustments of weight loss and control of DM, HTN, and dyslipidemia since metabolic comorbidities are less common |
Citation: Omar T. Ahmed, Tolga Gidener, Kristin C. Mara, and et all. Natural history of nonalcoholic fatty liver disease with normal body mass index: a population-based study. Clinical Gastroenterology and Hepatology. 2022; 20(6):1374–1381
DOI: 10.1016/j.cgh.2021.07.016
https://pubmed.ncbi.nlm.nih.gov/34265444/
