Prevalence, characteristics and mortality outcomes of obese, nonobese and lean NAFLD in the United States, 1999-2016. Zou B,Yeo Y H,Nguyen V H,Cheung R,Ingelsson E,Nguyen M H Journal of internal medicine BACKGROUND:Updated prevalence and outcome data for nonobese NAFLD for the multi-ethnic US population is limited. OBJECTIVES:We aimed to investigate the prevalence, clinical characteristics and mortality of obese and nonobese individuals with NAFLD in the United Sates. METHODS:A retrospective study was conducted using the 1999-2016 NHANES databases. We determined hazard ratio stratified by obesity status in NAFLD individuals using Cox regression and log-rank test. RESULTS:Overall NAFLD prevalence was 32.3%: 22.7% were obese and 9.6% were nonobese, with increasing trend over time for obese NAFLD, but not nonobese NAFLD. Amongst those with NAFLD, 29.7% (95% CI: 27.8%-31.7%) were nonobese, of which 13.6% had lean NAFLD. Nonobese NAFLD was more common in older (40.9% if ≥ 65 vs. 24.2% if < 65 years), male (34.0% vs. 24.2%) and foreign-born Asian people (39.8% vs. 11.4%) and uncommon in black (11.5% vs 30-35% in other ethnicities, P < 0.001). Metabolic comorbidities were common in nonobese NAFLD individuals who also had more advanced fibrosis. Nonobese NAFLD individuals had higher 15-year cumulative all-cause mortality (51.7%) than obese NAFLD (27.2%) and non-NAFLD (20.7%) (P < 0.001). However, DM and fibrosis, but neither obese nor nonobese NAFLD compared to non-NAFLD was independently associated with higher mortality. CONCLUSION:Nonobese NAFLD makes up about one-third of the NAFLD in the United States (even higher in older, male and foreign-born individuals) and carries higher mortality than obese NAFLD. Screening for NAFLD should be considered in high-risk groups even in the absence of obesity. 10.1111/joim.13069

Association between waist circumference trajectories and incident non-alcoholic fatty liver disease. Obesity research & clinical practice PURPOSE:Waist circumference (WC) is linked to non-alcoholic fatty liver disease (NAFLD) incidence. However, the impact of longitudinal WC changes on NAFLD remains unclear. We investigated WC trajectories and NAFLD incidence in a large population-based cohort. METHODS:We analyzed data from 2666 participants without NAFLD, who underwent biennial check-ups for 16 years, divided into a 6-year exposure period and a 10-year event accrual period. Participants were classified into increasing and decreasing WC trajectory groups during the median 5.9-year exposure period by group-based trajectory modeling. Multiple Cox proportional hazard regression analysis estimated the hazard ratio (HR) and 95 % confidence interval (CI) for incident NAFLD. RESULTS:During the median 9.7-year event accrual period, 799 participants developed NAFLD. The increasing WC trajectory group had a higher NAFLD risk than the decreasing group, with an HR of 1.20 (95 % CI: 1.02-1.42). After adjusting for confounders, the adjusted-HR was 1.28 (95 % CI: 1.07-1.53). Subgroup analyses revealed significant findings for groups, regardless of abdominal obesity status. CONCLUSION:An increasing WC trend was associated with a higher NAFLD risk, independent of abdominal obesity status. Monitoring WC changes may facilitate early detection of NAFLD risk groups and promote lifestyle modifications to prevent NAFLD onset. 10.1016/j.orcp.2023.09.005

Increased risk of cardiometabolic disease in normal-weight individuals with non-alcoholic fatty liver disease. Obesity research & clinical practice BACKGROUND:Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity, but there is increasing evidence that not all individuals who are overweight/obese also develop NAFLD. Currently, it is unclear whether normal-weight (Nw) individuals with NAFLD have a higher risk of cardiometabolic disease risk compared with individual sub-groups (Nw and Obesity [Ob]) of non-NAFLD. AIMS:This study aimed to compare the cardiometabolic profiles, cardiovascular disease, and diabetes between Nw vs. Ob with non-NAFLD vs. NAFLD. METHODS:This study utilized the Korea National Health and Nutrition Examination Surveys collected from 2019 to 2021. Individuals were stratified into Nw vs. Ob categories and further divided into non-NAFLD and NAFLD groups based on the hepatic steatosis index and liver fat score (N = 6615). RESULTS:The prevalence of non-NAFLD Nw, non-NAFLD Ob, NAFLD Nw, and NAFLD Ob groups was 36%, 20%, 7%, and 37%, respectively. NAFLD Nw vs. non-NAFLD Ob manifests deteriorated cardiometabolic disease risk profiles and surrogate markers of insulin resistance despite having higher weight, waist circumference, and BMI. In addition, compared to non-NAFLD Nw, individuals with NAFLD Nw had a significantly higher risk of CVDs (738%, p < .001) and diabetes (408%, p < .001), with no difference between NAFLD Nw and NAFLD Ob groups. CONCLUSIONS:Cardiometabolic disease risk is more closely related to NAFLD developments than adiposity status. Therefore, not all overweight/obese individuals have a higher cardiometabolic disease risk, and NAFLD in Nw is an aggressive disease that is associated with cardiometabolic disease risk compared with Ob individuals without NAFLD. 10.1016/j.orcp.2023.09.003

Dietary characteristics associated with the risk of non-alcoholic fatty liver disease and metabolic dysfunction-associated steatotic liver disease in non-obese Japanese participants: A cross-sectional study. JGH open : an open access journal of gastroenterology and hepatology Background and Aim:Dietary characteristics associated with non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) in non-obese patients remain to be elucidated. This study examined the association of NAFLD and MASLD with dietary characteristics according to obesity status. Methods:We performed a cross-sectional study of 15 135 participants ( = 7568 men and 7567 women) aged 35-74 years using data of annual health checks between 2008 and 2020. Obesity was defined as BMI ≥ 25 kg/m. Diagnosis of fatty liver was based on abdominal ultrasonography. Fatty-liver-related dietary characteristics were assessed using a self-administered questionnaire. Results:For non-obese participants, NAFLD was found in 31.0% of men and 19.4% of women. Non-obese MASLD was found in 27.6% of men and 18.1% of women. Multivariable-adjusted stepwise logistic regression analysis indicated that, in males, both non-obese NAFLD and non-obese MASLD were significantly and negatively associated with "often eat sesame/nuts", and positively associated with "often eat noodles/rice bowl" and "often eat evening meal" ( < 0.05). For non-obese women, both NAFLD and MASLD were significantly and positively associated with "often eat sweet buns/bread with fillings" ( < 0.05). Adjusted analyses showed that all dietary characteristics were not significantly associated with the risk of NAFLD/MASLD in obese men and women. Conclusion:This cross-sectional study indicates the existence of sex and obesity differences in the association of NAFLD and MASLD with dietary characteristics. Our findings suggest that some dietary characteristics are associated with NAFLD and MASLD prevalence in non-obese Japanese participants. 10.1002/jgh3.13082