Z Gastroenterol 2020; 58(05): e74
DOI: 10.1055/s-0040-1712243
VORTRÄGE

NAFLD in lean patients is associated with an increased cardiovascular risk, prediabetes and the metabolic syndrome

G Semmler
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
,
S Wernly
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
,
S Bachmayer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
,
B Wernly
2   Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
,
U Huber-Schönauer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
,
E Aigner
3   Department of Internal Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
,
D Niederseer
4   Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
,
C Datz
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
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Background and Aims Non-alcoholic fatty liver disease(NAFLD) in lean patients (body mass index[BMI] < 25 kg/m2) has been associated with an increased risk for metabolic diseases, although their phenotype is regarded more benign than NAFLD in obese patients, Here, we provide a comprehensive characterization of lean NAFLD in a screening cohort for colorectal carcinoma.

Methods 2893 individuals (mean age:58.9 ± 9.8years, 52 % male) undergoing colonoscopy between 2007-2019 were grouped by BMI and hepatic steatosis (BMI < 25 kg/m2 and no steatosis: n = 1254; BMI < 25 kg/m2 and steatosis: n = 251[i.e. lean NAFLD]; BMI≥ 25 kg/m2 and steatosis: n = 1388[i.e. overweight/obese NAFLD]). Patients were characterized using biochemical and metabolic parameters. Factors of the metabolic syndrome were defined according to the International Diabetes Federation (2005).

Results Compared to lean patients without NAFLD, lean patients with NAFLD had a higher prevalence of visceral obesity (62.3 % vs. 44.7 %), diabetes (12.0 % vs. 4.6 %), dyslipidemia (38.6 % vs. 19.9 %) and the metabolic syndrome (37.1 % vs. 15.6 %, all p < 0.001). Interestingly, patients carried a higher risk for dysglycemia indicated by a higher insulin resistance (HOMA-IR:1.49[IQR:1.11-2.11] vs. 1.13[IQR:0.80-1.57]) and higher blood sugar levels in an oral glucose tolerance test after 2 hours (115 ± 30 vs. 125 ± 39mg/dl) excluding diabetic patients, resulting in an impaired glucose tolerance in 21.9 % vs. 12.4 % and prediabetes in 39.2 % vs. 25.2 %(all p < 0.001). Moreover, chronic coronary syndrome was more prevalent (8.9 % vs. 3.7 %) and the median Framingham risk score(FRS) was higher in these patients (7[IQR:4-11] vs. 11 [IQR:7-18]points, both p < 0.001). However, lean patients with NAFLD had a milder phenotype than overweight/obese NAFLD patients in all characteristics mentioned above. On multivariate analyses investigating only patients with BMI < 25 kg/m2, NAFLD was associated with a higher risk for metabolic syndrome (adjusted odds ratio[aOR]: 2.288 [95CI:1.651-3.172],p < 0.001), prediabetes (aOR:1.614[95 %CI:1.179-2.209],p = 0.003) and higher FRS (regression coefficient B:1.382[95 %CI:0.592-2.172],p = 0.001) correcting for age, gender and BMI.

Conclusion NAFLD in lean patients is associated with an increased cardiovascular risk, prediabetes and the metabolic syndrome.



Publication History

Article published online:
26 May 2020

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