@article{fca4c0a154cd4a248ecafe27e3c70f10,
title = "Comparative Burden of Metabolic Dysfunction in Lean NAFLD vs Non-lean NAFLD - A Systematic Review and Meta-analysis",
abstract = "BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD.METHODS: Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis.RESULTS: Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval [CI], 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese.CONCLUSION: The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.",
keywords = "MAFLD, Metabolic Associated Fatty Liver Disease Definition, NAFLD, NAFLD in obese, Overweight/complications, Diabetes Mellitus/epidemiology, Comorbidity, Humans, Obesity/complications, Non-alcoholic Fatty Liver Disease/complications",
author = "Ansel Tang and Ng, {Cheng Han} and Phang, {Poh Hui} and Chan, {Kai En} and Chin, {Yip Han} and Fu, {Clarissa Elysia} and Zeng, {Rebecca Wenling} and Jieling Xiao and Tan, {Darren Jun Hao} and Jingxuan Quek and Lim, {Wen Hui} and Mak, {Lung Yi} and Wang, {Jiong wei} and Chew, {Nicholas W.S.} and Nicholas Syn and Huang, {Daniel Q.} and Siddiqui, {Mohammad Shadab} and Arun Sanyal and Mark Muthiah and Mazen Noureddin",
note = "Funding Information: Conflicts of interest These authors disclose the following: Arun J. Sanyal is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect, and Galmed; has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz, and Genfit; has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen, and Bristol Myers Squibb; and receives royalties from Elsevier and UptoDate. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland, and Norvatis. Mazen Noureddin has been on the advisory board/consultant for 89BIO, Altimmune, Gilead, cohBar, Cytodyn, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Madrgial, NorthSea, Prespecturm, Terns, Siemens, and Roche Diagnostic; has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; is a shareholder or has stocks in Anaetos, Chrownwell, Ciema, Rivus Pharma and Viking. The remaining authors disclose no conflicts. Funding Information: Ansel Tang (Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal), Cheng Han Ng (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal), Poh Hui Phang (Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal), Kai En Chan (Formal analysis: Supporting; Writing – original draft: Supporting), Yip Han Chan (Data curation: Supporting; Formal analysis: Supporting; Writing – original draft: Supporting), Clarissa Elysia Fu (Formal analysis: Supporting; Writing – original draft: Supporting), Rebecca Wenling Zeng (Formal analysis: Supporting), Jieling Xiao (Formal analysis: Supporting; Writing – original draft: Supporting), Darren Jun Hao Tan (Formal analysis: Supporting; Writing – original draft: Supporting), Jingxuan Quek (Writing – original draft: Supporting), Wen Hui Lim (Formal analysis: Supporting; Writing – original draft: Supporting), Lung Yi Mak (Writing – review & editing: Equal), Jiongwei Wang (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Nicholas W.S. Chew (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Nicholas Syn (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Daniel Q. Huang (Supervision: Equal; Validation: Equal; Writing – original draft: Equal), Mohammad Shadab Siddiqui (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Arun Sanyal (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mark Muthiah (Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mazen Noureddin, MD, MHSc (Conceptualization: Equal; Formal analysis: Supporting; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal) Conflicts of interest These authors disclose the following: Arun J. Sanyal is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect, and Galmed; has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz, and Genfit; has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen, and Bristol Myers Squibb; and receives royalties from Elsevier and UptoDate. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland, and Norvatis. Mazen Noureddin has been on the advisory board/consultant for 89BIO, Altimmune, Gilead, cohBar, Cytodyn, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Madrgial, NorthSea, Prespecturm, Terns, Siemens, and Roche Diagnostic; has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; is a shareholder or has stocks in Anaetos, Chrownwell, Ciema, Rivus Pharma and Viking. The remaining authors disclose no conflicts. Publisher Copyright: {\textcopyright} 2023 AGA Institute",
year = "2023",
month = jul,
doi = "10.1016/j.cgh.2022.06.029",
language = "English (US)",
volume = "21",
pages = "1750--1760.e12",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "7",
}