In a media briefing preceding Digestive Disease Week, on May 12, 2022, Karn Wijarnpreecha, MD, MPH, discussed his study regarding the prevalence of cardiovascular disease among lean and nonlean patients with nonalcoholic fatty liver disease (NAFLD).

Dr Wijarnpreecha is a transplant hepatology fellow at the University of Michigan.

“Lean individuals” are those who have a normal or healthy body mass index (BMI). Approximately 10%-20% of patients with NAFLD have a normal BMI. NAFLD is a multisystem disease that is associated with extrahepatic manifestations such as cardiovascular disease (CVD), diabetes mellitus (DM), and chronic kidney disease (CKD). It has not yet been determined whether those individuals with NAFLD and a normal BMI have less severe liver disease, CVD, and CKD, than their obese counterparts.

Dr Wijarnpreecha and colleagues compared the prevalence of diseases between lean patients and overweight and obese patients with NAFLD, where prevalence is defined as any diagnosis before or up to 90 days after NAFLD index date. The diseases examined were cirrhosis, cardiovascular diseases (coronary artery diseases, congestive heart failure, cerebrovascular disease, peripheral arterial diseases), metabolic diseases (DM, hypertension, dyslipidemia), and CKD. A total of 18,594 patients with NAFLD were included — 2,137 of those patients were lean; 2,692 were overweight; 5,234 had Class 1 obesity; and 6,531 had Class 2 or 3 obesity.

Researchers found a higher prevalence of CVD among lean patients with NAFLD compared with overweight or obese patients with NAFLD, despite a lower prevalence of metabolic diseases. Dr Wijarnpreecha noted, “We cannot definitively state that lean NAFLD patients have a higher risk of cardiovascular disease. The only conclusion we can draw from this study is that there was a higher prevalence of CVD in the lean group than in the overweight or obese NAFLD groups.” He went on to stress the need for further research and studies to better assess this potential association.

This study does express that NAFLD in lean individuals should not be considered a benign disease, and attention to cardiac risk stratification and intervention is warranted for lean patients with NAFLD.

—Allison Casey

References:
Wijarnpreecha K. Higher prevalence of cardiovascular disease among lean versus non-lean patients with nonalcoholic fatty liver disease, despite lower prevalence of atherogenic risk and metabolic diseases. Abstract presented at: DDW 2022 Media Briefing; May 12, 2022; Virtual.

Unexpected Data on the Prevalence of Cardiovascular Disease in Lean NAFLD Patients. Meeting News. DDW/AASLD. May 16, 2022.