| Abstrakt: |
Background and aims: Non-alcoholic fatty liver disease (NAFLD) is present in lean people. However, the magnitude of the prognostic hepatic and cardiovascular risk in these patients compared to non-lean counterparts remains unclear. We aimed to investigate this topic, and to explore whether these risks change based on factors related to NAFLD severity. Methods: PubMed and Embase databases were searched for cohort studies (published through April 2024) that evaluated liver and cardiovascular (CV) outcomes in lean and non-lean individuals with NAFLD and reported unadjusted or adjusted data. We pooled risk ratios (RRs) or hazard ratios (HRs) using a random-effects modeling and performed subgroup and meta-regressions analyses. Results: We identified 22 studies with over 1 million NAFLD patients (13.0% were lean). Lean NAFLD showed a similar risk of liver-related events in unadjusted analysis (RR 1.08, 95% CI 0.79–1.49, I2 = 31%), but a higher risk in adjusted analysis (HR 1.66, 95% CI 1.17–2.36, I2 = 83%) compared to non-lean NAFLD. Lean NAFLD had a higher risk of liver-related mortality (RR 2.22, 95% CI 1.57–3.15, I2 = 0%; HR 2.26, 95% CI 1.14–4.51, I2 = 0%). For CV outcomes, lean NAFLD had a lower risk of any cardiovascular disease in unadjusted analysis (RR = 0.82, 95% CI 0.70–0.95, I2 = 88%), but similar risk in adjusted analysis (HR 0.89, 95% CI 0.77–1.02, I2 = 78%), and similar risk of cardiovascular mortality (RR 1.09, 95% CI 0.71–1.66, I2 = 85%; HR 1.26, 95% CI 0.89–1.78, I2 = 46%) compared to non-lean NAFLD. Conclusions: Lean NAFLD patients have worse liver outcomes, but similar CV outcomes compared to non-lean NAFLD patients, highlighting the importance of monitoring both groups closely. [ABSTRACT FROM AUTHOR] |
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