Nonalcoholic fatty liver disease in thin patients associated with cardiovascular disease risk

Nonalcoholic fatty liver disease in thin patients associated with cardiovascular disease risk

A researcher reported that thin patients with nonalcoholic fatty liver disease (NAFLD) were more likely to develop cardiovascular disease (CVD) than those who were overweight or obese.

Among more than 18,000 patients, a logistic regression analysis–adjusting for demographics and clinical risk factors–showed that overweight or obese patients with NAFLD were associated with a significantly lower prevalence of any cardiovascular disease than were thin patients, according to Karn Wijarnpreecha, MD, MPH, from the University of Michigan at Ann Arbor. specially:

  • Overweight: odds ratio 0.8, 95% confidence interval 0.6-0.9
  • Obesity class 1: or 0.7, 95% confidence interval 0.6-0.9
  • Obesity class 2-3: OR 0.7, 95% confidence interval 0.6-0.8

While the thin patients had a lower prevalence of cirrhosis, diabetes, dyslipidemia, hypertension, chronic kidney disease (CKD) and other metabolic diseases, they had a greater prevalence of cerebrovascular accidents and peripheral arterial disease, Wijjarnbrica said during a pre-GI news conference. . illness week.

“We think it could be from a difference in lifestyle, diet, exercise, genetics, or even germs,” ​​he said. “These are factors that we did not observe in this current study and this could be the explanation why the lean group has a higher association or prevalence of CVD.”

Multisystem NAFLD develops more commonly in obese patients and often appears asymptomatic. NAFLD can lead to non-liver related conditions such as metabolic disease, CKD, and cardiovascular disease. However, approximately 10%-20% of individuals with a normal BMI can still develop nonalcoholic fatty liver. There is still a lack of data on whether those with a normal body mass index who develop nonalcoholic fatty liver disease have less serious liver disease, chronic kidney disease, or cardiovascular disease than those who are obese, according to Legarnbrescha and colleagues.

“Our team expected those with a normal BMI to see a lower prevalence of any metabolic or cardiovascular disease, so we were very surprised to find this association with CVD,” Wijarnbreccia said. “Too often, we ignore NAFLD patients who have a normal BMI because we assume that their risk of more severe conditions is lower than those who are overweight. But this way of thinking may put these patients at risk.”

The authors retrospectively examined electronic health record data for 18,594 adults diagnosed with NAFLD at University of Michigan Hospital (n=10.220) from January 1, 2012 to February 28, 2021 and the Michigan NAFLD cohort (n=8374; Wijarnpreecha did not identify the source of this data). ). Of these, 2137 were underweight (BMI 18.5-24.9), 4692 were overweight (BMI 25-29.9), and 5234 were grade 1 obese (BMI 30-34.9), and 6531 were obese in category 2-3 (BMI 35-<40), based on BMI cutoff recommendations for Asians and non-Asians provided by the World Health Organization.

The diagnosis of NAFLD was confirmed by liver biopsy, presence of hepatic steatosis on imaging, or a controlled attenuation parameter greater than 250 dB/m on vibration-controlled transient imaging. Patients with excessive alcohol consumption, alcohol-related diseases, and cancer, among others, were excluded. Multivariate analysis was adjusted for age, gender, race, smoking, diabetes, dyslipidemia, and hypertension.

Overall, more than half of patients in all weight groups were women, whites (78%-82%), and never smokers (56%-57%) with the most common comorbidity being hypertension (42%-60%). dyslipidemia (34%-52%), and any cardiovascular disease (29%-33%). Patients with obesity tended to have a higher prevalence of cirrhosis (4.7%).

The current study was retrospective and was conducted at one medical center. The authors concluded, “Nonalcoholic fatty liver disease in lean subjects is not a benign disease, and that attention to cardiac risk stratification and intervention is warranted for lean patients with nonalcoholic fatty liver disease.”

“The results are interesting because the authors found a significantly increased prevalence of CVD compared to overweight/obese individuals even though the prevalence of risk factors for atherosclerosis and metabolic disease was lower,” Andrew Talal, MD, of the University at Buffalo In New York said MedPage today. “Primary care physicians, endocrinologists, hepatologists, and public health officials should consider screening for CVD in thin individuals with NAFLD.”

“Future work is warranted to investigate the effect of CVD risk factor modulation in lean individuals with nonalcoholic fatty liver disease,” said Talal, who was not involved in this study.

  • Zina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She resides in Chicago.

Disclosures

Wijarnpreecha and co-authors have not disclosed any relationships with the industry.

2022-05-14 20:11:25

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