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The global epidemiology of lean nonalcoholic fatty liver disease: a systematic review and meta-analysis

The global epidemiology of lean nonalcoholic fatty liver disease: a systematic review and meta-analysis
The global epidemiology of lean nonalcoholic fatty liver disease: a systematic review and meta-analysis
Background and aim: lean nonalcoholic fatty liver disease (NAFLD) is a potentially metabolically unhealthy state that refers to NAFLD occurring in non‐overweight/non‐obese subjects. Yet its global epidemiology and metabolic characteristics are not extensively elucidated.

Methods: PubMed, EMBASE, Web of Science and Cochrane databases were searched for eligible studies to January 2020. Random‐effects/fixed‐effects models were used to estimate the global prevalence of lean NAFLD and to compare clinical characteristics among lean non‐NAFLD, lean NAFLD and overwight/obese NAFLD subjects. ‘Lean’ NAFLD was defined by ethnic‐specific body mass index measurements in the normal range. Meta‐regression and subgroup analyses were performed to determine potential sources of heterogeneity.

Results: 33 observational studies were included with 205,307 individuals from 14 countries. The global prevalence of lean NAFLD was 4.1% (95%CI: 3.4‐4.8%). In lean subjects the prevalence of NAFLD was 9.7% (95%CI: 7.7‐11.8%). The prevalence of lean NAFLD with diabetes, hypertension, metabolic syndrome, dyslipidemia or central obesity was 0.6% (95%CI: 0.4‐0.9%), 1.8% (95%CI: 1.2‐2.5%), 1.4% (95%CI: 1.0‐1.9%), 2.8% (95%CI: 1.9‐3.7%) and 2.0% (95%CI: 1.6‐2.4%), respectively. The prevalence of lean NAFLD showed an upward trend between 1988 and 2017. Asian individuals had the highest prevalence of lean NAFLD (4.8%, 95%CI: 4.0‐5.6%). Middle‐aged people (45‐59 years old) had the highest prevalence of lean NAFLD (4.4%, 95%CI: 3.2‐5.5%). The prevalence of metabolic complications in lean non‐NAFLD, lean NAFLD and overweight/obese NAFLD groups increased sequentially.

Conclusions: lean NAFLD occurs with metabolic complications and is not an uncommon condition. The highest prevalence of lean NAFLD occurs in middle‐aged individuals of Asian countries.
0815-9319
2041-2050
Lu, Feng-Bin
bdf1c6ed-1b5f-4976-8419-e45cf6744d24
Zheng, Kenneth I.
9c8f1d96-a27e-413b-a8c6-6f19ef8f379b
Rios, Rafael S.
7535aa4b-abb5-463a-a08b-d37917d1b154
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Zheng, Ming-Hua
20c5cac7-ff72-46c4-9f25-29daf622a3eb
Lu, Feng-Bin
bdf1c6ed-1b5f-4976-8419-e45cf6744d24
Zheng, Kenneth I.
9c8f1d96-a27e-413b-a8c6-6f19ef8f379b
Rios, Rafael S.
7535aa4b-abb5-463a-a08b-d37917d1b154
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Zheng, Ming-Hua
20c5cac7-ff72-46c4-9f25-29daf622a3eb

Lu, Feng-Bin, Zheng, Kenneth I., Rios, Rafael S., Targher, Giovanni, Byrne, Christopher and Zheng, Ming-Hua (2020) The global epidemiology of lean nonalcoholic fatty liver disease: a systematic review and meta-analysis. Journal of Gastroenterology and Hepatology, 35 (12), 2041-2050. (doi:10.1111/jgh.15156).

Record type: Article

Abstract

Background and aim: lean nonalcoholic fatty liver disease (NAFLD) is a potentially metabolically unhealthy state that refers to NAFLD occurring in non‐overweight/non‐obese subjects. Yet its global epidemiology and metabolic characteristics are not extensively elucidated.

Methods: PubMed, EMBASE, Web of Science and Cochrane databases were searched for eligible studies to January 2020. Random‐effects/fixed‐effects models were used to estimate the global prevalence of lean NAFLD and to compare clinical characteristics among lean non‐NAFLD, lean NAFLD and overwight/obese NAFLD subjects. ‘Lean’ NAFLD was defined by ethnic‐specific body mass index measurements in the normal range. Meta‐regression and subgroup analyses were performed to determine potential sources of heterogeneity.

Results: 33 observational studies were included with 205,307 individuals from 14 countries. The global prevalence of lean NAFLD was 4.1% (95%CI: 3.4‐4.8%). In lean subjects the prevalence of NAFLD was 9.7% (95%CI: 7.7‐11.8%). The prevalence of lean NAFLD with diabetes, hypertension, metabolic syndrome, dyslipidemia or central obesity was 0.6% (95%CI: 0.4‐0.9%), 1.8% (95%CI: 1.2‐2.5%), 1.4% (95%CI: 1.0‐1.9%), 2.8% (95%CI: 1.9‐3.7%) and 2.0% (95%CI: 1.6‐2.4%), respectively. The prevalence of lean NAFLD showed an upward trend between 1988 and 2017. Asian individuals had the highest prevalence of lean NAFLD (4.8%, 95%CI: 4.0‐5.6%). Middle‐aged people (45‐59 years old) had the highest prevalence of lean NAFLD (4.4%, 95%CI: 3.2‐5.5%). The prevalence of metabolic complications in lean non‐NAFLD, lean NAFLD and overweight/obese NAFLD groups increased sequentially.

Conclusions: lean NAFLD occurs with metabolic complications and is not an uncommon condition. The highest prevalence of lean NAFLD occurs in middle‐aged individuals of Asian countries.

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Accepted/In Press date: 18 June 2020
e-pub ahead of print date: 22 June 2020
Published date: December 2020
Additional Information: Please amend published to December 2020 thanks

Identifiers

Local EPrints ID: 441848
URI: http://eprints.soton.ac.uk/id/eprint/441848
ISSN: 0815-9319
PURE UUID: 6d2f5ad0-bd53-4f06-96cd-024307f34ed9
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 30 Jun 2020 16:30
Last modified: 28 Apr 2022 05:33

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Contributors

Author: Feng-Bin Lu
Author: Kenneth I. Zheng
Author: Rafael S. Rios
Author: Giovanni Targher
Author: Ming-Hua Zheng

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