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NONALCOHOLIC FATTY LIVER DISEASE IN LEAN SUBJECTS: CLINICAL , EPIDEMIOLOGICAL AND METABOLIC FEATURES

Salma Souissi 1, CYRINE MAKNI 1, Meriem Ellafi 1, raja Tlili 1, Leila Belhajammar 1, soumaya nsibi 1, Lamia Kallel 1

Affiliations

1 Mahmoud Matri Hospital, Ariana, Tunisia

Summary

AI Generated

A comparative study of 184 NAFLD patients found that lean subjects (19% of the cohort) had significantly higher triglycerides, fasting glucose, and liver enzyme elevations compared to overweight or obese NAFLD patients, suggesting greater metabolic and hepatic disturbances despite lower BMI.

Among 184 NAFLD patients identified from 317 subjects screened by Fibroscan, 19% had BMI below 25 kg/m² (lean NAFLD) while 81% were overweight or obese.
Lean NAFLD patients had significantly higher mean fasting plasma glucose (8.3 vs 6.4 mmol/l, p=0.01) and triglycerides (1.9 vs 1.6 mmol/l, p=0.03) compared to the obese group.
Liver enzyme elevations were greater in lean patients, with mean PAL significantly higher (458 vs 179, p=0.02) and trends toward higher AST, ALT, and GGT, though advanced fibrosis prevalence was similar (1.8%) in both groups.
The authors suggest lean NAFLD may be more severe with greater metabolic disturbances than obese NAFLD, warranting particular clinical attention to this population.
This material is relevant to hepatologists and general practitioners evaluating NAFLD in patients across the BMI spectrum.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease. It has been strongly connected to metabolic syndrome, and for many years, fatty liver was considered to be an exclusive feature of obese patients. However, recent studies have highlighted the presence of NAFLD in non-obese subjects, with or without increased visceral fat or even in lean subjects without increased waist circumference. “Lean NAFLD” is a relatively new concept and there is significant scientific interest in understanding the differences in pathophysiology, prognosis and management compared with NAFLD in overweight/obese patients.

Aims & Methods

The aim of our study was to compare the epidemioclinical and metabolic features of lean and obese NAFLD patients. We conducted a comparative observational study of all patients referred to our departement to evaluate their liver elasticity using Fibroscan®. A simultaneous measurement of steatosis was performed by the Controlled Attenuation Parameter (CAP) of Fibroscan®. The threshold used to define the presence or not of steatosis was 245 dB. A measurement of the metabolic parameters (Cholesterol, TG, Glycemia) was performed.
Our study population was then divided into 2 groups:
Group 1 (G1): a lean NAFLD group (BMI < 25 kg/m²)
Group 2 (G2): an overweight or obese NAFLD group (BMI >= 25 kg/m² ).
A descriptive and comparative study (p significant if <= 0.05) was performed between the two groups.

Results

We included 317 patients with a mean age of 52.31 +/- 13.40 years old. The prevalence of NAFLD in the overall population was 58%. Among the 184 subjects with NAFLD, 19% had a BMI <25 Kg/m².
G1 consisted of 35 patients (19%) with a mean age of 50.3 +/-13.06 years old, a sex ratio M/F of 1.05 and a mean BMI of 23.08 +/- 1.2 Kg/m². G2 was composed of 149 patients (81%) with a mean age of 53.13 +/- 11.7 years old , a sex ratio M/F of 0.5 and a mean BMI of 32.4 +/- 1.5 Kg/m².
When comparing the two groups, we found that lean patients with NAFLD were significantly younger than the obese NAFLD patients (50.3+/-13.06 years old versus 53.13+/- 11.7 years old ; p=0.02). Regarding biological parameters, the mean triglycerides and fasting plasma glucose (FPG) were significantly higher in G1 patients than in G2 patients with mean values of (1.9 mmol/l versus 1.6 mmol/l; p=0.03); (8.3 mmol/l versus 6.4 mmol/l; p=0.01) respectively. Liver function disturbances were greater in G1 patients than in G2 patients with mean levels of AST, ALT, PAL and GGT (56 versus 40 ; p=0.4); (66 versus 45; p=0.3); (458 versus 179; p=0.02); (123 versus 61; p= 0.09) respectively. The prevalence of advanced fibrosis was similar in both groups at 1.8% (p=0.6).

Conclusion

Our study suggests that NAFLD is more severe in lean subjects than in obese subjects and is associated to more hepatic and extrahepatic metabolic disturbances. That is why clinicians must be particularly cautious with these patients who had a healthier metabolic profile but seems to have a worse prognosis.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Re‑envisaging SLD in a wider metabolic context: ectopic adiposity, pancreatic steatosis and microbiome dysbiosis

Paul Brennan 1

Affiliations

1 Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Primary Care

Session

Public health aspects related to GI and steatotic liver disease (SLD)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Panel discussion: Does SLD matter to you in your practice?

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Barcelona 2026

Topics

Primary Care

Session

Public health aspects related to GI and steatotic liver disease (SLD)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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How to maintain adherence and consistent follow-up in coeliac disease

Carolina Ciacci 1

Affiliations

1 University of Salerno, Salerno, Italy

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Paediatrics Oesophagus Immunology IBD

Session

Transitioning into adulthood in gastroenterology

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Incidental findings in the bile tree/bladder

Max Lahaye 1

Affiliations

1 The Netherlands Cancer Institute, Amsterdam, Netherlands

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Hepatobiliary Pancreas

Session

Incidental findings in HPB: When are they clinically relevant?

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Endoscopic treatment: EMR/ESD

Raf Bisschops 1

Affiliations

1 Katholieke Universiteit Leuven, Leuven, Belgium

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Session

Barrett's oesophagus: Are we getting there?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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PSC-IBD crosstalk: From mechanisms to meaningful clinical practice (Dr. Falk Pharma) (Complete Session)

Münevver Demir 1, Michael Trauner 2, Emma Culver 3, Palak Trivedi 4

Affiliations

1 Charité - Universitätsmedizin, Berlin, Germany

2 Medical University of Vienna, Vienna, Austria

3 John Radcliffe Hospital, Oxford, Oxford, United Kingdom

4 University of Birmingham, Birmingham, United Kingdom

Summary

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Abstract

Publisher

Dr. Falk Pharma GmbH

Event

UEG Week Barcelona 2026

Session

PSC-IBD crosstalk: From mechanisms to meaningful clinical practice (Dr. Falk Pharma)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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