Non-obese histologically confirmed NASH patients with abnormal liver biochemistry have more advanced fibrosis

Wang, Q., You, H., Ou, X., Zhao, X., Sun, Y., Wang, M., Wang, P., Wang, Y., Duan, W., Wang, X., Wu, S., Kong, Y., Saxena, R., Gouw, A. S. H. & Jia, J., Nov-2019, In : Hepatology International. 13, 6, p. 766-776 11 p.

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  • Non-obese histologically confirmed NASH patients with abnormal liver biochemistry have more advanced fibrosis

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  • Qianyi Wang
  • Hong You
  • Xiaojuan Ou
  • Xinyan Zhao
  • Yameng Sun
  • Min Wang
  • Ping Wang
  • Yu Wang
  • Weijia Duan
  • Xiaoming Wang
  • Shanshan Wu
  • Yuanyuan Kong
  • Romil Saxena
  • Annette S. H. Gouw
  • Jidong Jia

Background and aims Non-alcoholic fatty liver disease (NAFLD) commonly affects subjects with obesity, yet non-obese NAFLD is increasingly being recognized. We aimed to investigate the clinicopathological and genetic characteristics of non-obese NAFLD patients. Methods The clinical, histological and genetic data of 84 NAFLD patients with biopsy for abnormal liver function test were reviewed. Both NAS-CRN and SAF scoring systems were applied for histopathological evaluation. PNPLA3 and TMS6F2 genotyping were also performed. Results All of the 84 patients were histologically diagnosed with non-alcoholic steatohepatitis (NASH), with 36 of them (42.9%) being non-obese (BMI <25 kg/m2). Compared with the obese group, non-obese group were predominantly females (88.9% vs 52.1%, p <0.001), tended to have higher prevalence of diabetes (p = 0.068). More importantly non-obese patients had a significant higher prevalence of advanced fibrosis (F = 3) (58.3% vs 29.2%, p = 0.013), and a trend of higher degree of ballooning (p = 0.061). In addition, values of liver stiffness measurement were also significantly higher in non-obese group (12.1 kPa vs 8.1 kPa, p = 0.032). There was also a trend of higher prevalence of TM6SF2 T allele in non-obese group (p = 0.085), while the prevalence of PNPLA3 risk allele did not differ between two groups. Multivariate analysis showed that higher fasting glucose (p = 0.038) and lower serum platelets (p = 0.040) were two independent predictors for advanced fibrosis in non-obese patients. Conclusions Non-obese NASH patients have a female predominance and more advanced fibrosis. Liver biopsy is crucial to evaluate the severity of disease in non-obese patients especially those with abnormal liver biochemistry. Clinical trial number NCT03386890.

Original languageEnglish
Pages (from-to)766-776
Number of pages11
JournalHepatology International
Issue number6
Publication statusPublished - Nov-2019


  • Non-alcoholic fatty liver disease, Non-obese, Non-alcoholic steatohepatitis, Hepatic fibrosis, NONALCOHOLIC FATTY LIVER, BODY-MASS INDEX, LEAN PATIENTS, SCORING SYSTEM, DISEASE, PREVALENCE, RISK, SEVERITY, POPULATION, LESIONS

ID: 117211394