Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease

doi:10.3748/wjg.v26.i15.1792

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Apr 21, 2020; 26(15): 1792-1804
Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1792

Table 1 Characteristics of the study population

Characteristic	LNN (n = 668)	LN (n = 142)	ONN (n = 135)	ON (n = 519)	P value
Characteristic	LNN (n = 668)	LN (n = 142)	ONN (n = 135)	ON (n = 519)	LN-LNN	LN-ONN	LN-ON
Age (yr)	55.81 ± 7.92	54.33 ± 9.24	58.83 ± 6.96	56.44 ± 7.26	0.258	0.000	0.049
Male sex, n (%)	310 (46.4%)	60 (42.3%)	54 (40.0%)	202 (38.9%)	0.283	0.307	0.199
BMI (kg/m²)	21.23 ± 1.33	21.74 ± 1.01	26.69 ± 2.27	27.98 ± 2.84	0.000	0.000	0.000
Waist circumference (cm)	73.49 ± 5.66	76.27 ± 6.03	88.22 ± 5.53	90.8 ± 6.53	0.000	0.915	0.000
Waist-to-hip ratio	0.83 ± 0.06	0.84 ± 0.05	0.85 ± 0.06	0.92 ± 0.1	0.115	0.839	0.000
Waist-to-height ratio	0.46 ± 0.03	0.48 ± 0.03	0.51 ± 0.03	0.58 ± 0.04	0.002	0.000	0.000
Systolic blood pressure (mmHg)	130.75 ± 17.05	137.81 ± 7.14	137.52 ± 17.43	142.85 ± 18.44	0.984	0.639	0.099
Diastolic blood pressure (mmHg)	80.14 ± 9.63	85.22 ± 9.93	84.24 ± 9.62	87.09 ± 10.31	0.035	0.045	0.344
Hypertension, n (%)	136 (20.4%)	52 (36.6%)	41 (30.4%)	270 (52.0%)	0.000	0.037	0.750
MetS, n (%)	85 (12.7%)	45 (31.7%)	42 (31.1%)	387 (74.6%)	0.026	0.987	0.000
Hb (g/L)	127.12 ± 14.81	129.98 ± 16.18	125.28 ± 13.17	130.01 ± 16.71	0.046	0.023	0.991
PLT (10⁹/L)	171.54 ± 46.53	186.61 ± 50.94	172.26 ± 52.14	189.18 ± 57.18	0.018	0.045	0.742
ALT (U/L)	19.71 ± 3.69	28.21 ± 14.69	23.09 ± 11.38	31.57 ± 19.01	0.016	0.583	0.288
AST (U/L)	23.44 ± 11.88	24.95 ± 7.58	23.38 ± 6.1	26.15 ± 9.34	0.323	0.099	0.342
AKP (U/L)	65.24 ± 19.05	72.14 ± 15.99	62.26 ± 19.65	76.35 ± 22.97	0.124	0.074	0.368
GGT (U/L)	19.51 ± 3.89	24.31 ± 14.28	39.33 ± 43.73	46.87 ± 31.4	0.128	0.141	0.002
LDH (U/L)	162.23 ± 25.23	175.86 ± 27.05	172.09 ± 34.15	173.05 ± 26.8	0.019	0.689	0.684
ALB (g/L)	45.74 ± 2.67	46.43 ± 2.67	45.89 ± 6.09	46.76 ± 3.89	0.390	0.707	0.727
GLU (mmol/L)	5.56 ± 0.89	5.84 ± 0.92	5.67 ± 1.06	6.02 ± 1.37	0.841	0.517	0.209
TC (mmol/L)	4.69 ± 0.79	4.88 ± 1.01	4.72 ± 0.92	4.93 ± 0.9	0.086	0.578	0.711
TG (mmol/L)	1.19 ± 0.68	1.56 ± 1.28	1.37 ± 0.91	1.93 ± 1.24	0.026	0.046	0.325
LDL-c (mmol/L)	2.72 ± 0.66	2.89 ± 0.86	2.83 ± 0.72	2.94 ± 0.75	0.021	0.322	0.992
HDL-c (mmol/L)	1.54 ± 0.3	1.29 ± 0.3	1.46 ± 0.41	1.34 ± 0.26	0.012	0.037	0.483
BUN (mmol/L)	5.19 ± 1.22	5.00± 1.06	5.41 ± 1.34	5.28 ± 1.22	0.055	0.015	0.072
SCr (μmol/L)	62.84 ± 13.06	62.56 ± 13.18	61.13 ± 12.48	62.8 ± 15.2	0.438	0.442	0.908
UA (mmol/L)	271.83 ± 64.94	305.66 ± 72.2	284.49 ± 66.4	311.17 ± 76.53	0.217	0.934	0.659
CAP (dB/m)	197.06 ± 31.91	269.53 ± 2.91	207.21 ± 41.08	292.4 ± 34.4	0.000	0.000	0.077
E (kPa)	5.47 ± 1.98	4.75 ± 5.27	5.86 ± 3.43	6.33 ± 2.06	0.513	0.793	0.038
FLI score	11.38 ± 9.56	26.58 ± 13.11	37.75 ± 21.40	60.88 ± 23.35	0.000	0.036	0.017

P values were obtained using chi-square or Kruskal-Wallis tests between different groups. Means ± SD were calculated for variables with a normal distribution; median and interquartile range are shown for variables with a skewed distribution. BMI: Body mass index; Hb: Hemoglobin; PLT: Platelet; ALT: Alanine amino transferase; AST: Aspartate aminotransferase; AKP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; LDH: Lactate dehydrogenase; ALB: Albumin; GLU: Glucose; TC: Total cholesterol; TG: Triglyceride; LDL-c: Low-density lipoprotein cholesterol; HDL-c: High-density lipoprotein cholesterol; BUN: Blood urea nitrogen; SCr: Serum creatinine; UA: Urea acid; CAP: Controlled attenuation parameter; FLI: Fatty liver index; NAFLD: Non-alcoholic fatty liver disease; LNN: Lean non-NAFLD with normal waist circumference; LN: Lean NAFLD with normal waist circumference; ONN: Obese non-NAFLD with normal waist circumference; ON: Obese NAFLD with large waist circumference.

Table 2 Factors associated with presence of non-alcoholic fatty liver disease in lean participants with a normal waist circumference

	Univariate analysis		Multivariate analysis¹
	OR (95%CI)	P value	OR (95%CI)	P value
WHtR	4.275 (2.242-5.167)	0.003	3.934 (2.543-5.854)	0.004
Diastolic blood pressure (mmHg)	1.097 (1.036-1.163)	0.005	-	-
Hb (g/L)	1.051 (1.019-1.084)	0.000	1.042 (1.003-1.082)	0.033
PLT (10⁹/L)	1.019 (1.009-1.029)	0.000	1.020 (1.006-1.033)	0.004
TG (mmol/L)	2.243 (1.579-3.204)	0.000	1.946 (1.227-3.085)	0.005
HDL-c (mmol/L)	0.013 (0.001, 0.128)	0.000	-	-
LDL-c (mmol/L)	1.512 (1.060, 2.156)	0.022	-	-

¹Factors with P < 0.05 in univariate analysis were included in the multivariate analysis. WHtR: Waist-to-height ratio; Hb: Hemoglobin; PLT: Platelet; TG: Triglyceride; LDL-c: Low-density lipoprotein cholesterol; HDL-c: High-density lipoprotein cholesterol.

Table 3 Performance of fatty liver index and waist-height ratio for diagnosis of non-alcoholic fatty liver disease in lean participants with a normal waist circumference

	AUROC (95%CI)	Cutoff value	Sensitivity	Specificity	Youden’s index
WHtR	0.761 (0.712-0.811)	0.474	0.889	0.625	0.514
FLI score	0.770 (0.721-0.819)	25.15	0.778	0.759	0.537

FLI: Fatty liver index; WHtR: Waist-height ratio; AUROC: Area under the receiver operating characteristic curve.

Table 4 Characteristics of the study population undergoing SNP genotyping

Genotype	LNN (n = 21)	LN (n = 6)	NNN (n = 37)	NN (n = 15)	ONN (n = 9)	ON (n = 44)	P value
Genotype	LNN (n = 21)	LN (n = 6)	NNN (n = 37)	NN (n = 15)	ONN (n = 9)	ON (n = 44)	LN-LNN	NN-NNN	ON-ONN
SIRT1 rs2273773 TT/TC.CC	10/11	1/5	22/15	6/9	2/7	29/15	0.233	0.363	0.022
APOC3 rs2070666 TT/TA.AA	8/13	3/3	16/21	6/9	7/2	17/27	1.000	0.374	0.030
PNPLA3 rs738409 CC/CG.GG	8/13	0/6	17/20	1/14	3/6	12/32	0.370	0.014	0.237
PNPLA3 rs738408 CC/CT.TT	8/13	0/6	17/20	1/14	3/6	12/32	0.370	0.014	0.237
PNPLA3 rs4823173 GG/GA.AA	8/13	0/6	16/21	1/14	3/6	12/32	0.277	0.010	0.237
PNPLA3 rs2072906 AA/AG.GG	7/14	0/6	15/22	1/14	3/6	12/32	0.332	0.014	0.208
AGTR1 rs5186 AA/AC.CC	17/4	5/1	33/4	13/2	9/0	39/5	0.900	0.801	0.024
AGTR1 rs440881 CC/CA.AA	0/21	0/6	0/37	0/15	0/9	0/44	0.639	0.319	0.054

P values were obtained using chi-square or Kruskal-Wallis tests between different groups. NAFLD: Non-alcoholic fatty liver disease; LNN: Lean non-NAFLD; LN: Lean NAFLD; NNN: Non-obese non-NAFLD; NN: Non-obese NAFLD; ONN: Obese non-NAFLD; ON: Obese NAFLD.

Citation: Zeng J, Yang RX, Sun C, Pan Q, Zhang RN, Chen GY, Hu Y, Fan JG. Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease. World J Gastroenterol 2020; 26(15): 1792-1804
URL: https://www.wjgnet.com/1007-9327/full/v26/i15/1792.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i15.1792