Lean or Non-obese Nonalcoholic Fatty Liver Disease Patients: Are They Really Lean?

Given the lower prevalence of NAFLD in the Asian countries compared to that in Western countries and the comparable proportion of lean or non-obese proportion of NAFLD between those populations [2], the Asian population, with a relatively lower BMI, is more vulnerable to NAFLD. [...]lean or non-obese NAFLD was considered a unique phenomenon among Asians in early studies, which is why most existing studies were conducted in Asian countries [2]. Given that lipid oxidation capacity regulated by visceral adiposity controls lipid accumulation in muscle [9,10], visceral adiposity might be the main and early phenotype of lean or non-obese NAFLD individuals as well as obese NAFLD individuals. [...]the BMI-based obesity index does not accurately reflect visceral adiposity or obesity. [...]the BMIbased obesity index may need to be revised, and metabolic dysfunction should be considered to identify high-risk individuals with NAFLD. [...]NAFLD treatment strategies, besides reducing body weight, should be established to improve body composition, which includes the reduction of visceral adipose tissues and the increment of muscle mass/quality. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis.