Lean-non-alcoholic fatty liver disease increases risk for metabolic disorders in a normal weight Chinese population

doi:10.3748/wjg.v20.i47.17932

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World Journal of Gastroenterology

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1007-9327

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Evidence-Based Medicine

World J Gastroenterol. Dec 21, 2014; 20(47): 17932-17940
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17932

Table 1 Baseline demographic characteristics of non-alcoholic fatty liver disease patients and controls

	Lean-NAFLD (n = 731)		Overweight-obese-NAFLD (n = 1048)		P value
	Controls	NAFLD	Controls	NAFLD	P value
Participants, n (%)	597 (81.67)	134 (18.33)	284 (27.10)	764 (72.90)
Age (yr)	43.19 ± 11.59	48.17 ± 10.5^a	46.72 ± 11.15^b	46.92 ± 11.19	< 0.01
Male (%)	28.48	54.48	51.41	72.25	< 0.01
Education (%)
Never	0.66	1.92	0.90	0.87	0.30
Primary	0.66	0.00	2.26	1.56
Junior	4.20	2.88	6.33	3.65
Senior	15.27	11.54	19.46	18.92
College	63.50	66.35	58.37	61.98
Postgraduate	15.71	17.31	12.67	13.02
BMI (kg/m²)	21.37 ± 1.71	22.74 ± 1.13^a	25.98 ± 1.66^b	27.57 ± 2.63^a^c	< 0.01
Body weight (kg)	57.64 ± 7.14	64.09 ± 7.31^a	71.32 ± 9.49^b	78.81 ± 11.64^a^c	< 0.01
Body fat (%)	24.83 ± 5.40	26.17 ± 4.96^a	29.61 ± 4.73^b	30.05 ± 4.49^c	< 0.01
Body fat mass (kg)	14.26 ± 3.37	16.59 ± 2.68^a	20.91 ± 3.34^b	23.59 ± 4.61^a^c	< 0.01
WC (cm)	75.50 ± 7.06	82.42 ± 6.29^a	87.06 ± 7.16^b	93.45 ± 8.70^c	< 0.01
VAI	1.52 ± 1.99	2.04 ± 2.21^a	1.85 ± 2.32^b	2.08 ± 1.50	< 0.01
SBP (mmHg)	119.48 ± 15.45	126.46 ± 16.24^a	129.37 ± 19.86^b	132.20 ± 17.29^c	< 0.01
DBP (mmHg)	74.04 ± 10.04	80.05 ± 11.74^a	79.33 ± 12.17^b	82.84 ± 10.57^a^c	< 0.01
Physical activity (%)
None	83.92	89.52	80.27	85.10	0.45
Moderate	14.98	10.48	18.39	13.86
Vigorous	1.10	0.00	1.35	1.04
Drinking (%)	23.82	36.89	39.25	49.02	< 0.01
Smoking (%)
Never	86.09	82.52	81.45	68.34	< 0.01
≤ 1 cigarettes/d	1.10	0.97	1.36	2.25
≤ 10 cigarettes/d	5.08	3.88	5.43	7.96
≤ 20 cigarettes/d	5.74	8.74	7.24	14.01
> 20 cigarettes/d	1.99	3.88	4.52	7.44
Diabetes (%)	4.58	15.67	9.54	16.49	< 0.01
Hypertension (%)	12.23	34.71	32.08	43.67	< 0.01
Hyperlipidemia (%)	34.20	49.25	47.69	59.47	< 0.01
MS (%)	3.06	14.53	26.47	46.64	< 0.01
Central obesity (%)	14.96	29.41	69.55	84.64	< 0.01
Obesity (%)	0.00	0.00	11.97	37.70	< 0.01

^aP < 0.05 vs control in same weight group;

^bP < 0.05 vs Lean-control group,

^cP < 0.05 vs Lean-NAFLD group. NAFLD: Non-alcoholic fatty liver disease; BMI: Body mass index; WC: Waist circumstance; VAI: Visceral adiposity index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MS: Metabolic syndrome.

Table 2 Clinical biochemical characteristics of non-alcoholic fatty liver disease and controls

	Lean-NAFLD		Overweight-obese-NAFLD		P value
	Controls	NAFLD	Controls	NAFLD	P value
FBG (mmol/L)	5.30 ± 1.36	5.91 ± 1.85^a	5.52 ± 1.31^b	5.76 ± 1.42^a	< 0.01
Fasting insulin (IU/mL)	6.42 ± 3.76	8.27 ± 3.93^a	7.28 ± 4.33	10.84 ± 5.28^a^c	< 0.01
HOMA-IR	1.55 ± 0.97	2.16 ± 1.42^a	1.87 ± 1.35^b	2.73 ± 1.53^a^c	< 0.01
TC (mmol/L)	4.86 ± 0.93	5.20 ± 1.01^a	5.00 ± 0.90^b	5.10 ± 0.92	< 0.01
TG (mmol/L)	1.18 ± 1.13	1.71 ± 1.23^a	1.40 ± 1.01^b	1.83 ± 1.19^a	< 0.01
HDL-C (mmol/L)	1.58 ± 0.35	1.45 ± 0.30^a	1.44 ± 0.30^b	1.35 ± 0.27^a^c	< 0.01
LDL-C (mmol/L)	2.90 ± 0.79	3.12 ± 0.78^a	3.09 ± 0.77^b	3.13 ± 0.78	< 0.01
ALT (U/L)	18.32 ± 13.85	21.61 ± 11.92^a	21.10 ± 16.13^b	27.23 ± 18.25^a^c	< 0.01
AST (U/L)	19.27 ± 6.85	21.07 ± 9.26^a	20.23 ± 11.10	22.37 ± 9.87^a	< 0.01
ALP (U/L)	64.34 ± 18.16	71.96 ± 20.49^a	66.94 ± 21.26	70.00 ± 18.47^a	< 0.01
GGT (U/L)	26.11 ± 27.99	35.76 ± 34.92^a	33.42 ± 33.95^b	47.26 ± 48.44^a^c	< 0.01
UA (μmol/L)	280.04 ± 82.31	303.30 ± 86.72^a	307.59 ± 85.54^b	340.60 ± 92.68^a^c	< 0.01
BUN (mmol/L)	5.00 ± 1.24	5.15 ± 1.25	5.16 ± 1.19	5.14 ± 1.24	0.15
CRE (μmol/L)	69.26 ± 14.37	70.34 ± 13.84	71.72 ± 14.18^b	74.53 ± 14.48^c	< 0.01

^aP < 0.05 vs control in same weight group;

^bP < 0.05 vs Lean-control group;

^cP < 0.05 vs Lean-NAFLD group. NAFLD: Non-alcoholic fatty liver disease; FBG: Fasting blood glucose; TC: Total cholesterol; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transferase; UA: Serum uric acid; BUN: Blood urea nitrogen; CRE: Serum creatinine.

Table 3 Hematological comparison between non-alcoholic fatty liver disease and controls among four groups

	Lean-NAFLD		Overweight-obese-NAFLD		P value
	Controls	NAFLD	Controls	NAFLD	P value
WBC (10⁹/L)	5.73 ± 1.46	6.40 ± 1.44^a	6.25 ± 1.58^b	6.72 ± 1.66^a^c	< 0.01
NEUT (10⁹/L)	3.28 ± 1.12	3.70 ± 1.04^a	3.62 ± 1.19^b	3.88 ± 1.25^a^c	< 0.01
LYMPH (10⁹/L)	1.96 ± 0.52	2.14 ± 0.56^a	2.10 ± 0.57^b	2.26 ± 0.60^a^c	< 0.01
MONO (10⁹/L)	0.36 ± 0.14	0.39 ± 0.13^a	0.39 ± 0.16^b	0.42 ± 0.15^a	< 0.01
EO (10⁹/L)	0.09 ± 0.09	0.13 ± 0.14^a	0.11 ± 0.10	0.14 ± 0.13^a	< 0.01
BASO (10⁹/L)	0.01 ± 0.04	0.01 ± 0.03	0.01 ± 0.03	0.02 ± 0.03	0.22
RBC (10¹²/L)	4.50 ± 0.41	4.76 ± 0.42^a	4.72 ± 0.48^b	4.96 ± 0.44^a^c	< 0.01
HGB (g/L)	136.13 ± 15.24	145.87 ± 16.44^a	143.30 ± 17.05^b	152.19 ± 14.22^a^c	< 0.01
HCT (%)	41.36 ± 4.11	44.09 ± 4.41^a	43.40 ± 4.55^b	45.68 ± 3.90^a^c	< 0.01

^aP < 0.05 vs control in same weight group;

^bP < 0.05 vs Lean-control group;

^cP < 0.05 vs Lean-NAFLD group. NAFLD: Non-alcoholic fatty liver disease; WBC: White blood cell count; NEUT: Neutrophils count; LYMPH: Lymphocytes count; MONO: Monocytes count; EO: Eosinophils count; BASO: Basophils count; RBC: Red blood cell count; HGB: Hemoglobin; HCT: Hematocrit value.

Table 4 Odds ratios of non-alcoholic fatty liver disease compared with controls

	¹OR (95%CI)	²OR (95%CI)
All NAFLD vs all controls
Hyperlipidemia	2.19 (1.81-2.65)	1.37 (1.04-1.80)
Hypertension	2.98 (2.37-3.74)	1.49 (1.10-2.03)
Diabetes	2.97 (2.14-4.11)	1.68 (1.08-2.62)
MS	6.29 (4.78-8.28)	2.34 (1.65-3.31)
Central obesity	6.56 (5.16-8.33)	1.97 (1.38-2.80)
Lean-NAFLD vs lean controls
Hyperlipidemia	1.87 (1.28-2.73)	1.29 (0.80-2.09)
Hypertension	3.26 (2.08-5.10)	1.72 (1.00-2.96)
Diabetes	3.87 (2.11-7.08)	2.47 (1.14-5.35)
MS	5.38 (2.66-10.89)	3.19 (1.38-7.35)
Central obesity	2.37 (1.44-3.90)	2.17 (1.17-4.05)
Overweight-obese NAFLD vs overweight-obese controls
Hyperlipidemia	1.61 (1.22-2.12)	1.36 (0.96-1.91)
Hypertension	1.64 (1.20-2.24)	1.33 (0.92-1.93)
Diabetes	1.87 (1.21-2.91)	1.34 (0.80-2.27)
MS	2.43 (1.75-3.38)	1.89 (1.29-2.77)

¹OR: Crude OR; ²OR: Adjusted by age, sex, body mass index, smoking, alcohol consumption and physical activities. NAFLD: Non-alcoholic fatty liver disease; OR: Odds ratio; CI: Confidence interval; MS: Metabolic syndrome.

Citation: Feng RN, Du SS, Wang C, Li YC, Liu LY, Guo FC, Sun CH. Lean-non-alcoholic fatty liver disease increases risk for metabolic disorders in a normal weight Chinese population. World J Gastroenterol 2014; 20(47): 17932-17940
URL: https://www.wjgnet.com/1007-9327/full/v20/i47/17932.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i47.17932