Published online Jan 27, 2021. doi: 10.4254/wjh.v13.i1.80
Peer-review started: June 13, 2020
First decision: October 21, 2020
Revised: October 22, 2020
Accepted: November 17, 2020
Article in press: November 17, 2020
Published online: January 27, 2021
Non-alcoholic fatty liver disease (NAFLD) has become a significant public health burden affecting not only obese individuals but also people with normal weight. As opposed to previous beliefs, this particular subset of patients has an increased risk of all-cause mortality and worse outcomes than their obese counterparts. The development of NAFLD in lean subjects seems to be interconnected with metabolic phenotype, precisely visceral fat tissue, sarcopenia, and insulin resistance. Here, we summarize available data focusing on the co-dependent relationship between metabolic phenotype, insulin resistance, and development of NAFLD in lean individuals, suggesting more appropriate tools for measuring body fat distribution for the screening of patients at risk.
Core Tip: The prevalence of non-alcoholic fatty liver disease among non-obese (overweight or lean) individuals seems to be much higher than previously reported, affecting almost 20% of the non-obese population. Non-alcoholic fatty liver disease is no longer considered solely an obesity-related disorder since non-obese individuals participate significantly in this entity. The metabolic phenotype is the key role-player in the development of non-alcoholic fatty liver disease in lean individuals. The detection of lean patients with non-alcoholic fatty liver disease is particularly challenging since the body-mass index is not a good indicator of metabolic health.