Abstract:Objective To investigate the factors affecting lean non-alcoholic fatty liver disease (NAFLD), so as to provide the reference for the prevention and treatment of lean NAFLD. Methods Individuals who underwent physical examination at Huzhou Central Hospital from January 1, 2023 to March 31, 2024 and had a body mass index (BMI) <23 kg/m2 was selected. Demographic information, lifestyle behaviors, dietary habits and physical examination data were collected through questionnaire surveys. Lean NAFLD was assessed using abdominal ultrasonography combined with BMI. Factors affecting lean NAFLD were analyzed by using a multivariable logistic regression model. Results A total of 627 individuals were surveyed, with a mean BMI of (20.83±2.01) kg/m2. There were 349 males (55.66%) and 278 females (44.34%). Lean NAFLD was detected in 74 cases, with a detection rate of 11.80%. Multivariable logistic regression analysis identified BMI (OR=1.830, 95%CI: 1.165-2.869), gender (male, OR=2.615, 95%CI: 1.402-4.875), triglycerides (OR=3.062, 95%CI: 1.613-5.812), alanine aminotransferase (OR=1.587, 95%CI: 1.106-2.277), vegetable and fruit intake (150-300 g/d, OR=0.416, 95%CI: 0.230-0.752; >300 g/d, OR=0.303, 95%CI: 0.141-0.649), dairy product intake (≥300 mL/d, OR=0.369, 95%CI: 0.195-0.701) and sugared beverage intake (1-250 mL/d, OR=1.601, 95%CI: 1.071-2.393; >250 mL/d, OR=2.438, 95%CI: 1.363-4.354) as factors affecting lean NAFLD. Conclusion The risk of lean NAFLD is associated with BMI, gender, triglyceride, alanine aminotransferase, and the vegetable and fruit, dairy product and sugared beverage intake.
[1] LI J,ZOU B Y,YEO Y H,et al.Prevalence,incidence,and outcome of non-alcoholic fatty liver disease in Asia,1999-2019:a systematic review and meta-analysis[J].Lancet Gastroenterol Hepatol,2019,4(5):389-398. [2] 罗平平,诸伟红,邹菁,等.非酒精性脂肪性肝病患者疾病感知及影响因素分析[J].预防医学,2022,34(3):222-226. [3] 孟怡媚,邱轩,李钰,等.瘦型非酒精性脂肪性肝病研究进展[J].中西医结合肝病杂志,2023,33(7):654-659. [4] ZOU B Y,YEO Y H,NGUYEN V H,et al.Prevalence,characteristics and mortality outcomes of obese,nonobese and lean NAFLD in the United States,1999-2016[J].J Intern Med,2020,288(1):139-151. [5] LONG M T,NOUREDDIN M,LIM J K.AGA clinical practice update:diagnosis and management of nonalcoholic fatty liver disease in lean individuals:expert review[J].Gastroenterology,2022,163(3):764-774. [6] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南(2018年更新版)[J].临床肝胆病杂志,2018,34(5):947-957. [7] NAVARROZA A M C,WONG S N.Comparison of clinical and metabolic profiles of lean versus non-lean nonalcoholic fatty liver disease[J].Indian J Gastroenterol,2021,40(4):380-388. [8] 张瑜娟,周希乔.瘦型非酒精性脂肪性肝病的研究进展[J].临床肝胆病杂志,2023,39(12):2914-2919. [9] HU P F,ZENG X,ZOU Z Y,et al.The presence of NAFLD in nonobese subjects increased the risk of metabolic abnormalities than obese subjects without NAFLD:a population-based cross-sectional study[J].Hepatobiliary Surg Nutr,2021,10(6):811-824. [10] NARISADA A,SHIBATA E,HASEGAWA T,et al.Sex differences in the association between fatty liver and type 2 diabetes incidence in non-obese Japanese:a retrospective cohort study[J].J Diabetes Investig,2021,12(8):1480-1489. [11] 王海强,李冰琪,周千瑶,等.雌激素对绝经期女性非酒精性脂肪肝病影响的研究进展[J].医学研究杂志,2023,52(11):1-5. [12] KUCHAY M S,MARTINEZ-MONTORO J I,CHOUDHARY N S,et al.Non-alcoholic fatty liver disease in lean and non-obese individuals:current and future challenges[J/OL].Biomedicines,2021[2024-08-23].https://doi.org/10.3390/biomedicines9101346. [13] 高秋爽,马爱江,成丽岚,等.老年体检人群非酒精性脂肪肝病的患病情况及相关因素分析[J].实用预防医学,2022,29(9):1102-1105. [14] 周瑞芬,杜秋菊,姚国萍,等.杭州市45~69岁人群非酒精性脂肪性肝病与2型糖尿病相关性研究[J].预防医学,2020,32(8):809-812. [15] ESLAM M,FAN J G,MENDEZ-SANCHEZ N.Non-alcoholic fatty liver disease in non-obese individuals:the impact of metabolic health[J].Lancet Gastroenterol Hepatol,2020,5(8):713-715. [16] 李军祥,陈誩,王允亮.非酒精性脂肪性肝病中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2017,25(11):805-811. [17] 刘珊珊,陆忠华.ALT水平正常的慢性乙型肝炎患者的血清学特征及肝组织病理学分析[J].临床肝胆病杂志,2024,40(5):940-945. [18] 康艳. 肝功能、血脂、血糖联合检测应用于非酒精性脂肪肝患者病情评估的价值[J].临床医学,2023,43(2):47-49. [19] LEE J H,BAEK S Y,JANG E J,et al.Oxyresveratrol ameliorates nonalcoholic fatty liver disease by regulating hepatic lipogenesis and fatty acid oxidation through liver kinase B1 and AMP-activated protein kinase[J].Chem Biol Interact,2018,289(3):68-74. [20] 唐英琪,李英,田坚.2型糖尿病患者合并非酒精性脂肪性肝病的影响因素分析[J].预防医学,2021,33(3):292-294. [21] DAI W,LIU H Y,ZHANG T J,et al.Dairy product consumption was associated with a lower likelihood of non-alcoholic fatty liver disease:a systematic review and meta-analysis[J/OL].Front Nutr,2023[2024-08-23].https://doi.org/10.3389/fnut.2023.1119118. [22] HAO S Q,MING L,LI Y F,et al.Modulatory effect of camel milk on intestinal microbiota of mice with non-alcoholic fatty liver disease[J/OL].Front Nutr,2022,9[2024-08-23].https://doi.org/10.3389/fnut.2022.1072133. [23] AHADI M,MOLOOGHI K,MASOUDIFAR N,et al.A review of non-alcoholic fatty liver disease in non-obese and lean individuals[J].J Gastroenterol Hepatol,2021,36(6):1497-1507.