Is non-alcoholic steatohepatitis in lean people a risk factor for liver or cardiovascular disease?

Konstantinos Imprialos, Konstantinos Stavropoulos, Michael Doumas, Georgios Sfikas, Charalambos Koumaras, Niki Katsiki, Vasilios Athyros



Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese or overweight individuals. However, lean individuals with NAFLD represent one notable part of the phenotypic clinical cases of NAFLD. Current evidence suggests that lean and obese patients with NAFLD share different metabolic and cardiovascular disease (CVD) risk profiles. Lean NAFLD and its advanced form non-alcoholic steatohepatitis (NASH), need further investigation including epidemiology, clinical risk assessment, liver histological changes, genetic and pathophysiologic predisposing mechanisms, natural history, relation to CVD risk, and treatment strategies in this population with this under-recognized disease. However, to the extent it induces hepatic fibrosis (50% of the cases of NASH) this is as harmful as NAFLD in obese individuals and needs treatment with pioglitazone and potent statin for the reduction of liver and CVD morbidity and mortality.

Keywords: Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, liver cirrhosis, cardiovascular morbidity, cardiovascular mortality, treatment