TY - JOUR
T1 - Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Comorbid Diseases
AU - Weinberg, Ethan M.
AU - Trinh, Huy N.
AU - Firpi, Roberto J.
AU - Bhamidimarri, Kalyan Ram
AU - Klein, Samuel
AU - Durlam, Jonathan
AU - Watkins, Stephanie
AU - Reddy, K. Rajender
AU - Weiss, Michael
AU - Zink, Richard C.
AU - Lok, Anna S.
N1 - Funding Information:
The authors thank all the investigators, participants, and research staff associated with TARGET-NASH (see Supplementary Material for full list). Conflicts of Interest These authors disclose the following: Ethan M. Weinberg has provided nonpromotional speaker education for Mallinckrodt. Huy N. Trinh has served on the speaker's bureau as well as on the advisory board for Gilead; and received research support from Gilead and Intercept. Kalyan Ram Bhamidimarri has served on the scientific advisory board for Gilead, AbbVie, Merck, and Intercept; provided promotional speaker education for Alexion; and received research support from Allergan, Conatus, Genfit, Gilead, Mallinckrodt, and Vital Therapies. Samuel Klein has received research support from Johnson and Johnson and Merck; and served on the scientific advisory board for Pfizer, Novo Nordisk, and Merck. Jonathan Durlam, Stephanie Watkins, and Richard C. Zink are employees of TARGET PharmaSolutions. K. Rajender Reddy has served on the advisory board for Merck, Shionogi, Dova, and Spark Therapeutics; and has received Research Support (paid to the University of Pennsylvania) Intercept, Conatus, Gilead, Merck, BMS, Exact Sciences, Mallinckrodt, Grifols, Salix, HCV TARGET PharmaSolutions, NASH TARGET PharmaSolutions, and HCC TARGET PharmaSolutions. Anna S. Lok has received research grants (to the University of Michigan) from Bristol-Myers Squibb, Gilead, and TARGET PharmaSolutions; and served on advisory board for Gilead and TARGET PharmaSolutions. The remaining authors disclose no conflicts. Funding The TARGET-NASH study is sponsored by TARGET PharmaSolutions, Inc.
Funding Information:
Funding The TARGET-NASH study is sponsored by TARGET PharmaSolutions, Inc.
Publisher Copyright:
© 2021 AGA Institute
PY - 2021/5
Y1 - 2021/5
N2 - Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is typically associated with obesity. Little is known about the prevalence of cirrhosis in patients with NAFLD and a normal body mass index (BMI). Methods: We determined prevalence of cirrhosis, cardiovascular disease (CVD), and metabolic abnormalities among participants in all BMI categories in the TARGET-NASH study. A total of 3386 patients with NAFLD were enrolled from August 2016 through March 2019. The odds ratios of cirrhosis, CVD, and metabolic abnormalities were estimated by age and race, adjusting for sex and center type. Results: Based on standard BMI cutoff values, 12.8% of study subjects were lean, 27.1% were overweight, 26.5% had class 1 obesity, and 33.7% had class 2 or 3 obesity. Asians accounted for 48.7% of lean participants, and proportions decreased as BMI categories increased (P < .0001). Lower proportions of lean participants had cirrhosis (22.6% vs 40.2% of non-lean participants), CVD history (9.0% vs 14.8% of nonlean participants), diabetes (32.6% vs 53.5% of non-lean participants), hypertension (47.8% vs 67.4% of non-lean participants), or dyslipidemia (54.0% vs 64.1% of non-lean participants). Asian participants had a lower prevalence of cirrhosis, history of CVD, cardiovascular events, and diabetes compared with non-Asians, independent of BMI category. After we adjusted for age, sex, and center type and site, the odds of NAFLD-associated cirrhosis in Asians who were lean was almost half the odds of NAFLD-associated cirrhosis in non-Asians who were lean (odds ratio, 0.47; 95% CI, 0.29–0.77). Conclusions: More than 10% participants in a cohort of persons with NAFLD in the United States are lean; Asians account for almost half of the lean persons with NAFLD. Lean participants had a lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-lean persons with NAFLD. Asian participants had a significantly lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-Asians in all BMI categories. ClinicalTrials.gov, Number: NCT02815891.
AB - Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is typically associated with obesity. Little is known about the prevalence of cirrhosis in patients with NAFLD and a normal body mass index (BMI). Methods: We determined prevalence of cirrhosis, cardiovascular disease (CVD), and metabolic abnormalities among participants in all BMI categories in the TARGET-NASH study. A total of 3386 patients with NAFLD were enrolled from August 2016 through March 2019. The odds ratios of cirrhosis, CVD, and metabolic abnormalities were estimated by age and race, adjusting for sex and center type. Results: Based on standard BMI cutoff values, 12.8% of study subjects were lean, 27.1% were overweight, 26.5% had class 1 obesity, and 33.7% had class 2 or 3 obesity. Asians accounted for 48.7% of lean participants, and proportions decreased as BMI categories increased (P < .0001). Lower proportions of lean participants had cirrhosis (22.6% vs 40.2% of non-lean participants), CVD history (9.0% vs 14.8% of nonlean participants), diabetes (32.6% vs 53.5% of non-lean participants), hypertension (47.8% vs 67.4% of non-lean participants), or dyslipidemia (54.0% vs 64.1% of non-lean participants). Asian participants had a lower prevalence of cirrhosis, history of CVD, cardiovascular events, and diabetes compared with non-Asians, independent of BMI category. After we adjusted for age, sex, and center type and site, the odds of NAFLD-associated cirrhosis in Asians who were lean was almost half the odds of NAFLD-associated cirrhosis in non-Asians who were lean (odds ratio, 0.47; 95% CI, 0.29–0.77). Conclusions: More than 10% participants in a cohort of persons with NAFLD in the United States are lean; Asians account for almost half of the lean persons with NAFLD. Lean participants had a lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-lean persons with NAFLD. Asian participants had a significantly lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-Asians in all BMI categories. ClinicalTrials.gov, Number: NCT02815891.
KW - Confounding Factor
KW - Ethnicity
KW - Fibrosis
KW - Risk Factor
UR - http://www.scopus.com/inward/record.url?scp=85102449170&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2020.06.066
DO - 10.1016/j.cgh.2020.06.066
M3 - Article
C2 - 32629123
AN - SCOPUS:85102449170
SN - 1542-3565
VL - 19
SP - 996-1008.e6
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 5
ER -