Table 2.
Prevalence and metabolic status of NAFLD in non-obese individuals.
| Author; Year | Country | Population | Sample size (n) | Proportion of non-obese among NAFLD individualsa | Prevalence of NAFLDb ; n (%) | Prevalence of MS among non-obese NAFLD persons; n (%) | Mode of diagnosis of NAFLD | Mode of diagnosis of IR/MS | Status of IR/MS in non-obese NAFLD |
|---|---|---|---|---|---|---|---|---|---|
| Riquelme A et al.,10 2009 | Chile | Urban population (Hispanics) | 832 | NR | 195 (23.4%) | NR | USG | HOMA-IR | HOMA-IR >2.16 significantly associated with NAFLD (OR 2.97) |
| Kwon YM et al.,86 2012 | Korea | Hospital cohort | 29,994 | 3,014 (49.9) | Overall 6,039 (20.1) Non-obese 3,014 (12.6) Obese 3,025 (50.1) |
NR | USG | HOMA-IR | NAFLD was associated with higher risk of components of MS regardless of gender and obesity |
| Sinn DH et al.,85 2012 | Korea | Hospital cohort (Selected non-obese individuals) | 5,878 | 5,878 (100) | 1,611 (27.4%) | 381 (23.64) | USG | HOMA2-IR ≥1.5 and NCEP-ATP III criteria |
IR in 13.6% (n = 801) MS in 6.5% (n = 381) NAFLD, not MS predicted IR |
| Xu C et al.,15 2013 | China | Hospital cohort (Employee Health Checkup) | 6,905 | 6,905 (100) | 502 (7.27 %) | NR | USG | NR | Components of MS were separately associated with NAFLD |
| Das K et al.,17 2010 | West Bengal, India | General population (Rural) | 1,911 | 90 (54%)c | 167 (8.7%) | 43 (26%)b | US and CT | Components of MS like FBG and TG were higher in non-obese NAFL than control. HOMA-IR was comparable | |
| Wei JL et al.,5 2015 | Hong Kong | General population (Urban) | 911 | 135 (51.52) | Overall 262 (28.8) Non-obese 135 (19.3) Obese 127 (60.5) |
51 (37.8) | Proton MRS | HOMA-IR, IDF and NCEP-ATP III criteria |
HOMA-IR, BMI and WC predicted NAFLD in non-obese individuals |
| Younossi Z M et al.,4 2012 | USA | National Health and Nutrition Examination Survey III (NHANES III) database | 11613 | 431 (17.29) | Overall 2492 (21.45) Non-obese 431 (3.71) Obese 127 (17.74) |
NR | USG | HOMA-IR | IR and dyslipidaemia were not associated with NAFLD in non-obese. NASH was associated with MS |
| Bugianesi E et al.,87 2005 | Italy | Selected non-obese, non-diabetic NAFLD subjects | 12 | – | Not designed to see prevalence | NR | Liver histology | Euglycemic Insulin clamp | Features of IR were present in all individuals |
| Feldman A et al.,31 2016 | Austria, Switzerland | Subjects selected from Salzburg Colon Cancer Prevention Initiative study |
187 | 55 (29.41) | Not designed to see prevalence | NR | USG | HOMA-IR OGTT | Lean NAFLD showed significant impairment in glucose tolerance |
| Musso G et al.,88 2008 | Italy | Healthy individuals | 197 | NR | Not designed to see prevalence | NR | USG with elevated ALT | HOMA-IR, OGTT, NCEP-ATP III criteria |
NAFLD was more significantly associated with IR than with ATP III criteria |
| Marchesini G et al.,89 1999 | Italy | Hospital cohort | 46 | – | Not designed to see prevalence | – | USG | HOMA-IR | NAFLD was associated with IR even in non-obese individuals |
| Kim H J et al.,82 2004 | Korea | Clinic attendee | 768 | 74 (41) | 180 | NR | USG | HOMA-IR | NAFLD was associated with components of MS in non-obese individuals |
| Fracanzani et al.,110 2017 | Italy | Hospital cohort | 669 | 143 (21.38) | Not designed to see prevalence | 17 (14) | Liver histology | HOMA-IR | Adipose tissue insulin resistance was higher in patients with NASH than in patients without even when analysed in lean and overweight/ obese patients separately |
aNon-obese defined as BMI ≪25 kg/m2; b Unadjusted prevalence; c Non-obese defined as BMI ≪25 kg/m2 and waist circumference ≪80 cm (female) /≪90 cm (male); ATP III, Adult Treatment Panel III; BMI, body mass index; CT, computed tomography; FBG, fasting blood glucose; HOMA-IR, homeostatic model assessment - insulin resistance; IDF, International Diabetes Federation; IR, insulin resistance; MRS, magnetic resonance spectroscopy; MS, metabolic syndrome; NAFLD, non-alcoholic fatty liver disease; NCEP, National Cholesterol Education Programme; NR, not reported; OGTT, oral glucose tolerance test; TG, triglyceride; USG, ultrasonography; WC; waist circumference.