Cardiovascular Disease Higher Among Lean Patients With Nonalcoholic Fatty Liver Disease

Researchers sought to determine the prevalence of cardiovascular disease, cirrhosis, metabolic diseases, and chronic kidney disease in lean vs overweight or obese NAFLD.

Lean patients with nonalcoholic fatty liver disease (NAFLD) were associated with increased prevalence of cardiovascular disease (CVD) compared with patients with overweight or obesity, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

For the study, researchers used a natural language processing search of electronic medical records from the University of Michigan hospital between 2012 and 2021 to identify patients. Adults (N=10,220) with NAFLD were evaluated for the prevalence of cirrhosis, CVD, metabolic diseases, and chronic kidney disease (CKD) on the basis of obesity status.

Patients were categorized as lean (n=1158), overweight (n=2513), class 1 obese (n=2824), or classes 2 or 3 obese (n=3725). The lean, overweight, class 1 obese, and classes 2 to 3 obese cohorts had a mean age of 51.8±18.3, 54.14±15.56, 52.61±14.85, and 48.56±14.00 years; and 40.3%, 53.6%, 51.7%, and 37.3% were men, respectively.

More lean patients were current smokers (P <.0001), had peripheral arterial disease (P =.003), cerebrovascular accident (P <.0001), CKD (P <.0001), and any CVD (P =.046) compared with nonlean patients. Fewer lean patients had metabolic diseases (all P <.0001).

Compared with lean patients, overweight individuals were less likely to have any CVD (adjusted odds ratio [aOR], 0.6; 95% CI, 0.5-0.8; P <.001), coronary artery disease (aOR, 0.7; 95% CI, 0.6-0.9; P <.01), and cerebrovascular accident (aOR, 0.5; 95% CI, 0.4-0.7; P <.001), but did not have differing rates of cirrhosis (aOR, 1.2; 95% CI, 0.8-1.9; P =.29).

Among the class 1 or classes 2 and 3 obesity cohorts, these patients were also associated with decreased prevalence of any CVD (aOR range, 0.6-0.6; both P <.001), coronary artery disease (aOR range, 0.6-0.7; both P <.01), and cerebrovascular accident (aOR range, 0.4-0.6; both P <.001), but not cirrhosis (aOR range, 1.4-1.5; both P ³.06) compared with lean patients.

Additional study is needed to evaluate whether the presence of NAFLD among lean patients increased risk for the associations observed in this study.

The study found that lean patients with NAFLD were associated with increased likelihood of CVD despite having lower rates of metabolic diseases.

“Too often, we overlook NAFLD patients with a normal BMI because we assume their risk for more serious conditions is lower than those who are overweight,” Dr Karn Wijarnpreecha, lead study researcher, said in a DDW 2022 news release. “But this way of thinking may be putting these patients at risk.”


  1. Wijarnpreecha K, Li F, Chen VL, Lok A. Higher Prevalence of Cardiovascular Disease Among Lean Versus Non-Lean Patients with NAFLD.Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract 325.
  2. More cardiovascular disease found in lean people with non-alcoholic fatty liver disease than in those who are overweight with the same condition: New study surprises researchers who say doctors may overlook lean patients with nonalcoholic fatty liver disease. News release. DDW 2022. May 13, 2022.

This article originally appeared on Gastroenterology Advisor