NASH: liver damage may be more serious in thin people

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NASH liver damage may be more serious in thin people

Contrary to what one might think, liver diseases such as NASH (“fatty” liver disease) or NAFLD also affect thin people and are even more severe in them.

L’accumulation of fat in the liver not linked to alcohol consumption is a disease known as NAFLD (newly called MASLD for liver disease associated with metabolic dysfunction, NASH Or “fatty liver disease” being a more evolved and aggressive MASLD). It mainly affects overweight, obese people or suffering from diabetes type 2. But people who are thin or of normal build (with a body mass index –BMI- less than 25) can also be affected and the disease would be much more serious in themreveals a recent study conducted from the French Constances cohort and published in the journal Hepatology.

Deaths from all causes were much more common in these patients

So, despite a good metabolic profile (blood tests within standards, editor’s note), thin people or people of normal build are not not spared from liver diseases associated with metabolic dysfunction and the severity of the disease seems greater in them:

  • 16% of subjects who presented with NAFLD were thin or of normal build and 50% of them had no metabolic risk factors. These patients were most often youth and women.
  • 3.7% of these people presented a state of advanced fibrosis (compared to 1.7% of overweight or obese people), lesions more severe hepatic problems and had transaminase levels ALAT (markers of liver condition) higher. These characteristics meant that Liver disease progressed more quickly in thin or normal people.
  • Other hepatic events (cirrhosis, decompensation, liver cancer), chronic kidney disease and death from all causes were much more frequent in these patients than in those who were overweight or suffering from obesity.

On the other hand, cardiovascular events remained more common in people who are overweight or obese, suggesting that obesity itself is a major risk factor for cardiovascular disease, independent of MASLD.

Pattern of progression of non-alcohol-related liver disease © ellepigrafica – stock.adobe.com

“Based on these results, which confirm those of other studies, we must seek to understand the pathogenesis of the disease in these thin and thin patients. study the role of the microbiota, genetics, diet but also specify that of alcohol and tobacco, the consumption of which was a little more frequent in this subpopulation. These patients probably have genetic and/or environmental risk factors“, underlined Professor Lawrence Serfaty (Head of the Liver Metabolic Unit of the new civil hospital in Strasbourg) during a press conference organized on the occasion of the congress Paris NASH meeting.

According to the authors, sarcopenia (progressive loss of muscle mass during aging) and the presence of bile acids synthesized by the liver could contribute to the severity of the disease in thin or normal people. Note that to achieve this result, scientists analyzed the state of the liver of 169,303 participants French during 3 and a half years. Individuals with excessive alcohol consumption, viral hepatitis, or other liver diseases were excluded. The diagnosis of NAFLD and fibrosis was made using the Fatty Liver Index and the Forns Index.


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