Studies found that nearly 26%of thin people also have fatty liver, which need to reduce weight and improve metabolic disorders!

Metabolic -related fatty liver disease (MAFLD), also known as fatty liver, is one of the world's most common chronic liver diseases. MAFLD is mainly caused by metabolic disorders (such as overweight, obesity, etc.), and the pathological process is manifested as liver inflammation and liver fibrosis. Some MAFLDs may cause end -end liver disease, liver cancer and liver transplantation.

About 20 million people die worldwide every year. According to the statistics of research data of global disease burden (GBD), MAFLD is the main reason for the rapid growth of liver cirrhosis, liver failure and liver cancer. Over the past few decades, the incidence of MAFLD has been increasing, which is related to the changes in high -calorie diet and lack of sports in the overall population.

However, it should be emphasized that not all MAFLD patients have overweight or obesity. MAFLD patients with normal weight (BMI = 18.5 ~ 24.9 kg/m2) are called "thin Mafld" patients. The management of this part of the fatty liver people has also become the focus of clinical attention.

Recently, Nature Reviews Gastroenterology & Hepatology, Nature, published a heavy review, which explained in detail about the characteristics of thin MAFLD, epidemiological performance, pathogenesis, management recommendation, etc.

Screenshot source: Nature Reviews Gastroenterology & Hepatology

MAFLD definition

According to the latest standards, patients with liver fat degeneration meet at least one of the following three standards, and can be diagnosed as MAFLD:

Due to overweight or obesity;

Diabetes with type 2;

There is evidence of metabolism (if its weight is normal);

For European descendants, the definition standards of normal body weight, overweight and obesity are: BMI = 18.5 ~ 24.9 kg/m2, BMI = 25 ~ 29.9 kg/m2, BMI ≥ 30 kg/m2. Among the Asian populations, the standards of normal, overweight and obesity are: BMI = 18.5 ~ 22.9 kg/m2, BMI = 23.0 ~ 24.9 kg/m2, BMI ≥25.0 kg/m2.

In addition, according to the definition of MAFLD international expert consensus, patients with liver fat degeneration or obesity patients are considered MAFLD; for people with normal weight, the diagnostic criteria for "thin MAFLD" are that patients must exist that liver liver must exist. Evidence of fat degeneration and metabolic disorders (at least two related risk factors, these factors include increased waist circumference, low blood pressure, low HDL-C levels, high glyceride hemia, ascending blood glucose damage, insulin resistance and chronic sub-clinical clinical clinical clinical clinical clinical clinical Inflammation).

MAFLD's timely diagnosis helps better predict the progress and prognosis of liver disease and combined diseases (such as cardiovascular disease, chronic kidney disease, lung function damage, and cognitive disorder).

Features of Slim MAFLD

The incidence of lean MAFLD reported by different countries and regions around the world is largely different from 5%to 26%. The proportion of lean MAFLD cases accounts for 15%to 50%of all MAFLD cases.

In China, based on a study of 810 cases of normal subjects, the incidence of lean MAFLD is about 17.5%; another 911 ordinary people (not accompanied by type 2 diabetes) in Hong Kong, China (not accompanied by type 2 diabetes) in Hong Kong, China (not accompanied by type 2 diabetes) Studies have shown that the incidence of lean MAFLD is about 19.3%.

It is more difficult to distinguish between thin MAFLD and other types of MAFLD from the perspective of morphology. The results of some cross -sectional studies show that the historical and metabolic characteristics of patients with thin MAFLD are better than patients with obesity MAFLD. This manifests:

The severity of tissue science is low: such as fatty hepatitis and advanced fibrosis ratio;

Low metabolic abnormalities: such as diabetes, hypertension, abnormal blood lipids, cirrhosis, and cardiovascular diseases.

The paper pointed out that the current long -term prognostic research data for patients with thin MAFLD are less and the conclusions contradict each other. Overall, the long -term ending of patients with thin MAFLD is worse than healthy individuals, and may be similar to the prognosis of MAFLD patients with overweight/obesity.

Lean MAFLD's pathogenesis

Although scientists are still unclear about the pathophysiology mechanism of thin MAFLDs, it is generally believed that metabolic disorders (such as cardiovascular metabolic diseases) may be a key decisive factor in the onset of lean MAFLD.

The paper emphasizes that under the comprehensive effects of genetic and lifestyle factors (such as alcohol intake, quantity/quality, physical exercise), liver and intestinal circulation, and intestinal flora, individual metabolic status has continued to change, and bad metabolism The state will increase the risk of MAFLD.

▲ The pathogenic factor of the thin MAFLD (picture source: reference materials [1])

In addition, for the research results of the apparent genome, the pathogenesis of thin MAFLD may be related to the interaction of genetic-environment. Specifically, the adverse uterine environment may induce the changes in the metabolism process of the fetus, increasing the risk of MAFLD after their adults.

In response to 90 children with MAFLD children, the slowdown in the palace is related to the more severe insulin resistance and the process of disease in the tange. This correlation is independent of BMI. Slim Mafld management

Due to the lack of research evidence, there is currently no specific guidelines for the management of thin MAFLD patients. Some observation research data suggests that patients with thin MAFLDs lose weight and may play the same role as patients with obese MAFLD patients (but the target value of the weight loss of patients with thin MAFLD may be lower).

A vertical study conducted for 16738 MAFLD adults (of which containing thin MAFLD 2383 cases) showed that whether it was a normal weight Mafld subject or for MAFLD subjects accompanied by overweight/obesity, these two categories were The weight loss of the crowd is associated with the dose -dependence between the alleviating of the fatty liver.

The Asia -Pacific Liver Research Association (APASL) guide pointed out that for patients with lean MAFLD, weight loss may be 3%to 5%.

In addition, diet quality is one of the main risk factors for metabolic health, and its influence is independent of BMI and waist and hips. Therefore, no matter what the patient's BMI status, professional dietary advice should be accepted. Similarly, whether or not it is thin Mafld, MAFLD patients should also strengthen daily physical exercise and reduce sedentary behavior, thereby improving metabolism and cardiovascular health.

Reference

[1]Eslam, M., El-Serag, H.B., Francque, S. et al. Metabolic (dysfunction)-associated fatty liver disease in individuals of normal weight. Nat Rev Gastroenterol Hepatol (2022). https://doi. ORG/10.1038/S41575-022-00635-5

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