Study Results Show More Cardiovascular Disease in Lean Individuals With NAFLD


Physicians often overlook those with lower BMIs who have nonalcoholic fatty liver disease and lower rates of other comorbidities, investigators say.

Individuals who have a normal body mass index (BMI) with non-alcoholic fatty liver disease (NAFLD) are more likely to have cardiovascular disease (CVD) than those who are obese or overweight, according to data presented at Digestive Disease Week 2022.

This link to CVD was found even though individuals who are lean were less likely to have cirrhosis, diabetes, high blood pressure, or high cholesterol.

“Our team had expected to see that those with a normal BMI would have a lower prevalence of any metabolic or cardiovascular conditions, so we were very surprised to find this link to cardiovascular disease,” Karn Wijarnpreecha, MD, MPH, transplant hepatology fellow at the University of Michigan, said in a statement.

“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. But this way of thinking may be putting these patients at risk,” Wijarnpreecha said.

The main characteristic of NAFLD is when the liver cells store too much fat, and typically, the disease presents no symptoms but can lead to other conditions, such as CVD, cirrhosis, and diabetes.

Even though NAFLD is more common in individuals who are obese or overweight, it is also found in those with normal BMIs. There is little research on this population and the associated conditions related to NAFLD, which is why investigators aimed to study this population.

Investigators conducted a retrospective cohort study of more than 10,000 individuals who were diagnosed with NAFLD at the University of Michigan Hospital between 2012 and 2021 to compare the prevalence of chronic kidney disease, cirrhosis, CVD, and metabolic disease among 4 classes of individuals.

The classes included individuals who are lean, with a BMI of 18.5 to 24.9; individuals who are overweight, with a BMI of 25 to 29.9; individuals with class 1 obesity, with a BMI of 30 to 34.9; and individuals with class 2 or 3 obesity, with a BM of 35 to greater than 40.

Investigators found that compared with individuals who were not lean, individuals who were lean had a lower prevalence of cirrhosis, diabetes, dyslipidemia, and hypertension. However, these individuals had a higher prevalence of any CVD, cerebrovascular disease, and peripheral vascular disease.

“In further analysis, we found that lean patients with NAFLD also had a significantly higher prevalence of cardiovascular disease, independent of age, sex, race, smoking status, diabetes, hypertension, and dyslipidemia,” Wijarnpreecha said in the statement.

Investigators plan to conduct additional long-term studies that will follow individuals to determine whether those who are lean have a higher risk of developing CVDs as a result of NAFLD.

Additionally, investigators encourage physicians to not overlook individuals who are lean and have NAFLD, because they could face serious health consequences similar to individuals who are obese or overweight.


More cardiovascular disease found in lean people with non-alcoholic fatty liver disease than in those who are overweight with the same condition. EurekAlert. News release. May 13, 2022. Accessed May 13, 2022.

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