Characterization of biopsy proven non-alcoholic fatty liver disease in healthy non-obese and lean population of living liver donors: The impact of uric acid

Background: Non-alcoholic fatty liver disease (NAFLD) is frequently seen among non-obese overweight individuals and lean subjects (those with normal body mass index). This study aimed to investigate prevalence and risk factors of biopsy proven NAFLD in a cluster of healthy non-obese and lean individuals. Methods and Materials: In a retrospective study, adult ( 18 years) apparently healthy individuals who had donated liver to pediatric patients between July 2012 and October 2018 were included. Non-obese and lean individuals were defined as BMI < 30 kg/m(2) and BMI < 25 kg/m(2), respectively. Results: Totally 310 patients were included. Seventy-six individuals (24.5%) had NAFL and 30 patients (9.67%) had non-alcoholic steatohepatitis (NASH) among non-obese population. In multivariate regression analysis, only higher BMI was marginally associated with NASH in non-obese compared to those without NASH (Odds ratio: 2.52, 95% CI: 0.097-6.54; P = 0.05). Totally, 246 individuals were lean. 55 individuals (22.3%) had NAFL and 20 individuals (8.2%) had NASH in their liver biopsies. In univariate analysis, serum triglyceride, cholesterol, LDL, ALT, alkaline phosphatase and uric acid were associated with NAFL among lean individuals (P < 0.05). In regression analysis, serum uric acid was associated with NAFL (Odds ratio: 1.70, 95% CI: 1.18-2.45; P = 0.004) and NASH in lean individuals (Odds ratio: 1.98, 95% CI: 1.27-3.10; P = 0.003). Conclusion: NAFLD/NASH is prevalent even in a healthy lean population when evaluated by liver biopsy. Higher BMI and serum uric acid were two major risks of NAFLD/NASH in non-obese and lean individuals. (c) 2019 Elsevier Masson SAS. All rights reserved.