A Comparative Study of Liver Steatosis in Lean and Obese Patients with Non-alcoholic Fatty Liver Disease Based on Bioelectrical Impedance Analysis and Controlled Attenuation Parameter

Background: Due to the predominance of obesity, bad eating habits, and sedentary lifestyle patterns, non-alcoholic fatty liver disease (NAFLD) is becoming an international health issue and accounts for 25% of prevalence globally. Although there was evidence that the pathophysiology of NAFLD was mostly influenced by increasing body fat, particularly abdominal visceral fat, recent epidemiological studies have reported an increase of non-obese individuals who have NAFLD worldwide. In order to evaluate the degree of steatosis and identify the metabolic profiles of lean NAFLD patients, this study evaluated the liver fatty liver disease and body composition of obese and lean NAFLD patients.

Methods: In this cross-sectional research, a hundred individuals participated aged more than 18 years old, both sexes, with clinical criteria of bright liver by ultrasound then NAFLD diagnosed by Controlled Attenuation Parameter (CAP) determination of liver steatosis more than 240 dB/min. Patients were divided into two categories: 50 individuals with hepatic steatosis made up Group 1 (the study group), which was further split into: 1a: Count 25 individuals that are fatty or overweight (BMI 25 kg/m2), and 1b: Include 25 people who are not obese (BMI <25 kg/m2). Group 2 (control group): included 50 participants without liver steatosis, further subdivided into: 2a: include 25 overweight-obese participants (BMI≥25kg/m2) and 2b: include 25 non obese participants (BMI<25kg/m2).

Results: The proportion of body fat, visceral fat, subcutaneous fat, free-fat mass index (FFMI), and fat mass index (FMI) in the NAFLD group elevated substantially more than those in the non-NAFLD group (P <0.001). The steatosis score and the systolic, diastolic, and triglyceride (TG) levels were positively correlated in the obese NAFLD group (P=0.039, =0.002, and =0.012, respectively). The risk variables for NAFLD in lean individuals were elevated TG, reduced lymphocytes, increased neutrophil-to-lymphocyte ratio (NLR), increased Homeostatic model assessment (HOMA), and decreased FFMI.

Conclusions: While raised systolic blood pressure and elevated triglycerides were the only independent risk factors for the development of NAFLD in obese individuals, increasing visceral obesity and insulin resistance, HOMA IR were the only independent risk factor for the development of NAFLD in lean patients.