Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Co-morbid Diseases.

Challenge

Lean NAFLD—affecting patients with normal BMI—represented a poorly characterized subpopulation with unclear cardiovascular and metabolic risk profiles compared to obese NAFLD patients, creating uncertainty about how to design inclusive trial enrollment criteria and interpret outcomes in this group.

Solution

The TARGET-NASH cohort was stratified by BMI and race to compare the prevalence of cirrhosis, cardiovascular disease, and metabolic comorbidities across lean, overweight, obese, and morbidly obese patients, providing the first large-scale real-world characterization of lean NAFLD in a diverse US population.

Impact

Demonstrating that lean NAFLD patients have a distinct, less severe clinical profile supports targeted enrollment strategies in NAFLD trials and informs the risk stratification of patients who would otherwise be misclassified by BMI-centric eligibility criteria.