Lean NAFLD patients have lower prevalence of cardiovascular, metabolic and severe liver disease compared to overweight or obese patients with NAFLD.

Challenge

Lean NAFLD represents a clinically distinct and understudied patient population, but whether lean patients have meaningfully different cardiovascular, metabolic, and liver disease severity profiles compared to obese NAFLD patients had not been characterized in a real-world US cohort.

Solution

The TARGET-NASH cohort was analyzed to compare cardiovascular disease history, metabolic comorbidity prevalence, and liver disease severity across lean, overweight, obese, and morbidly obese NAFLD patients, with additional analyses comparing Asian lean patients to non-Asian lean patients given known BMI differences.

Impact

Demonstrating that lean NAFLD patients have systematically lower rates of cirrhosis and metabolic comorbidity—particularly among Asians—informs risk-stratified enrollment strategies for NAFLD trials and supports more nuanced eligibility criteria that account for BMI-race interactions.