目的:非酒精性脂肪性肝病(NAFLD)存在于瘦弱人群中。然而,与非瘦患者相比,这些患者的预后肝脏和心血管风险的大小尚不清楚.我们的目的是调查这个话题,并探讨这些风险是否根据与NAFLD严重程度相关的因素而发生变化。
方法:在PubMed和Embase数据库中搜索队列研究(截至2024年4月发表),这些研究评估了患有NAFLD的瘦和非瘦个体的肝脏和心血管(CV)结局,并报告了未调整或调整的数据。我们使用随机效应模型汇集了风险比(RR)或风险比(HRs),并进行了亚组和荟萃回归分析。
结果:我们确定了22项研究,研究对象超过100万NAFLD患者(13.0%为瘦)。精益NAFLD在未调整分析中显示肝脏相关事件的风险相似(RR1.08,95%CI0.79-1.49,I2=31%),但与非精益NAFLD相比,调整后分析的风险更高(HR1.66,95%CI1.17-2.36,I2=83%)。精益NAFLD具有较高的肝脏相关死亡率风险(RR2.22,95%CI1.57-3.15,I2=0%;HR2.26,95%CI1.14-4.51,I2=0%)。对于CV结果,在未经调整的分析中,瘦NAFLD患任何心血管疾病的风险较低(RR=0.82,95%CI0.70-0.95,I2=88%),但在调整后的分析中风险相似(HR0.89,95%CI0.77-1.02,I2=78%),与非瘦NAFLD相比,心血管死亡率风险相似(RR1.09,95%CI0.71-1.66,I2=85%;HR1.26,95%CI0.89-1.78,I2=46%)。
结论:瘦弱的NAFLD患者的肝脏结局较差,但与非瘦NAFLD患者相比,CV结果相似,强调密切监测这两个群体的重要性。
OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is present in
lean people. However, the magnitude of the prognostic hepatic and cardiovascular risk in these patients compared to non-
lean counterparts remains unclear. We aimed to investigate this topic, and to explore whether these risks change based on factors related to NAFLD severity.
METHODS: PubMed and Embase databases were searched for cohort studies (published through April 2024) that evaluated liver and cardiovascular (CV) outcomes in lean and non-
lean individuals with NAFLD and reported unadjusted or adjusted data. We pooled risk ratios (RRs) or hazard ratios (HRs) using a random-effects modeling and performed subgroup and meta-regressions analyses.
RESULTS: We identified 22 studies with over 1 million NAFLD patients (13.0% were
lean). Lean NAFLD showed a similar risk of liver-related events in unadjusted analysis (RR 1.08, 95% CI 0.79-1.49, I2 = 31%), but a higher risk in adjusted analysis (HR 1.66, 95% CI 1.17-2.36, I2 = 83%) compared to non-lean NAFLD. Lean NAFLD had a higher risk of liver-related mortality (RR 2.22, 95% CI 1.57-3.15, I2 = 0%; HR 2.26, 95% CI 1.14-4.51, I2 = 0%). For CV outcomes, lean NAFLD had a lower risk of any cardiovascular disease in unadjusted analysis (RR = 0.82, 95% CI 0.70-0.95, I2 = 88%), but similar risk in adjusted analysis (HR 0.89, 95% CI 0.77-1.02, I2 = 78%), and similar risk of cardiovascular mortality (RR 1.09, 95% CI 0.71-1.66, I2 = 85%; HR 1.26, 95% CI 0.89-1.78, I2 = 46%) compared to non-lean NAFLD.
CONCLUSIONS: Lean NAFLD patients have worse liver outcomes, but similar CV outcomes compared to non-
lean NAFLD patients, highlighting the importance of monitoring both groups closely.