PREVALENCE AND CLINICAL CHARACTERISTICS OF FATTY HEPATIC DISEASE ASSOCIATED WITH METABOLIC DYSFUNCTION IN A POPULATION WITH NORMAL BODY MASS INDEX. (LEAN MAFLD)

Introduction and Objectives

The prevalence of fatty liver disease associated with metabolic dysfunction (MAFLD) is estimated at 39.1%. 4.1% of patients with lean MAFLD are characterized by steatosis, normal BMI, and metabolic alterations. This work aims to describe the prevalence of lean MAFLD and metabolic characteristics in the Mexican population.

Materials and Methods

Retrospective study of patients with preventive medical check-up from 2019-2020 includes elastography for evaluation of fibrosis and steatosis (controlled attenuation parameter, CAP). Criteria to define lean MAFLD: BMI <24.9 and ³2 metabolic alterations: blood pressure> 130/85, previous diagnosis of hypertension, glucose alterations (100 - 125 mg / dl; 140 -199 mg / dl postprandial; HbA1c 5.7 - 6.4%, triglycerides> 150 mg / dl, HDL <40 mg / dl in men and <50 mg / dl in women, treatment for dyslipidemia, abdominal circumference ≥102 cm in men and ≥ 88 cm in women and C-reactive protein> 2mg / L). Exclusion: history of liver disease, significant hepatotoxic and/or alcohol consumption (> 2 drinks/day in women,> 3 drinks/day in men). Measures of central tendency and dispersion present data according to the distribution of the sample. A test was performed to analyze differences in clinical variables.

Results

3863 patients were evaluated, 1754 (45.4%) presented steatosis (CAP> 263 dB / m) and 5.7% (n = 100) met criteria for lean MAFLD. 54% men with median age: 46 [40-56] years, BMI: 23.7 [22.8-24.4] kg / m2, CAP: 293 [271-314] dB / m and liver stiffness: 4.0 [3.5-4.7] kPa. 40% had grade 1 steatosis (> 263dB), 17% grade 2 (> 283 dB) and 43% grade 3 (> 296 dB). The clinical characteristics are shown in Table 1. The BMI showed a significant difference according to the degree of steatosis, being greater in patients with grade 3 (G1: 23.6 [IQR 22.8-24.3], G2: 23.3 [IQR 22.8 - 23.9] and G3: 24.1 [IQR 22.6 [24.1-24.7], p = 0.01)

Discussion

This study confirms the high prevalence of MAFLD / lean MAFLD in the Mexican population. The cut-off points to define the presence of steatosis (> 263 dB / m) has reported greater diagnostic precision (AUROC 0.97) than that used in the clinic (> 232 dB / m); When using the latter, the prevalence of steatosis rises to 65.9%; however, the prevalence of lean MAFLD does not change. This is the first report on the prevalence of Lean MAFLD in Mexico according to different cut-off points of CAP. With more inclusive MAFLD criteria, the prevalence of lean MAFLD does not change. Therefore, it is possible to start non-pharmacological therapy early in patients with overweight, obesity, or normal BMI.

Conclusion

The prevalence of lean MAFLD in the Mexican population is high, with a higher proportion of patients with grade 3 steatosis presenting a higher BMI. The prevalence does not change when using different cut-off points for CAP.

The authors declare that there is no conflict of interest.