Differential risk factors of fibrosis between lean and obese MAFLD

PMCID: PMC12177025

PMID: 40531393

DOI: 10.1007/s10238-025-01749-1

Journal: Clinical and experimental medicine

Publication Date: 2025-6-18

Authors: Mostafa AM, Fouad Y, Gaber Y, Alem SA, Pan Z, et al.

Key Points

• Lean MAFLD patients (3.6% prevalence) have distinct metabolic characteristics, including higher hypercholesterolemia and hypertension compared to obese patients
• 17.7% of MAFLD patients demonstrated significant fibrosis, with male gender, diabetes, and older age as primary risk factors
• Clinicians should not consider lean MAFLD as low-risk; metabolic screening and careful monitoring are essential regardless of body mass index

Summary

This comprehensive study investigated metabolic dysfunction-associated fatty liver disease (MAFLD) across lean and obese populations, revealing critical insights into fibrosis risk factors. Using data from 7,902 participants in the National Health and Nutrition Examination Survey, researchers examined the distinct characteristics and fibrosis progression in lean versus overweight/obese MAFLD patients.

The research demonstrated that lean MAFLD is not a benign condition, with significant fibrosis risks emerging across different patient subgroups. While lean MAFLD patients were older and had unique metabolic profiles, they exhibited comparable fibrosis potential to obese counterparts. Key predictors of significant fibrosis varied between lean and obese groups, with age, AST levels, and platelet counts being particularly important in lean patients, while diabetes, hypertension, and metabolic factors drove fibrosis risk in obese patients.