Non-obese histologically confirmed NASH patients with abnormal liver biochemistry have more advanced fibrosis

Qianyi Wang, Hong You, Xiaojuan Ou, Xinyan Zhao, Yameng Sun, Min Wang, Ping Wang, Yu Wang, Weijia Duan, Xiaoming Wang, Shanshan Wu, Yuanyuan Kong, Romil Saxena, Annette S.H. Gouw, Jidong Jia

Research output: Contribution to journalArticle


Background and aims: Non-alcoholic fatty liver disease (NAFLD) commonly affects subjects with obesity, yet non-obese NAFLD is increasingly being recognized. We aimed to investigate the clinicopathological and genetic characteristics of non-obese NAFLD patients. Methods: The clinical, histological and genetic data of 84 NAFLD patients with biopsy for abnormal liver function test were reviewed. Both NAS-CRN and SAF scoring systems were applied for histopathological evaluation. PNPLA3 and TMS6F2 genotyping were also performed. Results: All of the 84 patients were histologically diagnosed with non-alcoholic steatohepatitis (NASH), with 36 of them (42.9%) being non-obese (BMI < 25 kg/m2). Compared with the obese group, non-obese group were predominantly females (88.9% vs 52.1%, p < 0.001), tended to have higher prevalence of diabetes (p = 0.068). More importantly non-obese patients had a significant higher prevalence of advanced fibrosis (F ≥ 3) (58.3% vs 29.2%, p = 0.013), and a trend of higher degree of ballooning (p = 0.061). In addition, values of liver stiffness measurement were also significantly higher in non-obese group (12.1 kPa vs 8.1 kPa, p = 0.032). There was also a trend of higher prevalence of TM6SF2 T allele in non-obese group (p = 0.085), while the prevalence of PNPLA3 risk allele did not differ between two groups. Multivariate analysis showed that higher fasting glucose (p = 0.038) and lower serum platelets (p = 0.040) were two independent predictors for advanced fibrosis in non-obese patients. Conclusions: Non-obese NASH patients have a female predominance and more advanced fibrosis. Liver biopsy is crucial to evaluate the severity of disease in non-obese patients especially those with abnormal liver biochemistry. Clinical trial number: NCT03386890.

Original languageEnglish (US)
Pages (from-to)766-776
Number of pages11
JournalHepatology International
Issue number6
StatePublished - Nov 1 2019



  • Hepatic fibrosis
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Non-obese

ASJC Scopus subject areas

  • Hepatology

Cite this

Wang, Q., You, H., Ou, X., Zhao, X., Sun, Y., Wang, M., Wang, P., Wang, Y., Duan, W., Wang, X., Wu, S., Kong, Y., Saxena, R., Gouw, A. S. H., & Jia, J. (2019). Non-obese histologically confirmed NASH patients with abnormal liver biochemistry have more advanced fibrosis. Hepatology International, 13(6), 766-776.