Nonalcoholic fatty liver disease (NAFLD) is an established risk factor of cardiovascular disease (CVD) yet; the association between non-obese NAFLD and CVD remains largely unknown.

A study compared the CVD risk between non-obese and obese NAFLD patients and investigated the factors linked with subclinical atherosclerosis.

The study enrolled successive NAFLD patients estimated by magnetic resonance imaging-based proton density fat fraction (MRI-PDFF). Liver fat content (LFC) was measured with MRI-PDFF, liver stiffness was measured with shear wave elastography and CVD risk was determined by atherosclerosis index (AI), carotid intima-media thickness, carotid plaque, and Framingham risk score (FRS).

The following observations were made-

• 543 NAFLD patients were recruited. 
• Non-obese, as well as obese patients, demonstrated similarity regarding the presence of carotid intima-media thickening and carotid plaque, FRS, and AI. 
• Age increased per 10 years and liver fibrosis (liver stiffness > 6.1 kPa) were significantly related to carotid intima-media thickening, and elevated triglyceride was significantly associated with a carotid plaque in non-obese patients
• however, age increased per 10 years, liver fibrosis, and LFC > 10% were independent predictors of carotid intima-media thickening; and age increased per 10 years and LFC > 10% were significant predictors for carotid plaque in obese patients. 

Thus Liver stiffness and age serve as a strong predictor of subclinical atherosclerosis in all cases of NAFLD, while LFC serves as an added predictor in obese NAFLD patients. So, early CVD screening strategy is essential for NAFLD patients considering different BMIs.

Source: Dig Dis Sci,2020; 65:1850–1860. https://doi.org/10.1007/s10620-019-05926-7