Lean Patients With MASLD Face Higher Risk of Poor Outcomes and Mortality

Key Insight: As reported by Healio, metabolic dysfunction-associated steatotic liver disease (MASLD) is not exclusive to individuals with obesity. New research presented at The Liver Meeting reveals that lean patients with MASLD may experience worse liver-related outcomes and higher mortality compared to their obese counterparts.

Study Highlights

Higher Liver-Related Risk: Patients without obesity had a greater likelihood of developing cirrhosis (4.4% vs. 3.6%), liver-related events (7.1% vs. 3.7%), hepatocellular carcinoma (0.9% vs. 0.6%), and requiring liver transplant (0.5% vs. 0.3%).
Increased Mortality: Lean MASLD patients exhibited higher cardiovascular mortality (1.7% vs. 1%) and all-cause mortality (14.3% vs. 7.1%).
Relative Risks: Compared to obese patients, lean individuals had nearly double the risk for liver-related events (RR = 1.92) and twice the risk for all-cause mortality (RR = 2).

Why This Matters

“Although a few previous studies reported similar results, we were still surprised by our findings,” said Abdellatif Ismail, MD, gastroenterology fellow at Cleveland Clinic Florida. “The prevailing assumption has long been that being overweight is generally linked to poorer health outcomes, making these results particularly interesting.”

Dr. Ismail emphasized that MASLD can affect lean individuals and may lead to worse outcomes in this group. These findings underscore the need for clinicians to maintain a low threshold for diagnosing MASLD, even in patients without excess body weight.

Study Design

Data Source: TriNetX network
Population: 939,848 patients with hepatic steatosis (excluding alcohol-associated liver disease)
Groups:
- Lean (n = 121,612; BMI < 25)
- Obese (n = 818,236; BMI ≥ 25)
Criteria: All participants had at least one cardiometabolic risk factor
Follow-up: 10 years

Clinical Implications

The findings suggest lean MASLD patients may have greater metabolic dysfunction, increasing their risk for fibrosis, cirrhosis, and cardiovascular disease. Researchers advocate for:

Alternative Risk Assessment: Use of waist circumference and other anthropometric indices
Further Research: Prospective studies and mechanistic investigations to validate and explain these trends

Contact: For more details, reach out to Abdellatif Ismail, MD, at [email protected].