Heterogeneity of cardiometabolic and hepatic fibrosis risks in nonalcoholic fatty liver disease among lean, overweight, and obese populations: a multicenter cross-sectional study

OBJECTIVE: Given that cardiovascular events induced by metabolic disorders are the leading cause of death in nonalcoholic fatty liver disease (NAFLD), this study aimed to explore the heterogeneity of cardiometabolic and liver fibrosis risks among lean, overweight, and obese NAFLD individuals. METHODS: A multicenter cross-sectional study was conducted across three hospitals in Pudong from July 2022 to June 2023. Health checkup data were obtained and stratified by BMI categories. Multivariable logistic regression was performed to analyze the association between NAFLD and risk factors for cardiometabolic diseases and liver fibrosis across different BMI categories. RESULTS: The study included 37,122 patients, with 25.25% diagnosed with NAFLD. Over 97% of these patients met the criteria for metabolic dysfunction-associated fatty liver disease. NAFLD detection rates were 7.72% in lean, 33.99% in overweight, and 63.56% in obese individuals. Non-obese patients had significantly lower cardiometabolic disease prevalence than obese patients ( P < 0.001). All NAFLD subtypes, except lean NAFLD (negatively associated with total cholesterol) and obese NAFLD (no significant association with total triglycerides), were linked to other cardiometabolic or liver fibrosis risk factors ( P < 0.05). Additioinally, only obese NAFLD demonstrated a negative correlation with age. CONCLUSION: Non-obese NAFLD, despite a relatively better metabolic profile than obese NAFLD, still poses significant cardiometabolic and fibrosis risks. Interventions targeting cardiovascular events and liver disease progression are essential for all NAFLD subtypes, customized to their metabolic characteristics. The detection rates in this study provide a valuable reference for estimating local NAFLD prevalence.