Abstract
BackgroundWith the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities. Few longitudinal studies have explored the relationship between MHO and non-alcoholic fatty liver disease (NAFLD), which we address using over 4 million primary care patient records.MethodsA retrospective population-based longitudinal cohort was conducted using The Health Improvement Network (THIN) database incorporating adults with no history of NAFLD or alcohol excess at baseline. Individuals were classified according to BMI category and metabolic abnormalities (diabetes, hypertension and dyslipidaemia). Diagnosis of NAFLD during follow-up was the primary outcome measure. NAFLD was identified by Read codes.ResultsDuring a median follow-up period of 4.7 years, 12,867 (0.3%) incident cases of NAFLD were recorded in the cohort of 4,121,049 individuals. Compared to individuals with normal weight and no metabolic abnormalities, equivalent individuals who were overweight, or obese were at significantly greater risk of incident NAFLD (Adjusted HR 3.32 (95%CI 2.98–3.49), and 6.92 (6.40–7.48, respectively). Metabolic risk factors further increased risk, including in those with normal weight and 1 (2.27, 1.97–2.61) or = < 2 (2.39, 1.99–2.87) metabolic abnormalities.ConclusionsMHO individuals are at greater risk of developing NAFLD compared to those with normal weight. This finding supports that the MHO phenotype is a temporary state, and weight must be considered a risk factor even before other risk factors develop. Being normal weight with metabolic abnormalities was also associated with risk of NAFLD.
Highlights
With the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities
While the association between obesity and metabolic health with non-alcoholic fatty liver disease (NAFLD) has been examined in previous Asian cohorts, this study provides the first evidence from a cohort study characterising this relationship in a European population
This study provides a useful estimate of recorded NAFLD in clinical practice in UK according to subgroups based on body mass index (BMI) and metabolic health status, reflecting “real-life” care
Summary
With the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities. Few longitudinal studies have explored the relationship between MHO and non-alcoholic fatty liver disease (NAFLD), which we address using over 4 million primary care patient records. It is well established that there is significant variation in the presence of concurrent metabolic abnormalities such as hyperglycaemia, hypertension and hyperlipidaemia in patients with obesity. This has led to the characterisation of patients with obesity and associated metabolic abnormalities into subphenotypes. As defined by body mass index (BMI), may present without the aforementioned metabolic complications. This subpopulation has been described as “metabolically healthy obese” (MHO). The implications for the development of NAFLD across these subphenotypes remains unclear
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