{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:53:01Z","timestamp":1791910381115,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Backgrounds<\/jats:title><jats:p>Nonalcoholic fatty liver disease (NAFLD) is linked to obesity and metabolic syndrome conditions. However, a subset of NAFLD patients express a normal or low body mass index (lean NAFLD [L\u2010NAFLD]). Our aim is to compare the prevalence of L\u2010NAFLD to the obesity\u2010associated NAFLD in the United States by assessing prevalence, potential risk factors, liver\u2010related complications, and coronary artery disease outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>A multicenter database (Explorys Inc.) of &gt;70 million patients across the United States was screened. A cohort of patients with \u201cnonalcoholic fatty liver\u201d between 1999 and 2021 was identified. Two sub\u2010cohorts of NAFLD patients were identified: those with a body mass index (BMI)\u00a0&lt;\u00a025\u00a0kg\/m<jats:sup>2<\/jats:sup> (L\u2010NAFLD) and those with a BMI\u00a0&gt;\u00a030\u00a0kg\/m<jats:sup>2<\/jats:sup> (obesity\u2010associated NAFLD). We excluded patients with age &lt;18 and those who have viral hepatitis, hemochromatosis, Wilson's disease, biliary cirrhosis, alcoholic liver disease, cystic fibrosis, alpha\u20101\u2010antitrypsin deficiency, and autoimmune hepatitis. Multivariate analysis was performed to adjust for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>68\u2009892\u2009260 individuals were screened. NAFLD prevalence was four per 100\u2009000, and L\u2010NAFLD prevalence was 0.6 per 100\u2009000. Compared with those without, patients with L\u2010NAFLD tended to be older (OR 2.16), females (OR 1.28), and smokers (OR 4.67) and of Asian race (OR 2.12). L\u2010NAFLD patients were more likely to have acute coronary syndromes (OR 30.00) and metabolic syndrome (OR 2.31) despite the normal\/low BMI. Esophageal varices and hepatocellular carcinoma risks were high in both cirrhosis patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the largest study to assess L\u2010NAFLD prevalence in the United States. L\u2010NAFLD are at a significantly higher risk for acute coronary syndromes, esophageal varices, and hepatocellular carcinoma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16049","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T02:53:33Z","timestamp":1667530413000},"page":"269-273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Epidemiology and prevalence of lean nonalcoholic fatty liver disease and associated cirrhosis, hepatocellular carcinoma, and cardiovascular outcomes in the United States: a population\u2010based study and review of literature"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1648-0005","authenticated-orcid":false,"given":"Ashraf","family":"Almomani","sequence":"first","affiliation":[{"name":"Cleveland Clinic Foundation  Cleveland OH 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Health  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Alshaikh","sequence":"additional","affiliation":[{"name":"Mutah University  Al\u2010Karak Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almaza","family":"Albakri","sequence":"additional","affiliation":[{"name":"Jordanian Royal Medical Services  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3428-9282","authenticated-orcid":false,"given":"Leen","family":"Hussein","sequence":"additional","affiliation":[{"name":"Al Andalus University for Medical Sciences  Tartus Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebrahim","family":"Hussein","sequence":"additional","affiliation":[{"name":"Al Andalus University for Medical Sciences  Tartus Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"Asaad","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Foundation  Cleveland OH 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International Association for the Study of Obesity and the International Obesity Task Force.The Asia\u2010Pacific perspective: Redefining obesity and its treatment. Australia: IASO and IOTF 2000."}],"container-title":["Journal of Gastroenterology and Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgh.16049","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgh.16049","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgh.16049","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T01:46:36Z","timestamp":1692495996000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jgh.16049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,16]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/jgh.16049"],"URL":"https:\/\/doi.org\/10.1111\/jgh.16049","archive":["Portico"],"relation":{},"ISSN":["0815-9319","1440-1746"],"issn-type":[{"value":"0815-9319","type":"print"},{"value":"1440-1746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,16]]},"assertion":[{"value":"2022-04-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}