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In normal-weight individuals, also called \u2018lean\u2019, there is limited potential for effective lifestyle change in disease management. Additionally, biological mechanisms underlying the development of NASH in non-obese individuals may reveal novel targets for intervention. In this review, the authors discuss the clinical, histological and genetic features and risk factors for non-obese NAFLD and highlight gaps in knowledge and areas for future research.<\/jats:p>","DOI":"10.1136\/flgastro-2018-101119","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T17:19:37Z","timestamp":1576257577000},"page":"478-483","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Non-alcoholic fatty liver disease (NAFLD) in non-obese individuals"],"prefix":"10.1136","volume":"11","author":[{"given":"Meaghan","family":"Phipps","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York CIty, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0368-0860","authenticated-orcid":false,"given":"Julia","family":"Wattacheril","sequence":"additional","affiliation":[{"name":"Department of Medicine, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,13]]},"reference":[{"key":"2025090707583046000_11.6.478.1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jgh3.12070","article-title":"Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma and its implications","volume":"2","author":"Wong","year":"2018","journal-title":"JGH Open"},{"key":"2025090707583046000_11.6.478.2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e3182779d49"},{"key":"2025090707583046000_11.6.478.3","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jhep.2017.06.003","article-title":"New trends on obesity and NAFLD in Asia","volume":"67","author":"Fan","year":"2017","journal-title":"J Hepatol"},{"key":"2025090707583046000_11.6.478.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.726"},{"key":"2025090707583046000_11.6.478.5","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.cgh.2017.04.045","article-title":"Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease, and association with visceral obesity","volume":"15","author":"Fracanzani","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025090707583046000_11.6.478.6","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22350"},{"key":"2025090707583046000_11.6.478.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.12.015"},{"key":"2025090707583046000_11.6.478.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2009.03.021"},{"key":"2025090707583046000_11.6.478.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0160526","article-title":"Influence of ethnicity on the accuracy of non-invasive scores predicting non-alcoholic fatty liver disease","volume":"11","author":"Xia","year":"2016","journal-title":"PLoS One"},{"key":"2025090707583046000_11.6.478.10","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0608537103"},{"key":"2025090707583046000_11.6.478.11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/apt.14112","article-title":"Systematic review with meta-analysis: risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients","volume":"46","author":"Sookoian","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"2025090707583046000_11.6.478.12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/hep4.1124","article-title":"Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: a long-term follow-up study","volume":"2","author":"Hagstr\u00f6m","year":"2018","journal-title":"Hepatol Commun"},{"key":"2025090707583046000_11.6.478.13","doi-asserted-by":"crossref","DOI":"10.1016\/S0016-5085(14)63307-2","article-title":"379 characteristics and long-term prognosis of lean patients with nonalcoholic fatty liver disease","volume":"146","author":"Cruz","year":"2014","journal-title":"Gastroenterology"},{"key":"2025090707583046000_11.6.478.14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/ajg.2016.318","article-title":"Clinical and metabolic characterization of lean Caucasian subjects with non-alcoholic fatty liver","volume":"112","author":"Feldman","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"2025090707583046000_11.6.478.15","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-303816"},{"key":"2025090707583046000_11.6.478.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2017.04.001"},{"key":"2025090707583046000_11.6.478.17","doi-asserted-by":"crossref","unstructured":"Chen F , Esmaili S , Rogers G , et al . 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