{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:51:01Z","timestamp":1771332661898,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Metabolic dysfunction-associated fatty liver disease (MAFLD) in lean individuals indicates metabolic dysfunction and elevates risks of metabolic and cardiovascular diseases. Thus far, no studies have specifically examined the prevalence and risk factors of MAFLD in lean individuals with bipolar disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 1,072 patients aged 18 to 60 years. Participants were classified into two groups based on their Body Mass Index (BMI): those with a BMI \u226524 kg\/m\u00b2 were categorized as overweight or obese, while those with a BMI &amp;lt;24 kg\/m\u00b2 were defined as lean. Data were extracted from inpatient records at the Anhui Mental Health Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MAFLD prevalence markedly differed between groups (lean: 10.5% <jats:italic>vs<\/jats:italic>. overweight\/obese: 76.3%, p&amp;lt;0.001). Among lean BD patients, MAFLD-positive and MAFLD-negative subgroups significantly differed in: age, onset age, illness duration, BMI, ALT, key metabolic indices, marital status, diabetes, and hypertension. Stepwise binary logistic regression analysis revealed that fasting blood glucose level, triglyceride level, gamma-glutamyl transferase (GGT) level, female gender and diabetes status were significant risk factors for MAFLD, while high-density lipoprotein (HDL) level was identified as a protective factor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MAFLD is clinically relevant in lean BD patients. Fasting blood glucose level, triglyceride level, GGT level, female gender, and diabetes status were significant risk factors for MAFLD, whereas HDL level was a significant protective factor. Given the potential harm of MAFLD, it is essential to enhance vigilance and underscore the necessity of monitoring MAFLD among individuals with bipolar disorder, especially those who are lean.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1605484","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:52:49Z","timestamp":1753869169000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and risk factors of metabolic associated fatty liver disease in lean patients with bipolar disorder: a retrospective cross-sectional study"],"prefix":"10.3389","volume":"16","author":[{"given":"Weihong","family":"Lei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiahuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiyi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-050718\u2013095449","article-title":"Creativity and bipolar disorder: A shared genetic vulnerability","volume":"16","author":"Greenwood","year":"2020","journal-title":"Annu Rev Clin Psychol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)31544-0","article-title":"Bipolar disorders","volume":"396","author":"McIntyre","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.11.026","article-title":"Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review","volume":"132","author":"Gimenez-Palomo","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.1394","article-title":"Comorbidities and mortality in bipolar disorder A swedish national cohort study","volume":"70","author":"Crump","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2012.12050620","article-title":"Metabolic syndrome and metabolic abnormalities in bipolar disorder: A meta-analysis of prevalence rates and moderators","volume":"170","author":"Vancampfort","year":"2013","journal-title":"Am J Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4088\/JCP.13r08634","article-title":"Metabolic syndrome in bipolar disorder: A review with a focus on bipolar depression","volume":"75","author":"McElroy","year":"2014","journal-title":"J Clin Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2016.07.006","article-title":"Increased risk of chronic liver disease in patients with bipolar disorder: A population-based study","volume":"42","author":"Hsu","year":"2016","journal-title":"Gen Hosp Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28584","article-title":"Global epidemiology of nonalcoholic fatty liver disease: meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Lonardo","year":"2016","journal-title":"Hepatology"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.008","article-title":"Letter regarding \u201cA new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement","volume":"73","author":"Mak","year":"2020","journal-title":"J Hepatol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14664","article-title":"Response to: Comparison of MAFLD and NAFLD diagnostic criteria in real world","volume":"40","author":"Nguyen","year":"2020","journal-title":"Liver Int"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease","volume":"158","author":"Eslam","year":"2020","journal-title":"Gastroenterology"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1126\/science.1160794","article-title":"A stress signaling pathway in adipose tissue regulates hepatic insulin resistance","volume":"322","author":"Sabio","year":"2008","journal-title":"Science"},{"key":"B14","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2019.08.002","article-title":"Non-alcoholic fatty liver disease in lean individuals","volume":"1","author":"Albhaisi","year":"2019","journal-title":"JHEP Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30908","article-title":"Lean NAFLD: A distinct entity shaped by differential metabolic adaptation","volume":"71","author":"Chen","year":"2020","journal-title":"Hepatology"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2012.08.005","article-title":"In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not","volume":"62","author":"Younossi","year":"2013","journal-title":"Metabol-Clin Exp"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12916-022-02716-3","article-title":"Lean or diabetic subtypes predict increased all-cause and disease-specific mortality in metabolic-associated fatty liver disease","volume":"21","author":"Chung","year":"2023","journal-title":"BMC Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3967\/0895-3988.2013.01.001","article-title":"Empirical changes in the prevalence of overweight and obesity among chinese students from 1985 to 2010 and corresponding preventive strategies","volume":"26","author":"Ji Cheng","year":"2013","journal-title":"Biomed Environ Sci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/art.40807","article-title":"Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the national health and nutrition examination survey, 2007-2016","volume":"71","author":"Chen-Xu","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1560738","article-title":"Sex-specific associations between blood urea nitrogen and risk of hyperuricemia in US adults: the NHANES 1999-2020","volume":"16","author":"Chen","year":"2025","journal-title":"Front Endocrinol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2021.0067","article-title":"From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple","volume":"27","author":"Kang","year":"2021","journal-title":"Clin Mol Hepatol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2024.102973","article-title":"Prevalence and risk factors of MAFLD and its metabolic comorbidities in community-based adults in China: A cross-sectional study","volume":"18","author":"He","year":"2024","journal-title":"Diabetes Metab Syndr"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2024.101562","article-title":"Prevalence of NAFLD, MAFLD, and MASLD: NHANES 1999-2018","volume":"50","author":"Pan","year":"2024","journal-title":"Diabetes Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2147\/dmso.S437811","article-title":"Prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in non-obese patients with schizophrenia: A retrospective study","volume":"17","author":"Yi","year":"2024","journal-title":"Diabetes Metab Syndrome Obes"},{"key":"B26","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/acps.13239","article-title":"Non-alcoholic fatty liver disease in a sample of individuals with bipolar disorders: results from the FACE-BD cohort","volume":"143","author":"Godin","year":"2021","journal-title":"Acta Psychiatr Scandinavica"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1017\/s1092852922001043","article-title":"The bidirectional association of nonalcoholic fatty liver disease with depression, bipolar disorder, and schizophrenia","volume":"28","author":"Jawad","year":"2023","journal-title":"CNS Spectrums"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12633","article-title":"Cardiometabolic risks and omega-3 index in recent-onset bipolar I disorder","volume":"20","author":"Wulsin","year":"2018","journal-title":"Bipolar Disord"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202200742","article-title":"Hepatic MDM2 causes metabolic associated fatty liver disease by blocking triglyceride-VLDL secretion via apoB degradation","volume":"9","author":"Lin","year":"2022","journal-title":"Adv Sci"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.14218\/jcth.2021.00173","article-title":"Alcohol and metabolic-associated fatty liver disease","volume":"9","author":"Sun","year":"2021","journal-title":"J Clin Trans Hepatol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23719","article-title":"Hepatic lipotoxicity and the pathogenesis of nonalcoholic steatohepatitis: the central role of nontriglyceride fatty acid metabolites","volume":"52","author":"Neuschwander-Tetri","year":"2010","journal-title":"Hepatology"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2011.11.004","article-title":"Excessive hepatic mitochondrial TCA cycle and gluconeogenesis in humans with nonalcoholic fatty liver disease","volume":"14","author":"Sunny","year":"2011","journal-title":"Cell Metab"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jad.2023.04.068","article-title":"Insulin resistance in bipolar disorder: A systematic review of illness course and clinical correlates","volume":"334","author":"Miola","year":"2023","journal-title":"J Affect Disord"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-013-0425-9","article-title":"Toward clinically applicable biomarkers in bipolar disorder: focus on BDNF, inflammatory markers, and endothelial function","volume":"15","author":"Goldstein","year":"2013","journal-title":"Curr Psychiatry Rep"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1002\/iid3.70035","article-title":"The mediating role of insulin resistance in the association between inflammatory score and MAFLD: NHANES 2017-2018","volume":"12","author":"Chen","year":"2024","journal-title":"Immun Inflammation Dis"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-1902","article-title":"Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: A meta-analysis","volume":"41","author":"Mantovani","year":"2018","journal-title":"Diabetes Care"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2014.07.039","article-title":"Multilayered genetic and omics dissection of mitochondrial activity in a mouse reference population","volume":"158","author":"Wu","year":"2014","journal-title":"Cell"},{"key":"B38","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1186\/s12888-023-04846-1","article-title":"Hormonal and inflammatory signatures of different mood episodes in bipolar disorder: a large-scale clinical study","volume":"23","author":"Lyu","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1111\/bdi.12151","article-title":"Sex hormones and biomarkers of neuroprotection and neurodegeneration: implications for female reproductive events in bipolar disorder","volume":"16","author":"Frey","year":"2014","journal-title":"Bipolar Disord"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2006.02.003","article-title":"Gonadal steroid regulation of mood: The lessons of premenstrual syndrome","volume":"27","author":"Rubinow","year":"2006","journal-title":"Front Neuroendocrinol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02006-6","article-title":"Association of non-alcoholic fatty liver disease with total testosterone in non-overweight\/obese men with type 2 diabetes mellitus","volume":"46","author":"Yang","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2021.05.011","article-title":"The role of estrogen in insulin resistance A review of clinical and preclinical data","volume":"191","author":"De Paoli","year":"2021","journal-title":"Am J Pathol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"274.1-22","DOI":"10.1186\/s13046-023-02834-7","article-title":"ERR\u03b1 promotes glycolytic metabolism and targets the NLRP3\/caspase-1\/GSDMD pathway to regulate pyroptosis in endometrial cancer","volume":"42","author":"Su","year":"2023","journal-title":"J Exp Clin Cancer Res"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.119.312617","article-title":"HDL and reverse cholesterol transport","author":"Ouimet","year":"2019","journal-title":"Circ Res"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-physiol-031620-094944","article-title":"The ABCs of sterol transport","volume":"83","author":"Plummer","year":"2021","journal-title":"Annu Rev Physiol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.0912","article-title":"Association between high-density lipoprotein cholesterol levels and adverse cardiovascular outcomes in high-risk populations","volume":"7","author":"Liu","year":"2022","journal-title":"JAMA Cardiol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.4088\/jcp.18m12422","article-title":"High prevalence of metabolic syndrome among adolescents and young adults with bipolar disorder","volume":"80","author":"Li","year":"2019","journal-title":"J Clin Psychiatry"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2008.06.048","article-title":"Lipid levels in female patients with affective disorders","volume":"168","author":"Sagud","year":"2009","journal-title":"Psychiatry Res"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1605484\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:52:51Z","timestamp":1753869171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1605484\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":48,"alternative-id":["10.3389\/fendo.2025.1605484"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1605484","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,30]]},"article-number":"1605484"}}