Nonalcoholic Fatty Liver Disease Risk Higher in Individuals With Metabolically Healthy Obesity

Sarfaroj Khan 

July 13, 2020


  • Metabolically healthy individuals with overweight and obesity are at an increased risk of developing nonalcoholic fatty liver disease (NAFLD) compared with metabolically healthy normal weight individuals.

  • The risk is also higher in individuals who are normal weight with metabolic abnormalities.

Why this matters

  • Findings support that metabolically healthy obesity phenotype is a temporary state, and weight should be considered a risk factor for NAFLD even before other risk factors develop.

Study design

  • This retrospective study included 4,121,049 adults with no history of NAFLD or alcohol excess using data from The Health Improvement Network (THIN) database.

  • All participants were classified according to body mass index (BMI) category and metabolic abnormalities (diabetes, hypertension, and dyslipidaemia).

  • Primary outcome: diagnosis of NAFLD during follow-up.

  • Funding: None disclosed.

Key results

  • A total of 12,867 (0.3%) incident cases of NAFLD were recorded during a median follow-up period of 4.7 years (incidence rate, 0.55 per 1000 person-years).

  • Compared with individuals with normal weight and no metabolic abnormalities, the risk of developing NAFLD was significantly higher in:

    • individuals who were overweight (adjusted HR [aHR], 3.23; 95% CI, 2.98-3.49) and obese (aHR, 6.92; 95% CI, 6.40-7.48) with no metabolic abnormalities.

    • individuals who were normal weight with 1 (aHR, 2.27; 95% CI, 1.97-2.61) or ≥2 metabolic abnormalities (aHR, 2.39; 95% CI, 1.99-2.87).


  • Retrospective design.

  • Possibility of misclassification bias.


Vusirikala A, Thomas T, Bhala N, Tahrani AA, Thomas GN, Nirantharakumar K. Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom population-based cohort study using the health improvement network (THIN). BMC Endocr Disord. 2020;20(1):96. doi: 10.1186/s12902-020-00582-9. PMID: 32605642.  Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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