Non-alcoholic fatty liver disease (NAFLD) among underweight adults

Background: Non-alcoholic fatty liver disease (NAFLD), closely linked to obesity, has also been evident in lean and underweight adults. But data pertaining to NAFLD in underweight adults in Bangladesh is very limited. Therefore, we sought to estimate the prevalence and identify the factors associated with NAFLD in underweight adults in Bangladesh.

Methods: Underweight adults (BMI <18.5 kg/m²) who underwent abdominal imaging from December 2015 to January 2017 were included in this analysis. Multivariable logistic regression was performed to identify the factors associated with NAFLD in underweight adults.

Results: Total 286 (female = 117) participants with a mean age of 28.4 (±13.0) years were included in this analysis. The prevalence of NAFLD in underweight adults was 5.2% (95% CI: 2.6, 7.8). The prevalence was higher in adults ≥30 years (9.2 vs. 3.5 p-value = 0.048), married (9.0 vs. 1.4, p-value = 0.004), sedentary workers (8.7 vs. 1.5, p-value = 0.006, and diabetic individuals (60.0 vs. 5.0, p-value<0.001) compared to their counterparts. Multivariable logistic regression model demonstrated that rural residents had higher odds (aOR: 3.93, 95% CI: 1.07, 14.49, p-value = 0.048) of having NAFLD than urban inhabitants. The odds of NAFLD was 5 times higher (aOR: 5.60, 95% CI: 1.04, 30.29, p-value = 0.046) in patients with positive family history of metabolic traits. Being non-diabetic was protective against NAFLD (aOR: 0.06, 95% CI: 0.01, 0.45, p-value = 0.005) in this selected population.

Conclusion: The study results delineate that underweight adults living in rural areas, with a positive family history of metabolic traits and being diabetic are more likely to develop NAFLD in Bangladesh.