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Table 2. International Diabetes Federation guidance on waist circumference thresholds as a
measure of central obesity (2007).
Country / ethnic group Male Female
Europids ≥94 cm ≥80 cm
South Asians, Chinese & Japanese
Ethnic South and Central Americans ≥90 cm ≥80 cm
Sub-Saharan Africans
Eastern Mediterranean & Middle East Use South Asian recommendations until more data
Use European recommendations until more data
Use European recommendations until more data
Does NAFLD exist in lean patients?
The worldwide prevalence of NAFLD is 15-40%. However, since the diagnosis of NASH requires
histological assessment, the population prevalence of NASH remains unclear and is estimated at
10-30% among NAFLD patients. In a US clinic-based study where patients received abdominal
ultrasonography screening and liver biopsy was performed in the majority of those found to have fatty
liver, the prevalence of NAFLD and NASH was 46% and 12%, respectively [1]. NASH was found in
30% of those with NAFLD. A Hong Kong study using proton-magnetic resonance spectroscopy found
NAFLD in 27% of the adults in the general population [2]. Although liver biopsy was not performed,
this study used transient elastography and five clinical prediction formulae and estimated that around
4% of the NAFLD patients in the community have advanced fibrosis or cirrhosis.
Because of the different interpretation of BMI in different populations, most NAFLD data in lean
patients comes from Asia. Not surprisingly, NAFLD is more common in overweight and obese patients.
However, among individuals with BMI <25 kg/m2, 7-21% also have NAFLD (Table 3). The difference
in prevalence can be explained by the BMI distribution in the non-obese population and differences in
dietary habit and physical activities.
Table 3. Prevalence of NAFLD according to BMI (kg/m2) [2-5].
Location n Prevalence in subjects Prevalence in subjects
with BMI <25 with BMI ≥25
Taichung, Taiwan 3334
Nagasaki, Japan 1559 15% 31%
Shanghai, China 4506 11% 60%
West Bengal, India 1911 21% 39%
Hong Kong, China 922 7% 32%
Seoul, Korea 29994 19% 61%
13% 50%
Does NAFLD in lean patients matter?
Liver-related mortality is the third leading cause of death among NASH patients. Although NASH
patients more often die of cardiovascular complications and extrahepatic malignancies than liver
complications, the latter occur more commonly in NASH patients than in the general population. The
important question is whether lean patients with NASH also have adverse clinical outcomes.This would
determine how such patients should be managed.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 37
measure of central obesity (2007).
Country / ethnic group Male Female
Europids ≥94 cm ≥80 cm
South Asians, Chinese & Japanese
Ethnic South and Central Americans ≥90 cm ≥80 cm
Sub-Saharan Africans
Eastern Mediterranean & Middle East Use South Asian recommendations until more data
Use European recommendations until more data
Use European recommendations until more data
Does NAFLD exist in lean patients?
The worldwide prevalence of NAFLD is 15-40%. However, since the diagnosis of NASH requires
histological assessment, the population prevalence of NASH remains unclear and is estimated at
10-30% among NAFLD patients. In a US clinic-based study where patients received abdominal
ultrasonography screening and liver biopsy was performed in the majority of those found to have fatty
liver, the prevalence of NAFLD and NASH was 46% and 12%, respectively [1]. NASH was found in
30% of those with NAFLD. A Hong Kong study using proton-magnetic resonance spectroscopy found
NAFLD in 27% of the adults in the general population [2]. Although liver biopsy was not performed,
this study used transient elastography and five clinical prediction formulae and estimated that around
4% of the NAFLD patients in the community have advanced fibrosis or cirrhosis.
Because of the different interpretation of BMI in different populations, most NAFLD data in lean
patients comes from Asia. Not surprisingly, NAFLD is more common in overweight and obese patients.
However, among individuals with BMI <25 kg/m2, 7-21% also have NAFLD (Table 3). The difference
in prevalence can be explained by the BMI distribution in the non-obese population and differences in
dietary habit and physical activities.
Table 3. Prevalence of NAFLD according to BMI (kg/m2) [2-5].
Location n Prevalence in subjects Prevalence in subjects
with BMI <25 with BMI ≥25
Taichung, Taiwan 3334
Nagasaki, Japan 1559 15% 31%
Shanghai, China 4506 11% 60%
West Bengal, India 1911 21% 39%
Hong Kong, China 922 7% 32%
Seoul, Korea 29994 19% 61%
13% 50%
Does NAFLD in lean patients matter?
Liver-related mortality is the third leading cause of death among NASH patients. Although NASH
patients more often die of cardiovascular complications and extrahepatic malignancies than liver
complications, the latter occur more commonly in NASH patients than in the general population. The
important question is whether lean patients with NASH also have adverse clinical outcomes.This would
determine how such patients should be managed.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 37
