The effects of weight loss and improved metabolic health status on the risk of non-alcoholic fatty liver disease-results from a prospective cohort in China

Xin Huang; Wenbin Ouyang; Yang Hu; Bei Tang; Yongmei He; Hao Wu; Pingting Yang; Lu Yin; Qingqi Liu; Kui Chen; Jing Deng; Xiaohui Li; Ying Li

doi:10.3389/fnut.2023.1239996

The effects of weight loss and improved metabolic health status on the risk of non-alcoholic fatty liver disease-results from a prospective cohort in China

Front Nutr. 2023 Nov 28:10:1239996. doi: 10.3389/fnut.2023.1239996. eCollection 2023.

Authors

Xin Huang¹, Wenbin Ouyang¹, Yang Hu¹, Bei Tang¹, Yongmei He², Hao Wu³, Pingting Yang³, Lu Yin⁴, Qingqi Liu⁵, Kui Chen³, Jing Deng⁶, Xiaohui Li⁷, Ying Li³

Affiliations

¹ Department of Epidemiology, Hunan Normal University School of Medicine, Changsha, China.
² Department of Health Management, Aerospace Center Hospital, Beijing, China.
³ Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China.
⁴ Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, United States.
⁶ Department of Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China.
⁷ Department of Pharmacology, Xiangya School of Pharmaceutical Science, Central South University, Changsha, Hunan, China.

Abstract

Background: The impact of weight loss and/or improved metabolic status on the risk of non-alcoholic fatty liver disease (NAFLD) has yet to be determined.

Methods: A total of 35,322 participants without NAFLD were followed. NAFLD risk was compared between consistently metabolically healthy non-obese (MHNO) and non-MHNO who lost weight to become non-obese and/or improved their metabolic health, using Cox proportional hazards and logistic regression models.

Results: Following 148,186 person-years, 8,409 participants had onset NAFLD, with an incidence rate of 56.75 (95% CI: 55.57, 57.94) per 1,000 person-years. Metabolically healthy obese (MHO), metabolically unhealthy obese (MUO), and metabolically unhealthy non-obese (MUNO) at baseline were associated with increased NAFLD risk, with hazard ratios of 4.48 (95%CI:4.24, 4.73), 8.85 (95%CI:7.95, 9.84), and 10.70 (95%CI:9.73, 11.78). Weight loss and/or metabolic status improvements could significantly reduce NAFLD risk by 79.46 to 41.46%. Specifically, after weight loss from MHO to MHNO, the reduction in NAFLD risk [OR decreased from 12.01 (95%CI:9.40, 15.35) to 4.14 (95%CI:3.08, 5.57)] was greater than that of the MUNO subgroup whose metabolic status improved to MHNO [OR decreased from 5.53 (95%CI:5.15, 5.94) to 2.71 (95%CI:2.50, 3.93)]. In the MUO subgroup, the group with the greatest risk reduction of NAFLD was the weight and metabolic state both improvement group [MUO to MHNO, OR decreased from 22.74 (95%CI:17.61, 29.37) to 4.67 (95%CI:3.05, 7.16)], followed by the weight loss only group [MUO to MUNO, OR decreased to 6.83 (95%CI:4.87, 9.57)], and finally the group with the least and insignificant risk reduction was the metabolic state improvement group [MUO to MHO, OR decreased to 13.38 (95%CI:9.17,19.53)]. NAFLD risk was negatively correlated with the duration of improvement (p < 0.001).

Conclusion: Individuals with non-MHNO were more likely to develop NAFLD than those with consistent MHNO, but metabolic improvements and weight loss can alleviate the risk. Their NAFLD risk was negatively correlated with improvement duration. However, it remained higher than in individuals with consistent MHNO at an average follow-up of 4.2 years.

Keywords: NAFLD; cohort study; loss weight; metabolic health; obesity.

Grants and funding

This study was supported by funding from the National Natural Science Foundation of China (81973324 to YL and 82003537 to XH), the Hunan Young Talent Grant (2020RC3063 to YL), and the Wisdom Accumulation and Talent Cultivation Project of the Third Xiangya Hospital of Central South University (YX202002 to YL). The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the study.