Non-alcoholic Fatty Liver Disease in Normal Weight Individuals, Associations with Body Fat Percentage


Zeynab Hatamizargaran 1 , Mohammadreza Sasani 2 , Masoumeh Akhlaghi 1 , *

1 Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

How to Cite: Hatamizargaran Z, Sasani M, Akhlaghi M . Non-alcoholic Fatty Liver Disease in Normal Weight Individuals, Associations with Body Fat Percentage, Shiraz E-Med J. 2021 ; In Press(In Press):e108643.


Shiraz E-Medical Journal: In Press (In Press); e108643
Published Online: May 25, 2021
Article Type: Research Article
Received: September 18, 2020
Revised: March 06, 2021
Accepted: April 17, 2021


Background: Recent data have suggested that NAFLD can occur in normal weight subjects. We examined the association of body fat percentage (BF%) with NAFLD and its risk factors in normal weight individuals.

Objectives: The aim of the present study was to explain the influence of body fat on the risk of NAFLD.

Methods: Fifty nine subjects with body mass index (BMI) between 18.5 and 24.9 kg/m2 were selected from referrals to two major university polyclinics in Shiraz, Iran, from April to June 2019. Fatty liver grade, anthropometric characteristics, body composition, and cardiometabolic risk factors were measured.

Results: Waist circumference (P=0.012), fat mass (P<0.001), TG (P=0.027), VLDL (P=0.007), and TG/HDL-C ratio (P=0.003) increased while skeletal muscle mass decreased (P<0.001) across the tertiles of BF%. The average of fatty liver grade was similar in the first and second tertile but fatty liver grade of participants in the third tertile was significantly higher (1.3 ± 0.9 vs. 0.4 ± 0.7, P=0.005). In ordinal regression analysis, BF% (1.13, 95% CI: 1.04, 1.22, P=0.003), BMI (1.95, 95% CI: 1.02, 3.74, P=0.045), VLDL (1.77, 95% CI: 1.00, 3.12, P=0.049), TG/HDL-C ratio (2.21, 95% CI: 1.26, 3.86, P=0.006) had positive association while HDL-C (0.33, 95% CI: 0.16, 0.67, P=0.002) and dietary cholesterol (0.97, 95% CI: 0.95, 0.997, P=0.028) had inverse association with NAFLD after adjustment for age, sex, BMI, and physical activity.

Conclusions: Results of this study suggested that within normal weight ranges, NAFLD occurs more frequently in individuals with higher BF% and BF% can be used as an important marker in NAFLD screening.


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