P4652 - Lean Metabolic Dysfunction-Associated Steatotic Liver Disease: Higher Mortality and Complication Rates Compared to Higher BMI

Chaula Desai, MD, Anuj R. Sharma, MBBS, Suriya Baskar, MD, Saigopal R. Gujjula, MD, Sweta Lohani, MBBS, MD, Lucas Schwartz, , Jeeva Jaganathan, MD, Denzil Etienne, MD
Brooklyn Hospital Center, Brooklyn, NY

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease associated with significant morbidity and mortality. While obesity has been known to be a common risk factor for MASLD, the condition is increasingly being diagnosed in non-obese patients. The American College of Gastroenterology (ACG) has defined the concept of “Lean MASLD”, in individuals with a Body Mass Index (BMI)< 25 in non-Asians and < 23 in Asians. Our study aimed to compare differences in outcomes between these two groups.

Methods: Our study was conducted using data from the National Inpatient Sample (NIS) Database for the years 2016 to 2020, focusing on adult hospitalizations diagnosed with MASLD; determined using ICD-10 codes. The study aimed to investigate the relationship between lean BMI and MASLD-related complications. Statistical analyses were performed to compare categorical variables using the chi-square test and continuous variables using the t-test. To account for potential confounding factors, multivariable regression analyses were employed. These analyses adjusted for patient demographics, hospital characteristics, and relevant comorbidities, which included dyslipidemia, hypertension, diabetes, chronic kidney disease, congestive heart failure, coronary artery disease, and peripheral vascular disease.

Results: A total of 707,225 hospital admissions with MASLD and defined BMI categories were identified, out of which 92.5% were obese and 7.5% were lean. On average, patients with lean BMI were older (57 years vs. 52 years) and had higher mortality rates (adjusted Odds Ratio (OR) 2.21, p-value < 0.001). MASLD patients with lean BMI were also found to have significantly higher odds of complications like cirrhosis (OR 1.41, p-value < 0.001), Crohn’s disease (OR 2.75, p-value < 0.001), and ulcerative colitis (OR 2.65, p-value < 0.001). In contrast, lean BMI was associated with lower odds of cholelithiasis (OR 0.63, p-value < 0.001) and GERD (OR 0.74, p-value < 0.001).

Discussion: Our study highlights the importance of improving the identification and recognition of lean MASLD patients, who are potentially underdiagnosed and experience worse outcomes and complications compared to their non-lean counterparts. Approaching MASLD as lean and non-lean groups might help develop targeted interventions and improve patient outcomes.


Disclosures:


Chaula Desai, MD, Anuj R. Sharma, MBBS, Suriya Baskar, MD, Saigopal R. Gujjula, MD, Sweta Lohani, MBBS, MD, Lucas Schwartz, , Jeeva Jaganathan, MD, Denzil Etienne, MD. P4652 - Lean Metabolic Dysfunction-Associated Steatotic Liver Disease: Higher Mortality and Complication Rates Compared to Higher BMI, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.