News Release

Waist not weight -- the key to non-alcoholic fatty liver disease

Non-obese patients with a large waist circumference are at risk of non-alcoholic fatty liver disease complications

Peer-Reviewed Publication

European Association for the Study of the Liver

April 16, 2016, Barcelona, Spain: A new study presented today demonstrates that a build-up of fat around the waist can cause more serious complications than obesity in the development of non-alcoholic fatty liver disease (NAFLD). The study was presented at The International Liver CongressTM 2016 in Barcelona, Spain.

NAFLD is a condition in which fat builds up in the liver. In some cases this accumulation of fat can cause inflammation of the liver and eventually lead to permanent scarring (cirrhosis), which can seriously impair the liver's ability to function. NAFLD is a condition strongly linked to obesity, with a reported prevalence as high as 80% in obese patients.1 The 'lean' form of the disease can lead to diabetes, high blood pressure and even death,2,3 and has been reported in 16% of individuals with a normal body weight.1

"While NAFLD is commonly associated with obesity, research has highlighted that a percentage of patients are not actually obese", said Dr Rosa Lombardi, Unit of Internal Medicine, Policlinico Hospital, University of Milan, Italy and lead study author. "This is the first study to show that patients with lean-NAFLD who have increased levels of waist fat can in fact be at greater risk than obese patients with NAFLD."

The researchers in the Italian study evaluated the features of lean-NAFLD in 323 patients with biopsy-proven NAFLD. Subjects were divided according to BMI (<25kg/m2 defined as lean-NAFLD), waist circumference and abdominal fat.

The study found that NAFLD patients with a waist circumference greater than 35/40 inches, females/males, respectively, was significantly associated with metabolic syndrome (p=0.001) (the combination of diabetes, high blood pressure and obesity), carotid plaques (p=0.03) (the build-up of fatty substances and cholesterol deposits in the carotid artery), and significant fibrosis (p=0.03) (the first stages of liver scarring), compared to obese patients with NAFLD. This was true even in patients with normal weight (lean-NAFLD).

The research also suggested that metabolic, cardiovascular and tissue complications caused by NAFLD can be more effectively detected by combining Body Mass Index (BMI) and waist measurements.

"This study has proven to us that the severity of non-alcoholic fatty liver disease is not necessarily linked to how obese an individual is, but instead how much fat build-up they have around the waist," said Professor Frank Tacke, EASL Governing Board Member. "The results have highlighted the need for additional research into why analysing someone's waist, and not just their weight, is important in detecting individuals at risk for complications associated with this disease."


About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ takes place from April 13 - 17, 2016, at the Fira Barcelona Gran Via, Barcelona, Spain.

About EASL

Since EASL's foundation in 1966, this not-for-profit organisation has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European Association with international influence, with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.


For more information, please contact the ILC Press Office at:


Telephone: +44 (0)7841 009 252

Onsite location reference

Fatty liver disease: Clinical, Hall 8.0-A1

Saturday 16 April, 11:30 - 13:30

Presenter: Rosa Lombardi, Italy

Abstract: PS110, Lean-Non-Alcoholic Fatty Liver Disease with central visceral obesity identifies patients with more severe disease

Author disclosures of interest



1 Milic S, et al. Non-alcoholic fatty liver disease and obesity: Biochemical, metabolic and clinical presentations. World J Gastroenterol. 2014; 20(29):9330-9337.

2 Ren-Nan Feng et al. Lean-non-alcoholic fatty liver disease increases risk for metabolic disorders in a normal weight Chinese population. World J Gastroenterol. 2014; 20(47):17932-17940.

3 Dela Cruz AC, et al. Characteristics and Long-Term Prognosis of Lean Patients With Nonalcoholic Fatty Liver Disease. Gastroenterol. 2014;146(5) Suppl 1: S-909.

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