Lean MASLD shows milder histology but similar clinical outcomes

A multinational retrospective study of 18,326 biopsy-confirmed MASLD patients found that lean patients (6.7% by BMI) had lower rates of type 2 diabetes, advanced fibrosis, and disease activity scores compared with overweight/obese patients. The study reported that lean status was not independently associated with all-cause mortality or clinical events, while advanced fibrosis (F3-F4) was associated with both outcomes regardless of body weight; liver stiffness measurement showed higher accuracy than FIB-4 for detecting advanced fibrosis in lean individuals.

Most relevant for: Patients with biopsy-confirmed MASLD who have normal body weight, including those being evaluated with noninvasive fibrosis tests such as FIB-4 or transient elastography.

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