Liver Disease

Metabolically Healthy Obesity Increases the Risk of Liver Disease

Patients with metabolically healthy obesity may be at risk for subclinical liver involvement, according to the results of a recent study.

A cohort of patients with metabolically healthy obesity (n=149) and metabolically abnormal obesity (n=688) who were scheduled for bariatric surgery in France was examined prospectively for the prevalence of steatosis, nonalcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH). Metabolically healthy obesity was defined as not having metabolic syndrome.

The researchers found that 29.5% of participants with metabolically healthy obesity had at least moderate steatosis (>33% macrovesicular steatosis). Body mass index and alanine aminotransferase were significantly associated with severe steatosis (>66%). NASH was found in 5.4% of participants with metabolically healthy obesity and was positively associated with waist circumference.

The researchers also observed that individuals with metabolically healthy obesity had:

  • Significantly lower glycosylated hemoglobin levels
  • Lower homeostasis model assessment of insulin resistance
  • Increased C-reactive protein levels and
  • Were significantly younger


“Our study indicates that obese individuals without metabolic syndrome may develop subclinical liver involvement,” the researchers concluded. “Therefore, the occurrence of NAFLD and NASH in this population needs further investigation.”

—Leigh Precopio


Frey S, Patouraux S, Debs T, Gugenheim J, Anty R, Iannelli A. Prevalence of NASH/NAFLD in people with obesity who are currently classified as metabolically healthy. Surg Obes Relat Dis. 2020;16(12):2050-2057. doi:10.1016/j.soard.2020.07.009