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Oliveira et al. Hepatoma Res 2020;6:72 Hepatoma Research
DOI: 10.20517/2394-5079.2020.73

Original Article Open Access

The transcontinental variability of nonalcoholic fatty
liver disease

Claudia P. Oliveira , Angelo Paredes , Mohammed Siddiqui , Lawrence Serfaty , Abhijit Chowdhury ,
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6,7
3
4
1,2
Jose Tadeu Stefano , Denise Siqueira Vanni , Sherry Boyett , Arun J. Sanyal 4
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1 Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 01000-000, Brazil.
2 Laboratório de Gastroenterologia Clínica e Experimental (LIM-07) do Departamento de Gastroenterologia e Hepatologia do
Hospital das Clínicas HCFMUSP da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 01000-000, Brazil.
3 Internal Medicine, Gastroenterology and Hepatology Services, Brooke Army Medical Center, San Antonio, TX 78234, USA.
4 Div.of Gastroenterology, Hepatology and Nutrition, Dept. of Internal Medicine, Virginia Commonwealth University School of
Medicine, Richmond, VA 23298-0341, USA.
5 Viral and Metabolic Liver Unit, Department of Hepatology, Saint-Antoine Hospital, 75012 Paris, Paris.
6 Department of Hepatology, School of Digestive and Liver Disease, Institute of Post Graduate Medical Education & Research,
Kolkata 700020, India.
7 Disease Biology, John C Martin Centre for Liver Research and Innovations Sonarpur, Kolkata 7000150, India.
Correspondence to: Dr. Arun J. Sanyal, Professor of Medicine, Physiology and Molecular Pathology, Virginia Commonwealth
University School of Medicine, MCV Box 980341, Richmond, VA 23298-0341, USA. E-mail: asanyal@mcvh-vcu.edu
How to cite this article: Oliveira CP, Paredes A, Siddiqui M, Serfaty L, Chowdhury A, Stefano JT, Vanni DS, Boyett S, Sanyal AJ.
The transcontinental variability of nonalcoholic fatty liver disease. Hepatoma Res 2020;6:72.
Received: First Decision: Revised: Accepted: Published: http://dx.doi.org/10.20517/2394-5079.2020.73

Science Editor: Copy Editor: Production Editor: Jing Yu Received: 28 Jul 2020 First Decision: 27 Aug 2020 Revised: 9 Sep 2020 Accepted: 16 Sep 2020 Published: 12 Oct 2020
Academic Editor: Stefano Bellentani Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: To compare the phenotype of lean versus overweight (OW) and obese (OB) subjects with non-alcoholic fatty
liver disease (NAFLD) across multiple continents.

Methods: A retrospective study of histologically defined subjects from a single center each in France (Fr), Brazil
(Br), India (In) and United States (US) was performed.

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Results: A total of 70 lean [body mass index (BMI) < 25 kg/m ] subjects (Fr:Br:In:US: 16:19:22:13) with NAFLD were
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compared to 136 OW (BMI > 25 kg/m , BMI < 29 kg/m ) (n = 28:33:52:23) and 224 OB subjects (BMI > 29 kg/m )
(n = 81:11:22:103). Lean French subjects had the lowest incidence of type 2 diabetes while those from Brazil (P
< 0.01) had the highest. Lean subjects had similar low-density lipoprotein-cholesterol, but higher high-density
lipoprotein-cholesterol compared to obese subjects in all regions. In both lean and obese subjects, there were both
insulin-sensitive and insulin-resistant subjects. Lean French subjects were most insulin-sensitive while those from

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