Mixed
Lean individuals with Metabolic Dysfunction-Associated Fatty Liver Disease (lean-MAFLD) face a significantly higher risk of liver-related mortality compared to overweight or obese MAFLD patients, despite having equivalent metabolic profiles and similar risks for extrahepatic mortality.
If you are lean but have been diagnosed with fatty liver (MAFLD), do not assume you are safe because you are thin. Your risk of liver-related death is actually higher than that of obese patients with the same condition. Standard weight loss advice, especially rapid loss via drugs, can be dangerous for you because it strips away muscle, which your liver needs. Focus on metabolic health markers (blood pressure, glucose, lipids) and consult your doctor about treatments that preserve muscle mass rather than just focusing on weight loss.
Lean-MAFLD patients have an equivalent metabolic burden compared to overweight/obese-MAFLD patients and thus a similar incidence rate of major extrahepatic complications. However, they have an increased risk of liver-related mortality.
Why this rating
Based on a systematic review and meta-analysis of 14 studies involving over 10 million individuals, though with high heterogeneity (I2 > 98%).
Source
Global prevalence, metabolic characteristics, and outcomes of lean-MAFLD: a systematic review and meta-analysis
Mark Cheah et al. · Hepatology International · 2025
DOI 10.1007/s12072-025-10801-x
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