Mapouka M, Pabingui E, Tazinkeng NN, Gurmessa M, Vickos U, Ndemazie NB, Camengo Police SM. Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 114657 [DOI: 10.3748/wjg.v32.i13.114657]
Corresponding Author of This Article
Mexan Mapouka, MD, MPH Department of Internal Medicine, University of Maryland Capital Region Medical Center, 901 Harry S Truman Dr, Largo, MD 20774, United States. mexan.mapouka@umm.edu
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Gastroenterology & Hepatology
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Meta-Analysis
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Apr 7, 2026 (publication date) through Mar 27, 2026
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World Journal of Gastroenterology
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1007-9327
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Mapouka M, Pabingui E, Tazinkeng NN, Gurmessa M, Vickos U, Ndemazie NB, Camengo Police SM. Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 114657 [DOI: 10.3748/wjg.v32.i13.114657]
World J Gastroenterol. Apr 7, 2026; 32(13): 114657 Published online Apr 7, 2026. doi: 10.3748/wjg.v32.i13.114657
Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease
Mexan Mapouka, Milkessa Gurmessa, Department of Internal Medicine, University of Maryland Capital Region Medical Center, Largo, MD 20774, United States
Evariste Pabingui, Service de Médecine Interne et de Cardiologie, Centre Hospitalo-Universitaire de l’Hopital Commautaire de Bangui, Bangui 1450, Central African Republic
Nkengeh N Tazinkeng, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ 07112, United States
Ulrich Vickos, Faculté des Sciences de la Santé, Université de Bangui, Bangui 1450, Central African Republic
Nkafu Bechem Ndemazie, Department of Internal Medicine, Richmond University Medical Center, New York, NY 10310, United States
Serge Magloire Camengo Police, Service d’Hepato-Gastroenterologie, Centre Hospitalier Universitaire de l’Hôpital De L’amitié, Sino-Centrafricaine, Bangui 1335, Central African Republic
Author contributions: Mapouka M designed the study, performed data cleaning and statistical analysis, and wrote the abstract, methodology, result and conclusion sections; Tazinkeng NN edited the final version of the manuscript and improved the paper based on reviewer feedback; Ndemazie NB wrote the introduction; Pabingui E and Vickos U performed the literature search and collected eligible articles; Camengo Police SM, Gurmessa M, Pabingui E, and Vickos U edited the paper. MM approved the final version to publish.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Mexan Mapouka, MD, MPH Department of Internal Medicine, University of Maryland Capital Region Medical Center, 901 Harry S Truman Dr, Largo, MD 20774, United States. mexan.mapouka@umm.edu
Received: September 25, 2025 Revised: December 4, 2025 Accepted: February 13, 2026 Published online: April 7, 2026 Processing time: 183 Days and 15.9 Hours
Abstract
BACKGROUND
Cardiovascular and liver metabolic diseases are interconnected conditions, associated with obesity. However, both can occur in lean individuals, and the distinct clinical profiles and outcomes in this population remain poorly defined.
AIM
To compare liver and cardiovascular outcomes between lean and non-lean individuals with metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS
We conducted a systematic review and meta-analysis of studies published in the past 20 years comparing seven outcomes between lean and non-lean with dysfunction-associated steatotic liver disease individuals. A random-effects model was applied to calculate pooled odds ratios (pORs) with 95% confidence intervals (CIs) for the outcomes.
RESULTS
A total of 31 studies comprising 10735550 participants were included. Non-lean individuals with MASLD had higher odds of liver fibrosis (pOR = 2.0, 95%CI: 1.0, 3.9, P = 0.04) and hepatic steatosis (pOR = 2.1, 95%CI: 1.5, 2.9, P < 0.001) compared to lean individuals with MASLD. Lean individuals with MASLD had lower odds of cirrhosis (pOR = 0.7, 95%CI: 0.5, 0.9, P = 0.007) and hypertension (pOR = 0.7, 95%CI: 0.6, 0.9, P = 0.002) compared to non-lean individuals with MASLD. There was no significant statistical difference in mortality between lean and non-lean MASLD groups (pOR = 1.4, 95%CI: 1.0, 2.0, P = 0.06). Also, no statistically significant differences were found for metabolic dysfunction-associated steatohepatitis (pOR = 1.2, 95%CI: 0.7, 2.0, P = 0.5) and cardiovascular diseases (pOR = 0.9, 95%CI: 0.7, 1.0, P = 0.1).
CONCLUSION
In our study, lean individuals with MASLD have the similar odds of metabolic dysfunction-associated steatohepatitis, cardiovascular diseases and mortality compared to non-lean MASLD patients. Therefore, there is a need to expand MASLD screening and risk stratification strategies beyond obesity-based metrics alone.
Core Tip: Metabolic dysfunction-associated steatotic liver disease affects both lean and non-lean individuals. This meta-analysis of over 10 million participants found that non-lean patients had greater odds of hepatic steatosis, fibrosis, cirrhosis, and hypertension. Lean patients, however, showed similar risks of nonalcoholic steatohepatitis, cardiovascular disease, and mortality. These results support expanding metabolic dysfunction-associated steatotic liver disease screening and risk assessment beyond obesity-related criteria.
